Seroprevalence and prevention of hepatitis B, measles and rubella among healthcare workers in Dili, Timor-Leste

Celia Gusmao; Maria Y Tanesi; Nelia Gomes; Sarah L Sheridan; Nevio Sarmento; Tessa Oakley; Michael David; Johanna Wapling; Lucsendar Alves; Salvador Amaral; Anthony D K Draper; Bernardino Cruz; Danina Coelho; Helio Guterres; Nicholas S S Fancourt; Jennifer Yan; Kristine Macartney; Joshua R Francis; Paul Arkell

doi:10.1016/j.lansea.2022.100133

Seroprevalence and prevention of hepatitis B, measles and rubella among healthcare workers in Dili, Timor-Leste

Lancet Reg Health Southeast Asia. 2023 Jan 17:13:100133. doi: 10.1016/j.lansea.2022.100133. eCollection 2023 Jun.

Authors

Celia Gusmao¹, Maria Y Tanesi², Nelia Gomes², Sarah L Sheridan³, Nevio Sarmento², Tessa Oakley², Michael David^{4

5}, Johanna Wapling², Lucsendar Alves², Salvador Amaral², Anthony D K Draper^{2

6}, Bernardino Cruz⁷, Danina Coelho⁷, Helio Guterres¹, Nicholas S S Fancourt², Jennifer Yan², Kristine Macartney^{3

8}, Joshua R Francis², Paul Arkell^{2

9}

Affiliations

¹ Hospital Nacional Guido Valadares, Dili, Timor-Leste.
² Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
³ National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia.
⁴ Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, NSW, Australia.
⁵ School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia.
⁶ Northern Territory Centre for Disease Control, Darwin, Northern Territory, Australia.
⁷ Ministry of Health, Dili, Timor-Leste.
⁸ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁹ Imperial College, London, United Kingdom.

Abstract

Introduction: The World Health Organisation recommends that healthcare workers (HCWs) are immune to measles and rubella, and those at risk of exposure are offered the hepatitis B vaccine. No formal programme for occupational assessment and provision of vaccinations to HCWs currently exists in Timor-Leste.

Methods: A cross-sectional study was undertaken to determine the seroprevalence of hepatitis B, measles and rubella among HCWs in Dili, Timor-Leste. All patient-facing employees at three healthcare institutions during April-June 2021 were invited to participate. Epidemiological data were collected by interview-questionnaire and a serum sample was collected by phlebotomy and analysed at the National Health Laboratory. Participants were contacted to discuss their results. Relevant vaccines were offered to seronegative individuals and those with active hepatitis B infection were referred for further assessment and management in a hepatology clinic as per national guidelines.

Results: Three-hundred-and-twenty-four HCWs were included (representing 51.3% of all eligible HCWs working at the three participating institutions). Sixteen (4.9%; 95% CI: 2.8-7.9%) had active hepatitis B infection, 121 (37.3%; 95% CI: 32.1-42.9%) had evidence of previous (cleared) hepatitis B infection, 134 (41.4%; 95% CI: 35.9-46.9%) were hepatitis B seronegative, and 53 (16.4%; 95% CI: 12.5-20.8%) had been vaccinated. Two-hundred-and-sixty-seven (82.4%; 95% CI: 77.8-86.4%) and 306 (94.4%; 95% CI: 91.4-96.7%) individuals exhibited antibodies to measles and rubella, respectively.

Interpretation: There are significant immunity gaps and a high prevalence of hepatitis B infection among HCWs in Dili Municipality, Timor-Leste. Routine occupational assessment and targeted vaccination of this group would be beneficial and should include all types of HCWs. This study provided an opportunity to develop a programme for the occupational assessment and vaccination of HCWs and forms the template for a national guideline.

Funding: This work was supported by the Department of Foreign Affairs and Trade, Australian Government [Complex Grant Agreement Number 75889].

Keywords: Healthcare worker; Hepatitis B; Measles; Occupational health; Rubella; Serological surveillance; Vaccination; Vaccine preventable diseases.