Health screening for new entry medical students at Newcastle University Medicine (NUMed) Malaysia: a 4-year cross-sectional study
Authors: Goh Wei P , Evans Gareth , Hurn Eliot , Leong Adrian , Lim Yi K , Saw Yean T , Subramaniam Bhirom , Tan Zhi J , Ong Edmund L C 
Published: February 2021

Background

Newcastle University Medicine (NUMed) Malaysia adheres to the UK Medical Schools protocol on screening for blood borne viruses including hepatitis B (HBV), Hepatitis C and HIV as health requirements for new entry medical students’ admissions and continuing medical practice. This study specifically aims to assess the outcome of HBV vaccination and the subsequent seroconversion status along with other required vaccinations.

Methods

This 4-year cross-sectional study included 345 new entry Malaysian medical students to NUMed from 2015 to 2018 excluding 80 students with missing data. Demographic data, HBV vaccination status, and HBV surface antibody (anti-HBs) titers were obtained from participants’ health screening reports and recorded in a pre-designed data template. Seroconversion status (anti-HBs titer >10 IU/L) measured using an enzyme-linked immunoassay, was determined and seroconversion rates were calculated. None of the participants received a booster anytime prior to testing. Both demographic and vaccination data were matched to investigate seroconversion rate in relation to ethnicity and gender. Chi-square test was used for analysis using Prism with statistical significance defined as P < 0.05.

Results

Out of 345, only 223 (64.6%) vaccinated individuals showed seroconversion, while 117 (33.9%) did not seroconvert. Among participants, 121 (35.1%) were male and 224 (64.9%) were female. The majority of the participants were of Chinese ethnicity (62.0%), followed by Malay (19.7%) and Indian ethnicity (18.3%). None of the 345 new entry medical students were tested positive for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc), indicating an overall HBV prevalence of 0%. A total of 287 participants (83.2%) were vaccinated against varicella-zoster virus, while 58 (16.8%) were not vaccinated. Vaccination coverage of other vaccines, such as measles, rubella, MenQ and yellow fever were 257 (74.5%), 237 (68.7%), 154 (44.6%) and 20 (5.8%) respectively. There is no significant difference in the seroconversion rate of HBV vaccine between male participants (62.0%) and female participants (64.3%, P = 0.298). However, there is a statistically significant difference in the HBV seroconversion rate between the 3 ethnicity groups, with students of Malay ethnicity showing the lowest seroconversion rate of 47.1%, followed by those of Indian (68.3%) and Chinese ethnicity (69.6%) (P = 0.002).

Conclusions

This is the first study demonstrating a low HBV vaccine seroconversion rate (64.6%) among young new entry medical students at NUMed (median age: 19) following standard recommended 3-dose vaccination. Students of Malay ethnicity showed a significant non-conversion rate of 51.5% (p=0.002) as compared to the students of Chinese (29.4%) and Indian (28.6%) origin. Previous studies showed seroconversion rates of over 90% and further studies should be considered to investigate why this young population of Malaysian students did not mount protective antibody titer.