|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2018 | Volume
: 5
| Issue : 2 | Page : 42-49 |
|
Attitude of practicing dentists towards vaccine-preventable infectious diseases: A cross-sectional study
Mashael Khaled Althobati, Safeyah Alqarni, Salha H Huaylah, Fatimah Al-hamdi, Balsam Al-Almai, Rafi A Togoo
Department of Pediatric Dentistry and Orthodontics, King Khalid University College of Dentistry, Abha, Saudi Arabia
| Date of Web Publication | 3-Aug-2018 |
Correspondence Address:
Mashael Khaled Althobati
King Khalid University College of Dentistry, Abha
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdrr.jdrr_12_18
Background: The vaccination of dentists against various vaccine-preventable infections is the most important measure of primary prevention against such diseases which would otherwise prove fatal for both the dentists and their patients. Aim: A study was conducted among the general as well as specialist dentists to evaluate their attitude towards vaccine-preventable infectious diseases (VPIDs) in Asir, Saudi Arabia. Materials and Methods: A self-administered questionnaire was formulated and sent through E-mails to the dentists (both general and specialist dentists) who gave the consent in participation. For most of the questions, a 5-point Likert scale was used ranging from strongly disagree to strongly agree. The responses were subjected to statistical analysis. Results: Majority (76.5%) of the respondents strongly agree that a dentist should be compulsorily immunized against Hepatitis B, while 11.4% of the respondents strongly disagreed for the same. The difference between the responses was found to be highly significant (P = 0.0000**). Nearly 42.4% of the dental professionals agreed, while 27.3% strongly agreed that dentists should get vaccinated against influenza, compulsorily. Most of the respondents (19.7%) neither agreed nor disagreed that the dentists should be compulsorily vaccinated against influenza. Conclusion: It is concluded that dentists were aware as well as vaccinated against most of the VPIDs, except for influenza which was not considered much harmful by the subjects that resulted in less section of dental professionals being vaccinated against influenza.
Keywords: Dentists, hepatitis, vaccination
How to cite this article:
Althobati MK, Alqarni S, Huaylah SH, Al-hamdi F, Al-Almai B, Togoo RA. Attitude of practicing dentists towards vaccine-preventable infectious diseases: A cross-sectional study. J Dent Res Rev 2018;5:42-9 |
How to cite this URL:
Althobati MK, Alqarni S, Huaylah SH, Al-hamdi F, Al-Almai B, Togoo RA. Attitude of practicing dentists towards vaccine-preventable infectious diseases: A cross-sectional study. J Dent Res Rev [serial online] 2018 [cited 2023 Mar 29];5:42-9. Available from: https://www.jdrr.org/text.asp?2018/5/2/42/238531 |
| Introduction | |  |
It stands ascertained, since quite a long time, that the hands of health professionals are the major breeding field for the infectious agents. Health-care workers are at highest risk for occupational exposures such as percutaneous injuries, contact of mucous membrane, and contact with blood or other body fluids that are infectious and may acquire infections through blood, aerosols, and saliva. Moreover, they may also be the source of nosocomial transmission of infections to the patients and their attendees. Hence, their appropriate training and prevention is a paramount step. Specific precautions and well-designed equipment have been identified and recommended so as to prevent transmission or acquiring of occupational infections in hospitals/clinics and other health-care centers. Preexposure immunization has been documented as an imperative step of primary prevention against such hospital-acquired infections. Administration of a vaccine into a person to stimulate protective immune response so that the vaccinated person becomes immune to the disease if he/she gets in contact with the corresponding infectious agent is known as vaccination. It is the most cost-effective approach of prevention from diseases. Vaccination of doctors and other health-care staff has been proved to be the most important step towards the safety of patients as well as the doctors.[1]
The risk of exposure to infectious diseases is 3—4 times more in general dentists and 6 times greater in specialist surgeons than the general population as reported by previous studies.[2]
Majority of population is infected by Hepatitis B virus (HBV) affecting around 2 billion people acutely and 350 million chronically, in the world.[3] Due to contact with infected oral fluids or other secretions and blood of the patients through cuts by sharp instruments during invasive procedures, the dentists and the other dental staff are at highest risk of exposure to HBV.
