Alagappan Uma

Hepatitis B vaccination among medical students.

Sir, The incidence of liver disease associated with the hepatitis B virus (HBV) is a world-wide public health problem. The disease is transmitted by perinatal, parenteral, sexual routes.(1) Healthcare workers, particularly surgeons, pathologists, dentists and physicians working in hemodialysis and oncology units, are at a higher risk of contracting HBV infection via minor skin cuts and accidental needle punctures.(2) Since proper vaccination can prevent HBV infection, complete hepatitis B vaccination is necessary for medical and paramedical students. The present study was carried out to observe the attitude and practice of medical students towards hepatitis B vaccination and find out if they completed all three doses and, if not, elicit the reasons for incomplete vaccination. The study group consisted of medical students admitted in the year 2000 and 2001. After giving a brief introduction on the study, pre-tested, self-administered, anonymous questionnaires were distributed with reference to hepatitis B immunization history and reasons for non-compliance among those who had not completed three doses. The questionnaires were distributed in a single day in June 2005 in order to avoid sharing of information. The data were analysed statistically using Chi-square test. Out of the 250 questionnaires circulated, 217 (M = 130, F = 87) were returned, and the response rate was 86.8%. Among them, only 29 (22.3%) boys and 21 (24.1%) girls maintained their vaccination record. Nineteen (8.7%) (9 boys, 10 girls) students had already completed three doses and received booster dose on admission. Unfortunately, without vaccination against HBV, 12 (9.2%) boys and 3 (3.4%) girls produced certificates from qualified and registered medical practitioners. Among the rest (183), the numbers that received the first, second and third dose of hepatitis B vaccination were 109 (100%), 62 (56.9%) and 33 (30.3%) boys, respectively, and 74 (100%), 41 (55.4%) and 31 (41.9%) girls, respectively. Complete coverage was significantly (P < 0.05) more among girls. The reasons for non-compliance were many and are mentioned in Table 1. Some dominant reasons were forgetfulness (38.8%), no reminder (35.8%), lack of knowledge on hepatitis B infection (23.1%), lack of compulsion (20.1%), etc. Table 1 Reasons for non-compliance of hepatitis B vaccination Medical students are susceptible to HBV infection during their exposure to clinical cases and different procedures. Hence, medical students were advised to have vaccination against HBV before coming to clinical side, as they acquire good immune response with immune memory.(3) Three doses of vaccination are provided free of charge to all the students (both day scholars and hostelites) during the time of admission. They were provided with a vaccination card indicating the schedule for subsequent doses. For want of follow-up, reminding, monitoring and supervising systems, 119 did not complete vaccination. Hence, it is suggested that the students and their parents/family members who come on the day of admission should be educated on HBV infection and motivated for successful and effective vaccination. The process of vaccination may be completed with the help of student council. The study also highlights the need for a national policy in countries where hepatitis B vaccination to health care personnel is not made mandatory. Limitations of this study include non-availability of vaccination record in many and recall bias in addition to non-screening of their blood for hepatitis B surface antigen and antibodies too.

Attitude and practice of medical students studying in Hungary and India toward health during overseas and domestic travel.

BACKGROUND It is presumed that medical students are travelers who can take care of their health, and thus the present study was conducted to elicit the attitude and practice [AP] of medical students from two different countries toward travel health issues. OBJECTIVES To elicit the attitude and practice of medical students from two different countries toward travel health issues and identify the reasons for any variations. MATERIAL AND METHODS An anonymous pre-tested structured questionnaire consisting of socio-demographic details, travel aspects, travel health issues, and precautions [medicines carried, vaccination history, and pre-travel consultation] adopted was distributed to 250 foreign medical students studying at the University of Debrecen, Hungary [Group I] and another 250 native medical students in India [Group II]. Data were analyzed by simple descriptive statistics and Student t-test. RESULTS A total of 428 students responded among total eligible population of 500; 228 [90.2%] in group I and 200 [80%] in group II. In 2008, 188 [82%] of the former and 33 [16.5%] of the latter groups traveled to international destinations. Among groups I and II, health problems were experienced by 73 [32%] and 65 [32.5%] students, respectively. During hospitalization, students of group I were admitted for one of the following illnesses such as severe asthma, dehydration, malaria, and tibial fracture, while two other students were admitted to the hospital with deep vein thrombosis [DVT]. During travel, the category of medicines carried by students belonging to group I/II were anti-diarrhoeal [75/19], anti-emetics [53/39], anti-giddiness [49/7], anti-histamines [55/12], anti-pyretics plus analgesics [197/70], anti-spasmodics [55/11], antibiotics [33/10], vitamin pills [84/0], and laxatives [47/6]; supportive items such as adhesive plaster [64/3], and thermometer [37/1]; personal protective materials viz., mineral water [165/88], hygienic food [100/132], insect repellents [86/14], special clothes such as full sleeves and cap [150/0], sun screen [160/14], and items against sexually transmitted diseases [159/0]; health documents such as medical insurance card [161/3], previous health records [40/0], immuno-prophylaxis [127/0], family physicians phone number [43/9] and pre-travel advice [57/2]. COMMENTS Students studying in Hungary were better informed about travel-related issues than native students from Indian medical colleges. The probable reasons for such variations were cultural differences, variation in their pre-medical curricula and teaching, frequent travel, a previous university degree, military training, maturity, and staying away from parents. The overall attitude and practice of medical students toward travel health issues were sub-optimal, since the subjects taught did not focus much on travel and health-related issues. Hence, there is an urgent need to initiate standardized teaching in the field of travel medicine for the students of health sciences for the benefit of the community.

Dual Infection of HIV-1 and HTLV-I in South India: A Study on a Patient with AIDS-Related Complex

A dually HIV‐and HTLV‐infected ARC patient was found by serological studies in South India. These viruses were isolated and molecular study showed that the patient had both HIV‐1 and HTLV‐I but not HIV‐2 and HTLV‐II. In addition to this, 9 other dually infected persons which include another full‐blown AIDS case have been identified as on July 1993 in South India. Our findings provide an opportunity to clarify geographical distribution of these human retroviruses.