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Revista Odonto Ciência

versão On-line ISSN 1980-6523

Rev. odonto ciênc. (Online) vol.26 no.3 Porto Alegre  2011 



Knowledge of occupational diseases and immunization among healthcare students


Conhecimento de doenças ocupacionais e imunização entre estudantes de saúde



Ana Flávia Granville-GarciaI; Eveline Sales RochaI; Raulison Vieira de SousaI; Veruska Medeiros MartinsI; Andreza C. de L. Targino MassoniII; Saul Martins PaivaIII

IFaculty of Dentistry, State University of Paraíba, Campina Grande, PB, Brazil
IIFaculty Dentistry, Integrated Faculty of Patos, Patos, PB, Brazil
IIIFaculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil





PURPOSE: To investigate the knowledge and practices of immunization against occupational diseases and its associated factors among health students.
METHODS: An exploratory cross-sectional study was carried out with a random sample of 275 graduate students from the Schools of Dentistry, Physiotherapy, Pharmacy, Psychology and Nursing. During data collection we carried out individual interviews on issues related to immunization coverage, diseases and occupational accidents and sociodemographic variables. The statistical tests used were the Pearson's chi-square and Fisher's exact tests (a=0.05).
RESULTS: Most students considered influenza (65.5%) and hepatitis B (58.5%) occupational diseases. Almost 30% of the students reported having attended to patients with infectious diseases, especially AIDS. Contact with body fluids or accidental exposure was reported by 12.7% being 34.3% by accident with drills; 88.2% of the students had incomplete immunization coverage due to lack of time in most cases (27%). None of the variables was significantly associated with vaccination coverage.
CONCLUSION: The students' knowledge of occupational diseases and vaccination coverage was poor, which reflects the need for motivational policies through activities for clarification and expansion of vaccination coverage.

Key words: Immunization coverage; healthcare students; infection control; occupational risks


OBJETIVO: Investigar o conhecimento e as práticas de imunização contra doenças ocupacionais e fatores associados entre estudantes de saúde.
METODOLOGIA: Foi realizado um estudo transversal exploratório, com amostra probabilística composta por 275 universitários dos Cursos de Odontologia, Fisioterapia, Farmácia, Psicologia e Enfermagem. Na coleta de dados utilizou-se entrevista individual com questões relacionadas à cobertura vacinal, ao conhecimento de doenças, a acidentes ocupacionais e fatores sociodemográficos. Os dados foram analisados por testes Qui-Quadrado de Pearson e o Exato de Fisher (a=5%).
RESULTADOS: A maioria dos estudantes considerou influenza (65,5%) e hepatite B (58,5%) como doenças ocupacionais. Quase 30% relataram já ter atendido pacientes com doenças infectocontagiosas, principalmente AIDS (7%). O contato com fluidos orgânicos ou a exposição acidental foi relatada por 12,7% dos entrevistados, através de acidente com instrumento perfuro-cortante (34,3%); 88,2% dos acadêmicos apresentaram cobertura vacinal incompleta, sendo a falta de tempo o motivo mais citado (27%). Nenhuma variável mostrou associação significativa com a cobertura vacinal.
CONCLUSÃO: O conhecimento dos acadêmicos sobre doenças ocupacionais e a cobertura vacinal foram deficientes, refletindo a necessidade de políticas motivacionais, através de atividades de esclarecimento e ampliação da cobertura vacinal.

Palavras-chave: Cobertura vacinal; estudantes de ciências da saúde; controle de infecção; risco ocupacional




Health professionals are a group of particular concern in relation to infectious diseases, since during their work activities they are usually exposed to risks posed by biological agents due to contact with body fluids potentially contaminated with a variety of pathogens (1). Among the measures to prevent some infections in the workplace are included the immunization and monitoring of vaccination status of professionals, considered essential in infection control programs for this group (2).

In Brazil, the Norm of the Ministry of Labour (NR 32) determines the mandatory vaccination of health (3).  However, the National Immunization Program (NIP) does not present a specific protocol of vaccination coverage for this group of workers. In general the vaccines recommended by this program include: hepatitis B, measles, rubella, diphtheria and tetanus (4).

The inadequate immunization status of health professionals is a serious public health problem (5), not only by the possibility of contamination of their peers but also of patients (6). Vaccination is performed for free in health clinics; nevertheless, vaccine coverage in Brazil is far from achieving the 100% vaccination goal (3). This finding may be attributed to lack of knowledge by health professionals, lack of availability of these vaccines in the health services, as well as by the little importance given to this specific protection procedure (5).

There is a growing concern that health professionals enter the job market in a disorderly way, usually without biosecurity training and without checking their immunization status (5). In this sense, it is necessary to know the individual immunity for professionals and students in this area in order to identify and correct gaps in coverage for immunopreventable diseases. In relation to students, it is recommended that corrective measures are taught while they are still in grad school, before contact with patients, to avoid exposure to unnecessary risks (2). Additionally, the awareness of occupational diseases, the risk of transmission and the need for immunization should be present from the period of academic training. From this perspective, Higher Education Institutions have a great responsibility to prepare students for safe clinical practice.

Thus, this study aims to evaluate the knowledge and practices for immunization against infectious diseases among students in the health field of the State University of Paraíba, Brazil.



This study was approved by the Human Research Ethics Committee of the State University of Paraíba (0415.0.133.000-09 Protocol), according to Resolution 196/96 of the National Health Council. Moreover, when students agreed to participate in the study, they signed the informed consent form.

