Occupational Stress Suppress Production of Anti-HBsAg Antibody in Nurse Staffs Following Hepatitis B Vaccination

Background and Objectives: 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 is exposed to occupational stress risk, this study was designed to investigate the potential impact of occupational stress on anti-HBsAg antibody titration. Methods: A total of 115 nurses who were fully vaccinated against hepatitis B in triplicate format and whose titers of anti-HBsAg antibody had been measured participated in the study. Titration data was derived from the laboratory archive or the HIS system. Occupational stresses and demographic characteristics were recorded using a validated job stress questionnaire. Data were summarized using descriptive statistical methods and analyzed using analysis of variance (ANOVA) and t test. Findings: 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 the age, sex and BMI-score groups. Conclusions: Based on our results, occupational stress may be an important risk factor to the effectiveness of vaccination against hepatitis B. This 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 from infection.