Due to the high prevalence of HBV in the population, the risk of acquiring the disease is very high. In Saudi Arabia, its prevalence is at a higher end, so the disease is of more significance as far as its acquisition is concerned.[4] Other commonly found vaccine-preventable infections are influenza, Measles, Mumps, and Rubella (MMR), varicella, pertussis, meningococcal, and diphtheria. Health-care workers and management have made the recommendations for the preventive ways against vaccine-preventable diseases that include the vaccination of all people involved with health care.[5] Although various recommendations have been made for all health professionals and other staff related with health care, practically they are not being followed by all health-care workers which might prove fatal for them.
Hence, a study was carried out among the general as well as specialist dentists to evaluate their attitude towards vaccine-preventable infectious diseases (VPIDs) in Saudi Arabia.
| Materials and Methods | | |
A cross-sectional questionnaire-based study was conducted among practicing general dentists, dental specialists, and dental professionals in Asir, Saudi Arabia. Prior to the conduct of the study, ethical approval was obtained from the Scientific Research Committee, King Khalid University College of Dentistry. A total of 165 dentists were contacted through phone calls and their E-mail addresses were inquired and noted down, after taking their consent for participation in the study. A self-administered questionnaire [Appendix 1], having two sections was formulated; the first section included the demographic data (such as age and gender) as well as personal information such as specialty, type of practice, number of years in practice, number of working hours per week, and approximate number of patients seen per day, and the other section included the questions related to the respondents' attitude towards vaccination against vaccine-preventable diseases (such as HBV, influenza, MMR and varicella zoster) and was sent to the study participants through their E-mail addresses. For most of the questions, a 5-point Likert scale was used to assess the attitude of the respondents which ranged from strongly disagree to strongly agree. Respondents were asked to signify their level of agreement to a given statement by choosing one of the five response categories. The length of the questionnaire was restricted to 9 items only so that it is convenient for the respondents to answer the questions in 20—25 min. Pretesting of the questionnaire was done on a sample of ten respondents to test all the aspects of a questionnaire including question content, clarity of words, and question difficulties. To measure the reliability of the questionnaire, Cronbach's alpha was used. The Cronbach's alpha coefficient of 0.78 was found, indicating the acceptable internal reliability.
Out of the total 165 participants who were sent the questionnaires, only 132 filled the questionnaires completely. The data hence received were put to statistical analysis. Descriptive analysis and Chi-square test were used with P < 0.05 for significance.
| Results | | |
In the present study, around 52.2% of the respondents were males and 47.8% were females. Among the respondents, majority (41.6%) belonged to general dentistry followed by those belonging to restorative dentistry (11.9%), while the rest were belonging to other specialties. Majority were in academics (44.3%), followed by government employees (30.5%) and private practitioners (25.2%) [Table 1]. | Table 1: Sociodemographic percentage frequency distribution of respondents
Click here to view |
Majority (76.5%) of the respondents strongly agree that a dentist should be compulsorily immunized against HBV, while 11.4% of the respondents strongly disagreed for the same. The differences between the responses were found to be highly significant (P = 0.0000**). Nearly 42.4% of the dental professionals agreed, while 27.3% strongly agreed that dentists should get vaccinated against influenza, compulsorily. Almost 19.7% of the respondents neither agreed nor disagreed that the dentists should compulsorily be vaccinated against influenza [Table 2]. | Table 2: Percentage frequency distribution of respondents' attitude towards vaccination
Click here to view |
The responses of questions 7, 8, and 9 are shown in [Graph 1],[Graph 2], and [Graph 3], respectively.
| Discussion | | |
Health-care workers including the dentists deal with the patients in their day-to-day life, and these patients may be carriers or sufferers of VPIDs. The dentists, while treating the patients and relieving them from pain, might pose a danger to their own health by acquiring VPIDs from the patients. It is not only true for dentists, but the patients also are at highest risks, if the dentist is a carrier of such infections. Hence, it is essential for all health-care workers including the dental professionals to get vaccinated against such infections, apart from taking all other recommended precautions of infection control measures. Vaccination can lead to the healthy work environment for both the dentists and the patients and for the society as a whole. Hence, a study was conducted among the dentists of Saudi Arabia to assess their attitude and knowledge towards vaccination against VPIDs.
