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It is well known that community awareness of hepatitis B (HB) can lead to vaccination and testing. The study objectives were to assess the prevalence of HBV infection and knowledge of HB among adult patients attending randomly selected primary care clinics. A cross-sectional sero-survey was conducted in March 2013 in the Zgorzelec region, Poland, with the use of an investigator-developed questionnaire containing 22 questions regarding HB knowledge. Serum samples were assayed for anti-HBc total and anti-HBs with enzyme immunoassay. The prevalence of anti-HBc total among 410 participants (median age 56 years) was 10.3 % (95 % CI 7.6–13.8 %), nobody was aware of an infection. The main sources of HB knowledge were the media and medical staff. The mean knowledge score was 14.8 ± 4.9; 76.7 % of the respondents had scores >50 %. Particular gaps were detected relating to knowledge of unprotected sexual intercourse and MTCT; 45.6 % patients were not aware of the potential asymptomatic course of HBV infection, 41.2 % about chronic HB treatment. A patient’s low educational level was negatively associated with a high knowledge level; the willingness for further education on HB and HBV vaccination in the past were independently associated with good knowledge. In conclusion, the HBV infection remains a public health threat in Poland, since the prevalence of infection markers in asymptomatic adult patients was high. Knowledge gaps call for awareness campaigns which may increase testing and diagnosis, audiences representing lower education level should be targeted first. Knowledge on HB might serve as an effective tool in decision making regarding vaccination.

BackgroundHepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection. Therefore, HBV vaccination is widely recommended for those not covered by the national immunisation program. Objective: To assess the coverage and influencing determinants of HBV vaccination among adult patients attending GP clinics as well as to establish serological status in terms of HBV infection.MethodsPatients who were seen consecutively in March 2013 at four randomly selected GP practices located in Zgorzelec county, in south-western part of Poland, were invited to participate and complete questionnaires on socio-demographic data and other factors related to vaccination. A pilot study was done in one urban GP practice in the city of Gryfino (Gryfino county), the results have been included in the study. Patients’ immunisation status was assessed basing on vaccination cards and anti-HBs titer with the use of third-generation testing methods. In addition, serum samples were assayed for anti-HBc total.ResultsResponse rate: 99.3 %. Of 410 participants (66.1 % females, median age 56 years), 55.4 % (95%CI:50.5-60.1 %) were previously vaccinated; in those 11.5 % took 2 doses, 66.1 % - 3 doses,18.1 % – 4 doses. Elective surgery was the main reason (57.7 %) for HBV immunization, 4.8 % - were vaccinated due to recommendations by GPs. The multivariable logistic regression model revealed that living in a city (OR 2.11), and having a surgery in the past (OR 2.73) were each associated with greater odds of being vaccinated. Anti-HBc total prevalence among those unvaccinated was 13.6 % (95%CI:9.3 %-19,5 %), and 7.2 % (95%CI:4.4-11.8 %) among those vaccinated.ConclusionsLow HBV immunization coverage among adult patients from GP clinics and the presence of serological markers of HBV infection among both - those unvaccinated and vaccinated call for comprehensive preventative measures against infection, including greater involvement of family doctors. Although interventions should cover the whole population, inhabitants living in the rural areas should be a group of special interest. Preoperative immunization for HBV seems to be an efficient public health tool to increase the vaccination uptake.

