Hepatitis A and B immunity and vaccination willingness among special school employees in Rhineland-Palatinate

Abstract

Introduction:

Employees at special schools face elevated risks of hepatitis A and B (HAV/HBV) due to close contact with pupils requiring personal care. Evidence on immunity and vaccination uptake in this occupational group is limited.

Methods:

Data from 1,742 employees at special schools in Rhineland-Palatinate, Germany (2021–2023), were collected through online anamnesis forms, selected to ensure efficiency and effectiveness, as well as medical evaluations, vaccination records, and anti-HBs testing during mandatory occupational health care. Self-assessed infection risk, HAV/HBV immunity, and vaccination acceptance rates were analyzed using descriptive statistics and logistic regression.

Results:

74% of the participants (83.5% female; median age: 43.7 years; 33.3% teachers, 62.2% educational specialists, 2.2% trainees, 2.4% others) completed the online anamnesis; 79% reported an increased occupational infection risk. Medical assessments confirmed HAV immunity in 54% and HBV immunity in 59%. Despite this awareness, vaccination gaps persisted: 58% of all employees received a recommendation for HAV and/or HBV vaccination, but only about half accepted it during the occupational health consultation. Younger age was the only significant predictor of vaccine acceptance (aOR 0.968 CI [0.952, 0.985]; p < 0.001).

Discussion:

Employees at special schools perceive a high risk of infection, yet substantial gaps in HAV and HBV immunity remain. Despite counseling, vaccination uptake was modest, with younger staff more likely to accept. The discrepancy between high perceived risk and low uptake suggests barriers such as vaccine hesitancy, distrust, or convenience factors. Moreover, the mismatch between self-reported and confirmed immunity underscores the importance of systematic medical examinations. Occupational health care offers a key opportunity for targeted pre-employment vaccination and education, particularly for older employees.