Majority (76.5%) of the respondents strongly agreed that a dentist should compulsorily be immunized against HBV, while 11.4% of the respondents strongly disagreed for the same. This finding was in agreement to the previously conducted studies by Tripati et al.[6] and the one conducted by Kursun et al.,[7] wherein they found the dentists' knowledge about immunization to be 86% and 70%, respectively. Although majority of the dentists are aware about the measures of prevention from infections, it does not confirm about their practical adherence to the predetermined guidelines for the same. The dentists should strictly adhere to getting themselves vaccinated against HBV so as to protect themselves, their family members, colleagues, as well as the patients from the adverse outcomes of the fatal disease.
In the present study, 42.4% of the dental professionals agreed, while 27.3% strongly agreed that dentists should get vaccinated against influenza, compulsorily. Nearly 19.7% of the respondents neither agreed nor disagreed to the same that indicated their level of dilemma about it. In the previous studies, numerous reasons for undergoing vaccination against influenza have been explored. Some dentists do so for their own protection,[8] while others go for vaccination so as to prevent patients from getting infected.[9] Dentists should take up vaccination for his/her as well as his/her patients, colleagues, and family members' protection against influenza. In the present study, when the respondents were inquired about the uptake of influenza vaccine by them, very less percentage (3.8%) of dentists had undergone influenza vaccination that calls for the need of informing the dentists about its importance and also exploring the barriers against influenza vaccination so as to overcome those to reduce the morbidity and mortality caused due to influenza. The less frequency of vaccinated individuals against influenza does not imply that the facilities are not made available for the health professionals, but it may be attributed to other factors such as less interest, deficient awareness, and misconceptions. Few of the barriers that were investigated in previous studies were misunderstanding about influenza disease and wrong perception about ineffectiveness of vaccine against it.[10],[11],[12] Vaccination of health-care workers has been documented as being an indirect protection to the high-risk group such as immunocompromised patients as well as aged patients due to the fact that their effectiveness of influenza vaccine is low when compared to the young age group; hence, immunization of health-care workers becomes beneficial for both the old patients and the health professionals.[13]
In the present study, 39.7% of the dentists agreed about the compulsory vaccination of dentists against measles; 31.3% of respondents strongly agreed for the same, while 15.2% of the dentists neither agreed nor disagreed about it. Although majority of them were aware about the importance of vaccination against measles, rest of them could not decide about it, hence depicting their lack of knowledge. Measles has been reported as being fatal vaccine-preventable disease; it includes several complications such as diarrhea, pneumonia, kerato-conjunctivitis, encephalitis, and the extreme one being death.[14] It is mentioned in an earlier study that there is a need of 92%—95% of coverage of vaccination of measles so that those who are not vaccinated would be protected from the disease by the way of herd immunity.[15] It is worth mentioning here that the risk of acquiring measles is 13—19 times greater among health-care workers than the general population.[16],[17] Health-care workers are at higher risk because the disease is transmitted from the affected patients even before the signs/symptoms could be distinguished clinically.
