Διαμόρφωση στρατηγικής εμβολιασμού έναντι λοιμωδών νοσημάτων σε φοιτητές επιστημών υγείας

Abstract

Background: Healthcare students (HCS) are at risk of contracting and transmitting infectious diseases in the hospital setting. Aim: The aim of this study was to evaluate the vaccination history of HCS and their serologic immunity against vaccine-preventable disease in order to determine the most appropriate vaccination strategy. Methods: This prospective cohort study took place in a university children΄s hospital in Athens, Greece. HCS were recruited during April through November 2007. Information obtained during personal interviews included demographic data and the history of varicella, measles, mumps, rubella and HAV or HBV infection.The vaccination history and documentation of disease were abstracted from medical records. Serum antibodies against the above-mentioned viral agents were determined by ELISA. HCS who were seronegative and those with immunization gaps were referred to local vaccination clinics, and compliance with recommendations was assessed 3 months later. Results: A total of 187 HCS were recruited, 131 (70,1%) of whom provided complete documentation of vaccination history. Adequate immunity against diphtheria and tetanus was documented for 55 (37,2%) and 73 (49,3%) of the 148 participants, respectively, whereas age-appropriate vaccination against pertussis, diphtheria, tetanus and poliomyelitis was noted for 138 (93,2%), 147 (99,3%), 147 (99,3%) and 147 (99,3%) students, respectively. Of 185 HCS, 171 (92,4%)were immune to varicella. Of 182 HCS, 179 (98,4%) were immune to measles, 163 (89,6%) were immune to mumps, and 176 (96,7%) were immune to rubella. Of 179 HCS, 151 (84,4%) were immune to HBV. Of 178 HCS, 26(14,6%) were immune to HAV. Antibodies (≥10 mIU/ml) to HbsAg were detected for 151 (84,4%) of 179 HCS,and antibodies (>10mIU/ml) to HAV were detected for 26 (14,6%) of 178 HCS. To ensure the adequate protection of healthcare students, our options include blind immunization of everyone who has missing or incomplete vaccine records or selective vaccination after serologic confirmation of susceptibility.Selecting the most cost-effective strategy depends on the proportion of healthcare students with serologic immunity and on the costs of screening and vaccination.In our hospital setting, the post screening approach would be the most cost-effective strategy for providing immunity against all vaccine-preventable diseases examined in the present study, with the exeption of hepatitis A virus,for which blind immunization would be more economical. The necessary vaccines should be administered at the place of examination and free of charge.Conclusions: We have determined that there are a certain proportion of healthcare students who are susceptible to certain vaccine-preventable diseases. The development of an appropriate vaccination strategy is required to decrease the risk of transmission in a hospital setting.