Halpern SD et al. (2006) Inadequate hepatitis B vaccination and post-exposure evaluation among transplant surgeons: prevalence, correlates and implications. Ann Surg 244: 305–309

To quantify the proportion of US transplant surgeons vaccinated against hepatitis B virus (HBV), Halpern et al. mailed questionnaires to all 625 active transplant surgeons. The researchers received 347 completed questionnaires. After excluding 36 respondents who had legitimate reasons for not being vaccinated, the authors found that 70 of the remaining 311 (22.5%) had received fewer than the recommended three vaccine injections. Compared with adequately vaccinated surgeons, inadequately vaccinated surgeons were more likely to have been practicing for longer (odds ratio 1.5 per 10-year increment in length of practice) and to be more fearful of infection (odds ratio 1.2 for each unit increase in fear out of 10). Fifteen percent of the 94 surgeons who reported needle-stick exposure while operating on a patient infected with HBV were not adequately vaccinated. Respondents who were inadequately vaccinated against HBV considerably underestimated the risk of both percutaneous exposure to infected blood during surgery, and of patient-to-surgeon transmission following exposure.

Although this study was limited by reliance on self-reporting and the conservative definition of adequate HBV vaccination, the authors suggest that these biases should, if anything, have led them to underestimate the true proportion of inadequately vaccinated surgeons. Given that unprotected surgeons underestimate the risk of HBV transmission but still fear infection, Halpern et al. suggest that informing theater staff about true transmission risks might improve adherence to HBV vaccination regimens. In the meantime, because unprotected surgeons pose risks to themselves and their patients, the authors suggest that proof of vaccination be a requirement for surgical personnel.