Occupational Stresses Suppress Production of anti-HBsAg Antibody in Nurses Following Hepatitis B Vaccination

Vaccination is the major strategy to protect nurses against infection with hepatitis B virus. However, some nurses do not produce sufficient amount of anti-HBsAg antibody required for immunity against infection. Chronic occupational stress has been proposed as a risk factor to humoral immunity. Given that nursing staff are also at risk of occupational stresses, this study was designed to investigate the potential impact of occupational stress on anti-HBsAg antibody titration. A total of 115 nurses who were fully vaccinated against hepatitis B in triplicate format and whose titers of anti-HBsAg antibody were measured were participated in the study. Titration data was derived from laboratory archived or the HIS system. Occupational stresses and demographic features were recorded using a validated job stress questionnaire. Data were summarized using descriptive statistical methods and analyzed using ANOVA and t-test. Nurses with higher occupational stress exhibited significantly lower anti-HBsAg antibody titration. No significant difference in the level of anti-HBsAg antibody titration was observed between age, sex and BMI-score groups. Based on our results occupational stress may be an important risk factor to the effectiveness of vaccination against hepatitis B, which implies that stressed nurses are at risk of viral infection. Our study hence recommends urgent investigation of this hypothesis at larger scales, and if validated, taking appropriate measures to protect nurses against infection.