StreszczenieWprowadzenie: Zagadnienia dotyczące krwiopochodnych zakażeń pacjentów przez personel medyczny budzą kontrowersje. Celem badania była ocena postaw wobec ujawniania operowanym pacjentom informacji o zakażeniu HBV/HCV/HIV pracowników i odsuwania tych pracowników od wykonywania zabiegów operacyjnych oraz ocena występowania anty-HBc total, HBsAg, anty-HCV, anty-HIV u personelu zabiegowego. Materiał i metody: W okresie od stycznia do września 2009 wśród personelu zabiegowego 16 wylosowanych szpitali województwa zachodniopomorskiego przeprowadzono badanie epidemiologiczne przekrojowe z użyciem anonimowej ankiety. Do wykrywania anty-HBc, HBsAg, anty-HCV i anty-HIV zostały wykorzystane testy ELISA. Wyniki: W badaniu uczestniczyły 362 pielęgniarki i 65 lekarzy (mediana wieku: 42 lata). Częstość występowania anty-HBc wynosiła 16,6%, HBsAg -0,7%, anty-HCV -1,4%, a anty-HIV -0%. Prawidłowych odpowiedzi odnośnie do ryzyka zakażenia po ekspozycji na HIV udzieliło 18,7% respondentów, na HBV -26,5%, a na HCV -19,7%. Co szósty ankietowany (16,2%) uważał, że personel zabiegowy zakażony HBV, HCV lub HIV powinien ujawniać swój status serologiczny, a zdania, że zakażone osoby powinny zostać odsunięte od wykonywania zabiegów operacyjnych było 39,8% w odniesieniu do pracowników zakażonych HBV lub HCV oraz 42,6% w odniesieniu do zakażonych HIV. Badani poprawnie szacujący ryzyko zawodowego zakażenia istotnie rzadziej optowali za odsunięciem pracowników zakażonych HIV, HBV, HCV od wykonywania zabiegów operacyjnych (dla HIV -p = 0,0001; dla HBV -p = 0,03; dla HCV -p = 0,01). Wnioski: U części personelu zabiegowego stwierdza się obecność markerów zakażenia HBV/HCV i osoby takie mogą być źródłem zakażenia dla pacjentów. Wiedza personelu zabiegowego na temat ryzyka ekspozycji na patogeny krwiopochodne nie jest satysfakcjonująca, co może przekładać się na restrykcyjne postawy dotyczą-ce odsunięcia zakażonych HBV, HCV lub HIV od wykonywania zabiegów operacyjnych i ujawniania ich statusu serologicznego pacjentom. Med. Pr. 2013;64(5):639-647 Słowa kluczowe: personel zabiegowy, zakażenia personel-pacjent , HBV, HCV, HIV, przenoszenie zakażenia, postawy Abstract Background: Issues regarding the transmission of blood-borne viruses from infected medical personnel to patients are controversial to both parties. The aim of this study was to evaluate the attitudes towards disclosure of HBV/HCV/HIV-infected surgeons and the possibility of being forced to give up surgical procedures, as well as to assess the prevalence of anti-HBc total, HBsAg, anti-HCV and anti-HIV in surgical staff. Material and Methods: Using an anonymous questionnaire a cross-sectional sero-survey was conducted among surgeons and nurses of surgical wards in 16 randomly selected hospitals,

INTRODUCTION: Hepatitis B is a significant health burden in Poland with nosocomial transmission being the main source of infection. Therefore, HBV vaccination before surgery is widely recommended. Objective: To assess the determinants of HBV vaccination uptake among patients attending family medicine clinics (FMC) and to establish their serological status in terms of HBV infection. METHODS: In March 2013 consecutive patients attending three randomly selected FMCs located in Zgorzelec region, Poland, completed an anonymous questionnaire on HBV vaccination history. Immunization status was based on self-reports, checked by the results of vaccination cards and anti-HBs titer. In those unvaccinated, serum samples were assayed for anti-HBc total with the use of third-generation testing methods. RESULTS:Response rate: 99.3%. Of 410 participants (66.1% females, median age 56 years), 55.4% (95% CI 50.5-60.1%) were previously vaccinated against HBV; in those 11.5%-with two doses of vaccine, 66.1%-with three doses,18.1% -with four doses. Elective surgery was the main reason (57.0%) for HBV immunization, 4.9%-were vaccinated due to recommendations by GPs. The multivariable regression model revealed that high educational status (OR 1.35), living in a city (OR 1.75), as well as having a surgery in the past (OR 2.93) were each associated with greater odds of being vaccinated. Anti-HBc total prevalence among those unvaccinated was 13.6% (24/176 95% CI 9.3%-19,5%). None of the patients had the history of clinical hepatitis B, none was aware of an infection. CONCLUSIONS: Low HBV immunization coverage among adult patients and the presence of serological markers of HBV infection among those unvaccinated call for comprehensive preventative measures against infection, including greater FMCs involvement. Although interventions should cover the whole population, low educated inhabitants living in the rural areas should be a group of special interest. Preoperative immunization against HBV seems to be an efficient tool to increase the vaccination uptake.

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