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Tetanus vaccination coverage among nurses in Greece

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Tetanus vaccination coverage among nurses in Greece
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  Hepatitis B vaccination coveragelevels among nurses in Greece To the Editor: Hepatitis B virus is mainly transmitted parenterallyandrepresentsamajorriskfactorforhealthcareworkersbecause of their frequent exposure to patient biologicmaterials (blood and body fluid). 1 Epidemiologic studieshave shown that the incidence of infection following a needlestick contaminated with hepatitis B virus rangesfrom 6% to 30%. 2 Therefore, workers performing tasksinvolving exposure to blood or blood-contaminatedbody fluids should be vaccinated.With this study, we wanted to estimate the coveragelevels of hepatitis B vaccination among Greek nursesagainst hepatitis B. A self-reported questionnaire wasused, based on the srcinal questionnaire used in thesurvey of McEwen and Farren 3 (after permission of the authors).In our study, 63.2% of the participant Greek nursesreported that they were fully vaccinated. The majorityof immunized nurses (66%) was female (  P  5 .008), and72.6% of fully vaccinated nurses worked in intensivecare units; 84.3% of those who were fully vaccinatedhad their antibody titer measured to assess the efficacyof the vaccine. Of these, 10.5% reported their titer wasnegative. Reported reasons for declining vaccinationincluded concerns about adverse effects, beliefs thatare not in increased risk for infection and prior hepati-tis B infection. The main reasons for receiving vaccina-tion were self-protection and fa mily protection.Comparedwithotherstudies, 3,4 wefoundlowervac-cination rates among nurses. The higher vaccinationlevels in these studies probably rely in developmentand application of continuing immunization programsfor health care workers.In conclusion, our study showed that a substantialnumber of Greek nurses (40%) are not vaccinated forhepatitis B, despite being in great risk for infectionbecause of frequent exposure to blood or other poten-tially infectious biologic materials. Although effortshave been made to tackle this issue during the lastyears,thereisstillaneed formoreefficientvaccinationstrategies. This would contribute further into reducingthe number of unprotected health care workers andensuring that all personnel at risk are actively offeredand accept hepatitis B immunization. Aikaterini Toska, RN, MSc, PhDMaria Saridi, RN, MSc, PhDMaria Rekleiti, RN, MScAnastasia Alonistioti, RN General Hospital of Korinthos, Korinthos, Greece Greta Wozniak, MD, PhD Medical School, Universityof Thessaly, Larissa, Greece Ioannis Kyriazis, MD, PhD, FSCOPE Internist-Diabetologist, 2nd Internal MedicineDepartment & Diabetes Outpatient ClinicGeneral Hospital ‘‘Asclepeion’’ Voulas, Greece Eleni Apostolopoulou, RN, PhD Associate Professor, Faculty of NursingUniversity of Athens, Athens, GreeceAddress correspondence to Greta Wozniak, MD, PhD,MedicalSchool,UniversityofThessaly,Larissa,Greece.E-mail: greta@med.uth.gr References 1. Centers for Disease Control and Prevention. Updated US public healthservice guidelines for the management of occupational exposures toHBV, HCV, and HIV and recommendations for postexposures prophy-laxis. MMWR Morb Mortal Wkly Rep 2001;50:1-42.2. Cardo DM, Bell DM. Bloodborne pathogen transmission in health careworkers. Infect Dis Clin North Am 1997;11:331-43.3. McEwen M, Farren E. Actions and beliefs related to hepatitis B andinfluenza immunization among registered nurses in Texas. Public HealthNurs 2005;22:230-9.4. Simard EP, Miller JT, George PA, Wasley A, Alter MJ, Bell BP, et al. Hep-atitis B vaccination coverage levels among healthcare workers in theUnited States, 2002-2003. Infect Control Hosp Epidemiol 2007;28:783-90.doi:10.1016/j.ajic.2010.09.010 Tetanus vaccination coverageamong nurses in Greece To the Editor: Tetanus is unique among diseases for which vacci-nation is routinely recommended in that it is non-communicable. In areas where routine childhoodvaccinations, appropriate use of tetanus toxoid, andimproved wound management are commonplace, theincidence of tetanus has decreased dramatically. Themajority of tetanus cases reported in the recent yearshas been in nonimmunized or inadequately immu-nized adults.The health care workers are not in a higher risk of infections than general public, although The Centersfor Disease Control and Prevention (CDC) recommendsvaccinationwithtetanusanddiphtheriavaccinesforallhealth workers. 1 Through this study, we wanted to es-timate the vaccination levels for tetanus among Greeknurses. This is a cross-sectional questionnaire-based 0196-6553/$36.00Copyright ª 2011 by the Association for Professionals in Infec-tion Control and Epidemiology, Inc. Published by Elsevier Inc.All rights reserved. 