Hepatitis B, measles and varicella infections, among newly recruited military and healthcare employees in the Saudi National Guard : associated knowledge, concerns and barriers to vaccination

Abstract

Background: Vaccine-preventable diseases are easily transmitted in healthcare and military facilities. Despite deliberate efforts being instigated, vaccine preventable diseases in KSA remain the most commonly reported infectious diseases among adults. This study aimed to enhance understanding of the epidemiological pattern, seroimmunity, associated knowledge, and concerns on Hepatitis B virus (HBV), measles and varicella infections; investigating barriers to vaccine compliance among newly recruited health care workers (HCWs) and soldiers. Methods: A mixed methods model of analysis was performed: (1) A quantitative analysis through a cross-sectional survey and gathering results of blood samples and (2) a qualitative analysis through in-depth interviews and focus group discussions. Results: 315 multinational HCWs and 426 male Saudi soldiers completed similar questionnaires. The HCWs scored an intermediate median knowledge level of 43 HBV, 27 measles and 33 varicella questions, 32, 15 and 19 respectively, with the soldiers scoring a low median knowledge level 8, 4 and 7 respectively. Blood samples of 4,328 multinational HCWs and 1,030 male Saudi soldiers were screened. The HBsAg seroprevalence among HCWs was 0.4% and among soldiers 0.2%. The HBcAb positive seroimmunity was 6.7% and 0.8% respectively, and HBsAb positive seroimmunity 68.3%, and 29.4% respectively. Among HCWs IgG measles positive seroimmunity was 64.3% and for soldiers 31.2%, IgG varicella positive seroimmunity was 85.2% and 68.3% respectively. Vaccine barriers and acceptability for the vaccination were identified, comprising five main barriers related to: individual, vaccine, HCWs providing vaccine, organisation, and social and cultural factors. Conclusion: Low and intermediate levels of awareness among military and HCWs respectively confirm the need for educational campaigns to reduce infection transmission and increase vaccine compliance. The rate of HBV, measles and varicella immunity was low indicating the need to vaccinate susceptible groups.