Efficacy of hepatitis B vaccination and revaccination and factors impacting on response in patients with inflammatory bowel disease.

OBJECTIVES: We assessed the effectiveness of hepatitis B virus (HBV) vaccine in inflammatory bowel disease (IBD) patients, evaluated the impact of immunosuppressors and anti-tumor necrosis factor (anti-TNF) agents, and assessed the effectiveness of revaccination. METHODS: IBD patients were vaccinated against HBV with a quick (0, 1, and 2 months) and double-dose schedule (Engerix B). A second vaccination was administered to nonresponders. RESULTS: Of 241 vaccinated patients, anti-HBs was >10 IU/l in 59% and >100 IU/l in 39%. The response rate (anti-HBs >10 IU/l) was lower among patients under anti-TNF therapy: 46% vs. 62%. In the multivariate analysis, a lower response rate was demonstrated in older patients and those receiving anti-TNFs. The response rate (anti-HBs >100 IU/l) after revaccination was 42%. CONCLUSIONS: The response rate to the HBV vaccination--even with a double-dose schedule--is very low in IBD patients, mainly in those receiving anti-TNFs. However, treatment with immunosuppressors did not affect the efficacy of the vaccine. A considerable--albeit insufficient--success rate may be obtained when two consecutive vaccination courses, each with a three-dose vaccine series, are administered.

Comparison of the effectiveness of two protocols for vaccination (standard and double dosage) against hepatitis B virus in patients with inflammatory bowel disease.

BACKGROUND: The response rate to hepatitis B virus (HBV) vaccination in patients with inflammatory bowel disease (IBD) is low. AIM: To compare two vaccination protocols-the standard dose and the double dose-in IBD patients. METHODS: Patients diagnosed with IBD from three tertiary hospitals were vaccinated against HBV with two different protocols: the standard protocol (Engerix-B single dose at 0, 1 and 6 months) and the new faster protocol based on a double dose (Engerix B double dose at 0, 1 and 2 months). Anti-HBs titres were measured 1-3 months after the last dose. A multivariate analysis was performed to identify factors that were predictive of response to the vaccine. RESULTS: The study sample comprised 148 patients (mean age 40 years, 69% Crohn's disease), 70% of whom were receiving immunosuppressive therapy (22% thiopurines, 23% anti-TNF and 25% both). The standard protocol was followed in 46% of patients and the double dose protocol in 54%. Considering anti-HBs >10 IU/L as a successful response to vaccination, the seroconversion rate was higher among patients vaccinated with the double dose than with the standard dose: 75% (95% CI, 65-85%) vs. 41% (95% CI, 29-54%) (P < 0.001). In the multivariate analysis, vaccination with the double dose was the only factor associated with a better response to the vaccine (OR, 4; 95% CI, 2-8; P < 0.001). CONCLUSIONS: The response rate to the HBV vaccination in IBD patients is low. Administration of a double dose was associated with a higher response rate. Therefore, the double dose protocol could be a suitable option in patients with IBD.

Characterization of a possible nosocomial aspergillosis outbreak.

OBJECTIVE: To study the epidemiologic aspects of a suspected outbreak of nosocomial invasive aspergillosis. METHODS: Sixteen Aspergillus fumigatus strains were isolated from bronchoalveolar washings or sputa of 10 patients during a 9-month period. Furthermore, two environmental samples, isolated in a microbiological screening of the hospital, were also available for analysis. Random amplified polymorphic DNA analysis (RAPD) was carried out. RESULTS: The analysis performed by RAPD clearly demonstrated substantial genetic variation among the isolates. Both of the two different primers selected for RAPD analysis (R-108 and AP12h) were able to demonstrate that the strains isolated from all patients infected with the same fungal species and the environmental samples were genotypically distinct. The results by RAPD typing demonstrated that this technique could detect variability among isolates of Aspergillus fumigatus from different patients and even from the same patient. CONCLUSIONS: RAPD genotyping proved that the outbreak of invasive aspergillosis consisted of a series of events, non-related, and probably not coming from the same source within the hospital. This type of analysis is an easy, quick and highly discriminatory technique that may help in planning epidemiologic studies of aspergillosis.

[Assessment of job satisfaction of the nursing staff]. / Evaluación de la satisfacción del personal de enfermería.

OBJECTIVE: To find the overall and specific levels of job satisfaction of nursing staff in an Area's Health Institutions. DESIGN: Descriptive study of a crossover type of a population base. SETTING: Primary (PC) and Specialist (SC) Care within INSALUD in Madrid's Area 10. PARTICIPANTS: Nursing staff with at least six months in their post. All 147 working in PC were included and a random sample of 130 from SC. INSTRUMENT: The Font-Roja questionnaire, which measures overall job satisfaction and a series of specifics, was used. MEASUREMENTS AND MAIN RESULTS: 68.2% replied. By means of a factorial analysis of the main components, 9 dimensions explaining 59.2% of the variance were obtained. There was average general job satisfaction (3.05 +/- 0.35). The most valued dimension was that which referred to work content (4.01 +/- 0.59) and the least valued was tension associated with the job (2.47 +/- 0.70). CONCLUSIONS: Nursing staff at both levels of Health Care are less satisfied in the areas of "tension associated with work," "promotion prospects" and "over-work". The greatest satisfaction was found in "work content" and "relationships with colleagues". PC nursing staff showed greater satisfaction in "communication with superiors", "satisfaction with the post", "tension associated with the job" and "professional autonomy." Temporary scored higher than permanent staff in "satisfaction with the post" and "tension associated with the post." In general the afternoon shift provides most satisfaction.