532  survey, conducted by the University of Athens, in 17public hospitals of the country. A self-reported anony-mous questionnaire was used.In our study, 60% of responders reported being vac-cinated in childhood, whereas 30.5% responded thatthey were unaware of whether they were vaccinated.Only 28.2% of the nurses under survey had receivedthe booster dose over the past 10 years. Among thefully immunized nurses, the reasons for being vacci-nated with the booster dose were compliance to thevaccination schedule (65.6%) and postexposure man-agement of injury (34.4%).A significant proportion (14.4%) of nurses hadreceived tetanus antitoxin after an injury while onduty in the hospital. Only 19.6% knew that the dura-tion ofvaccine-related immunitywas10years. Acorre-lation was found among booster dose administration,educational level (  P   5  .002), and work department(  P  5 .049). Contrary to otherstudies concerning adults’vaccination against tetanus, 2,3 our study displayedlower vaccination rates among nurses. There are fewstudies 4 involving health care workers’ vaccinationagainst tetanus; thus, this study faces the limitation of insufficient comparisons in the literature.In conclusion, our study displayed poor compliancewith tetanus vaccination among nurses. Given that theantibody levels wane with age, more efforts should bemade to increase the immunization levels by boostingdoses administration in health care workers. Aikaterini Toska, RN, MSc, PhDMaria Saridi, RN, MSc, PhDMaria Rekleiti, RN, MSc General Hospital of Korinthos, Korinthos, Greece Greta Wozniak, MD, PhD Medical School, University of Thessalia, Larissa,Greece Kyriakos Souliotis Lecturer, Faculty of Social ScienceUniversity of Peloponnese, Tripoli, Greece Eleni Apostolopoulou, RN, PhD Associate Professor, Faculty of NursingUniversity of Athens, Athens, GreeceAddress correspondence to Greta Wozniak, MD, PhD,Medical School, University of Thessalia,Larissa, Greece.E-mail: greta@med.uth.gr References 1. CDC. Immunization of health care workers: recommendations of theAdvisory Committee on Immunization Practices(ACIP) and the hospitalInfection Control Practices Advisory Committee (HICPAC). MMWR1997;46(RR-18):1-42.2. Skowronski D, Pielak K, Remple V, Halperin B, Patrick D, Naus M, et al.Adult tetanus, diphtheria and pertussis immunization: knowledge, be-liefs, behavior and anticipated uptake. Vaccine 2004;23:353-61.3. Coulibaly N, De Serres G. Coverage of anti-tetanus vaccinations inadults in Canada-year 2002. Can J Public Health 2004;95:456-9.4. Dinelli M, Moreira T, Paulino E, Da Rocha M, Graciani F, De Moraes-Pinto M. Immune status and risk perception of acquisition of vaccinepreventable diseases among healthcare workers. Am J Infect Control2009;37:858-60.doi:10.1016/j.ajic.2010.09.014 Occupational exposure to blood inworkers in a Greek hospital To the Editor: Health care workers are at risk for occupationalexposure to bloodborne pathogens, including hepatitisB virus, hepatitis C virus, and HIV. 1 Exposures occurthrough needlesticks or cuts from other sharp instru-ments contaminated with an infected patient’s bloodor through contact of the eye, nose, mouth, or skinwith a patient’s blood. The risk of acquiring hepatitis Cinfection following a needlestick injury is estimated atapproximately3%,hepatitisBis30%,andHIVis0.3%. 2 We designed this study to estimate the incidence of occupationalexposuretobloodandbodyfluidsinhealthcare staff in a rural hospital. Our study took place from June 2006 to June 2008, and the sample consisted of 338 participants (29.9% males, 70.1% females). Themajorityoftheparticipantswasnurses(59.8%),followedbyphysicians(19.5%),technicalpersonnel(10.4%),andadministrative personnel (3.8%).Overall, 6.5% of the health care staff reported acci-dents during the study: 46% of them werenurses, 36%physicians, and 18% were members of the cleaningstaff. A significant proportion of those who had anaccident (63.6%) reported that they had a needlestickinjury, and 36.4% were injured by other sharps. In all(100%) occasions, blood samples were collected fromthose injured, and, in 19 occasions (86.4%), bloodsamples were collected from the patients who wereinvolved as well.Aftertheaccident,adoseoftetanusimmunoglobulinwasgiventothe68.2%ofthehealthcarestaff,whereas68% ofthesamplewerealsogivenadoseofhepatitisBimmunoglobulin. In addition, 63.6% of the individualswho were injured were vaccinated against hepatitis B,and 13.6% were immunized for tetanus.The present study displayed a correlation amongexposure, gender, and years of employment. Male pro-fessionals with many years of employment have a higherexposurepercentage.Wealsofoundthatneedle-stick injuries were more common in unvaccinated pro-fessionals.Otherstudiespointalsotowardacorrelationamongexposureandgender, 3 butotherauthors 4,5 havenot detected any correlation among vaccination statusand types of occupational exposure. www.ajicjournal.orgVol. 39 No. 6 Letters to the Editor   533
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