In the present study, around 50% and 30.3% of the respondents agreed and strongly agreed, respectively, that the dentists should compulsorily take vaccination against mumps. When asked about Rubella vaccination, majority (43.9% and 30.3%) agreed and strongly agreed, respectively, that the dentists should get vaccinated for the same. Nearly 40.2% and 30.3% agreed and strongly agreed, respectively, that dentists should get vaccinated compulsorily against varicella zoster. According to a previous study by Maltezou and Poland, it has been documented that the vaccination of health-care workers is compulsory due to the reason that the patients are at risk of getting the infectious diseases such as HBV, influenza, MMR, pertussis, and varicella zoster.[18]
A bulk of respondents (90.2%) underwent HBV vaccination. This finding was similar to the finding of Di Giuseppe et al. who found that 85.7% of Italian dentists were vaccinated against HBV. In their study, they explored the reasons for the dentists to get vaccinated against HBV and influenza, wherein they found that prevention from onset of disease or its complications was the main reason for the dentists to get vaccinated. Those individuals who did not get vaccinated reported that vaccines were not safe to use and they were not beneficial against the HBV. Those who did not get vaccinated against influenza believed that the disease was not harmful to them.[19] Although the reasons for being or not being vaccinated were not explored in the present study, from previous studies, it is obvious that misconceptions do exist among the dental professionals regarding the safety and importance of vaccinations against VPIDs.
Limitations
- The specialty, work experience, and type of practice could not be correlated with the responses given by the dentists
- The responses were not verified with their medical records
- The number of vaccination doses, especially for hepatitis, was not asked.
Recommendations
- All the workplaces should make the vaccinations mandatory so as to ensure maximum vaccination coverage
- Various educative programs and vaccination campaigns should be carried out by the concerned authorities for all health-care workers, especially the medical and dental ones
- The educative programs should include the topics of the beneficence and safety of vaccinations.
| Conclusion | | |
Within the limitations of the study, it is concluded that dentists were aware as well as vaccinated against most of the VPIDs, except for influenza which was not considered much harmful by the respondents that resulted in a less percentage of dental professionals being vaccinated against influenza.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| Appendix | | |
Appendix 1: Questionnaire
Dentists' attitude towards vaccine-preventable diseases
- Gender
- Age group (years)
- ≤30
- 31—35
- 36—40
- 41—45
- 46—50
- >50.
- Specialty
- General dentistry
- Restorative dentistry
Endodontics
- Prosthetics
- Periodontics
- Pedodontics
- Orthodontics
- Oral surgery
- Others
- Community dentistry
- Oral medicine and radiology
- Oral pathology
- Dental intern.
- Primary practice type
- Private
- Government
- Academic institution.
- Number of years in practice
- Number of hours worked for a week
- Approximate number of patients seen in a workday
Respondents' attitude towards vaccination:
A dentist should be compulsorily immunized against the following:
- Hepatitis B:
- Strongly disagree
- Disagree
- Neither agree nor disagree
- Agree
- Strongly agree.
- Influenza
- Strongly disagree
- Disagree
- Neither agree nor disagree
- Agree
- Strongly agree.
- Measles
- Strongly disagree
- Disagree
- Neither agree nor disagree
- Agree
- Strongly agree.
- Mumps
- Strongly disagree
- Disagree
- Neither agree nor disagree
- Agree
- Strongly agree.
- Rubella
- Strongly disagree
- Disagree
- Neither agree nor disagree
- Agree
- Strongly agree.
- Varicella-zoster
- Strongly disagree
- Disagree
- Neither agree nor disagree
- Agree
- Strongly agree.
- The vaccination you think is most important for a dentist would be
- a. Hepatitis
- b. Influenza
- c. Measles
- d. Mumps
- e. Rubella
- f. Varicella-zoster
- others.
- The vaccination you think is least important for a dentist would be
- a. Hepatitis
- b. Influenza
- c. Measles
- d. Mumps
- e. Rubella
- f. Varicella-zoster
- Others:
- It is better to take all vaccine
- Titani.
- The vaccination you have had is
- a. Hepatitis
- b. Influenza
- c. Measles
- d. Mumps
- e. Rubella
- f. Varicella-zoster.
