Hepatitis B Immunization Among Healthcare Students: A Narrative Review of Occupational Risk, Seroprotection, and Immunization Management

Vollständiger Abstract

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Background/Objectives: Healthcare students face an occupational risk of hepatitis B virus (HBV) exposure during clinical training, often many years after receiving their primary vaccination series in infancy or childhood. Progressive waning of anti-hepatitis B surface (anti-HBs) antibody titres, heterogeneous vaccination histories in international student cohorts, high rates of underreported needlestick injuries, and variable occupational health protocols across institutions raise important questions about the adequacy of pre-clinical immunization surveillance in this population. This review aimed to synthesize current evidence on hepatitis B immunization among healthcare students, focusing on occupational exposure risk, seroprotection and immunological memory, clinical management of low or absent anti-HB titres including post-exposure prophylaxis, and the specific challenges posed by multicultural academic settings. Methods: A narrative review was conducted through a systematic literature search of PubMed/MEDLINE and Scopus, covering publications from January 2000 to December 2025, supplemented by key seminal references. After the removal of duplicates and stepwise screening, 49 references were selected for final inclusion. Results: Needlestick and sharps injuries occur at measurable rates during clinical training, with medical students accounting for approximately 30% of occupational exposure events in some series, and with underreporting rates estimated at 19–80% across studies. Pooled seroprotection prevalence at clinical training entry is approximately 73.8% (95% CI 69.1–78.0%), with substantially lower rates among students vaccinated in infancy—as low as 28% at 16–20 years post-vaccination in longitudinal data—compared with adolescence immunization. The majority of students with non-protective titres retain immunological memory, with 90.9% (95% CI 87.7–93.3%) demonstrating an anamnestic response after a single booster dose. Post-exposure prophylaxis pathways depend critically on pre-existing immunological status, reinforcing the operational value of pre-clinical serological screening. International student cohorts present additional complexity due to heterogeneous vaccination schedules, documentation gaps, and variable natural immunity profiles. Conclusions: Systematic pre-clinical serological screening (anti-HBs, HBsAg, and anti-HBc), combined with evidence-based stepwise immunization management and structured educational interventions, is essential to protect healthcare students from occupational HBV exposure. The primary operational goal of screening is the identification of the approximately 5% of true non-responders who require tailored occupational health management. These findings support a proactive, integrated approach to hepatitis B immunization surveillance in healthcare education, aligned with the WHO 2030 viral hepatitis-elimination targets.