Need for a comprehensive, consistently applied national hepatitis B vaccination policy for healthcare workers in higher educational institutions: A case study from South Africa

Background: Hepatitis B virus (HBV) is transmitted by infected blood and other body fluids, placing healthcare workers (HCWs) and student HCWs at increased risk of HBV infection through occupational exposure. Aim: To establish the existence, content and implementation of hepatitis B (HB) vaccination policies for student HCWs being trained at higher educational institutions (HEIs) in South Africa. Methods: Self-administered structured questionnaires were sent to 23 nursing colleges and 11 universities in South Africa that train doctors, nurses or dentists. Findings: Twelve (35%) questionnaires were returned. Ten HEIs had a policy consisting mainly of recommendations given to students at registration. Nine HEIs made HB vaccinations available, with four HEIs covering the cost through student fees. Seven HEIs did not require a record of previous vaccination. Six HEIs did not accept non-responders (NRs), three HEIs would only accept an NR after receiving a second three-dose vaccination series and counselling, six HEIs regarded an HBV carrier as infectious, and 10 HEIs would accept HBV carriers as students. The low response rate makes it difficult to generalize the results, but may suggest a lack of an HB vaccination policy for student HCWs at non-responding HEIs. Conclusions: Policies of responding HEIs regarding HB vaccination, HBV carriage and response to HB vaccination were variable, sometimes inappropriate and not sufficiently comprehensive to protect student HCWs against occupationally acquired HBV. This emphasizes the need for a comprehensive, consistently applied, nationally coordinated vaccination policy to ensure that student HCWs receive proper protection against HBV infection.