Others:
- Nothing
- Most of these vaccination
- All done except rubella
- Hepatitis, measles, mumps
- A-C-B-E-F.
| References | | |
| 1. | Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, et al. Guidelines for infection control in dental health-care settings-2003. MMWR Recomm Rep 2003;52:1-61.  |
| 2. | Polakoff S, Tillett HE. Acute viral hepatitis B: Laboratory reports 1975-9. Br Med J (Clin Res Ed) 1982;284:1881-2. |
| 3. | Hadler SC. Global impact of hepatitis A virus infection. In: Hollinger BF, Lemon SM, Margolis HS, editors. Proceedings of the 1990 International Symposium on Viral Hepatitis and Liver Diseases: Viral Hepatitis and Liver Disease. Vol. 14. Baltimore: Williams & Wilkins; 1991. p. 94-7. |
| 4. | Alrowaily MA, Abolfotouh MA, Ferwanah MS. Hepatitis B virus sero-prevalence among pregnant females in Saudi Arabia. Saudi J Gastroenterol 2008;14:70-2. [ PUBMED] [Full text] |
| 5. | Maltezou HC, Wicker S, Borg M, Heininger U, Puro V, Theodoridou M, et al. Vaccination policies for health-care workers in acute health-care facilities in Europe. Vaccine 2011;29:9557-62. |
| 6. | Tripati S, Kamala BK, Kiran K. Hepatitis B awareness among the dental professionals, students and dental hygienists in a dental school — An epidemiological study. Int J Contemp Dent 2011;2:45-50. |
| 7. | Kursun S, Akbulut N, Öztaş B, Kurşun S, Çölok G. Knowledge, attitude and behaviour regarding hepatitis B and infection control in dental clinical students. Clin Dent Res 2011;35:21-7. |
| 8. | Al-Tawfiq JA, Antony A, Abed MS. Attitudes towards influenza vaccination of multi-nationality health-care workers in Saudi Arabia. Vaccine 2009;27:5538-41. |
| 9. | Seale H, Leask J, MacIntyre CR. Attitudes amongst Australian hospital healthcare workers towards seasonal influenza and vaccination. Influenza Other Respir Viruses 2010;4:41-6. |
| 10. | Hollmeyer HG, Hayden F, Poland G, Buchholz U. Influenza vaccination of health care workers in hospitals — A review of studies on attitudes and predictors. Vaccine 2009;27:3935-44. |
| 11. | Abramson ZH, Levi O. Influenza vaccination among primary healthcare workers. Vaccine 2008;26:2482-9. |
| 12. | Maltezou HC, Maragos A, Katerelos P, Paisi A, Karageorgou K, Papadimitriou T, et al. Influenza vaccination acceptance among health-care workers: A nationwide survey. Vaccine 2008;26:1408-10. |
| 13. | Goodwin K, Viboud C, Simonsen L. Antibody response to influenza vaccination in the elderly: A quantitative review. Vaccine 2006;24:1159-69. |
| 14. | Haviari S, Bénet T, Saadatian-Elahi M, André P, Loulergue P, Vanhems P, et al. Vaccination of healthcare workers: A review. Hum Vaccin Immunother 2015;11:2522-37. |
| 15. | Anderson RM, May RM. Immunisation and herd immunity. Lancet 1990;335:641-5. |
| 16. | Botelho-Nevers E, Cassir N, Minodier P, Laporte R, Gautret P, Badiaga S, et al. Measles among healthcare workers: A potential for nosocomial outbreaks. Euro Surveill 2011;16. pii: 19764. |
| 17. | Muscat M. Who gets measles in Europe? J Infect Dis 2011;204 Suppl 1:S353-65. |
| 18. | Maltezou HC, Poland GA. Immunization of health-care providers: Necessity and public health policies. Healthcare (Basel) 2016;4. pii: E47. |
| 19. | Di Giuseppe G, Nobile CG, Marinelli P, Angelillo IF. A survey of knowledge, attitudes, and behavior of Italian dentists toward immunization. Vaccine 2007;25:1669-75. |
[Table 1], [Table 2]
|
Search Pubmed for