A cross-sectional and exploratory study was carried out, with an inductive approach and descriptive-analytical statistical procedure. A total of 275 students attending courses from the State University of Paraiba, Campina Grande, Brazil, in the Health field (Dentistry, Physiotherapy, Pharmacy, Nursing and Psychology) participated in the study. Campina Grande is the second most important city in the state of Paraiba. This city is situated 130 km from state capital, in the area, between the coast and hinterland in the Eastern Highlands of Borborema. The city area covers 620.6 km² and has about 371,060 inhabitants (population density: 612 inhabitants/km²). It is considered the educational center of the interior of Paraiba (7). The number of students was obtained directly from the coordination of each course, totaling 1,548 students, of which 668 were enrolled in the professional stage (clinical care), representing the population of interest for this study. The sample design was probabilistic with proportional split to the number of students in each course. The sample size calculation considered a 95% confidence level with a 5% margin of error and expected ratio equal to 50%. Thus, the minimum sample size was 245 students and 20% increase was added to this value due to possible losses, yielding a sample size of 294 students.

Data collection was randomly performed, through individual interviews during the period between September to December 2009. The sample was simple random, with the list of students obtained from the courses' coordination. On the form were included questions related to sociodemographic factors, knowledge of occupational diseases, occupational infections and vaccination table status (vaccination coverage) of students, based on the calendar for health professionals recommended by the Ministry of Health (6) and the reasons for not being vaccinated. It was considered to have full vaccination coverage of those who had reported having been immunized (full dosage) against: hepatitis B – three intramuscularly 1 mL doses, with 30 days interval from the 1st to the 2nd dose and 180 days interval from the 1st to the 3rd dose. Dual viral (measles and rubella) – single subcutaneously 0.5 mL dose. Influenza – one subcutaneously 0.5 ml dose, annually. dT – three intramuscularly 0.5 mL doses at 60 days intervals. Responses were recorded on a specific form, ensuring the confidentiality of all information and not exceeding the time of ten minutes per respondent. The interviews were conducted by two researchers, appropriately trained at the University itself, aimed at not interfering with the daily activities of students.

The reliability of responses was tested by the "face" validation method in 10% of subjects in the research. By this method, the researcher asks the research subjects for an explanation, in their own words, of their understanding about each question (8).

From the data analyses were obtained the uni- and bivariate absolute and percent distributions and the statistical measures: mean, standard deviation, coefficient of variation, minimum and maximum values of the age variable (descriptive statistics) and used the Pearson's chi-square and Fisher's exact tests when the conditions for using the chi-square test were not verified (inferential statistical techniques). The level of significance used in statistical tests was 5.0% (P<0.05). The software used to obtain the statistical calculations was SAS (Statistical Analysis System), version 12.0.



A total of 275 students were interviewed and 19 refused to participate in the study. The age of respondents ranged from 18 to 57 years old (mean: 23.22 years old, median: 23 years old, standard deviation: 4.21 years old; coefficient of variation: 18.13%).

Table 1 shows that the majority of participants were 22-23 years old (36%), female (65.8%), single (92.4%), did not work (87.6 %) and did not live with parents (55.6%). The course with greater frequency of participation was Physiotherapy (34.9%).



Table 2 presents the list of occupational diseases considered as occupational by the participants of this study, among which the most commonly cited were influenza (65.5%) and hepatitis B (58.5%).



According to Table 3, 29.5% of students reported having attended to patients with infectious diseases, especially with the AIDS virus (45.7%) and hepatitis (38.3%). Contact with body fluids that could be contaminated or accidental exposure was highlighted by 12.7% of respondents, which occurred through skin-piercing instruments (34.3%) and contact with saliva (31.4%).



Most students (82.2%) reported that their vaccination tables were incomplete due to lack of time (30.3%) and forgetfulness (22.5%). There was a significant difference between the means of contamination (p = 0.01) reported by students of the different courses (Table 4).

In Table 5 there was no association between the variables analyzed and vaccination table of students surveyed.



The profile of respondents is predominantly young, female and single, who reported no other work activities beyond those academically performed in their courses and not living with their parents (Table 1). This aspect reflects the city of Campina Grande which is known as a "college town", since it has two public universities, twelve private and one Federal Institute. It is usual students from other places to come and live in the city to study (7). Considering the growing concern about the prevention of occupational diseases, few studies address the issue, especially among college students (2,9,10).

The most often reported occupational disease by students was influenza (65.5%) followed by hepatitis B (58.5%), corroborating another Brazilian study (1). Indeed influenza is an illness that causes concern, not only by the risk to health professionals but also due to its transmission in hospitalized patients with low immunity (11). Hepatitis B, however, is the occupational disease of greatest risk to health professionals, being the major cause of acute and chronic liver disease, cirrhosis and hepatocellular carcinoma (15-17). Varicella (19.6%), whooping cough (13.8%) and diphtheria (11.8%) were rarely mentioned (Table 2). However, these conditions are considered as high risk in some situations with the vaccination considered as priority (12), such as pertussis, especially in groups of professionals working on neonatology, pediatrics, and patients with chronic-respiratory disesases (13). AIDS has not been cited, reflecting the lack of information from these students, or even denial about the problem that is still a stigma (14). However, the hepatitis B and C viruses and the human immunodeficiency virus (HIV) are an important infectious agent in occupational infections occurring in health services (15).

The report of attendance experience on patients with infectious diseases was made by 29.5% of students, who reported AIDS and hepatitis (Table 3) among health problems. AIDS still has no vaccine to prevent its infection requiring the rules of Standard Precautions (personal protective equipment) to be adopted in full, regardless of the definite or presumed diagnosis of this condition (16). For hepatitis, it is necessary not only to use personal protective equipment but also to have the immunization (17).

Exposure to potentially contaminated body fluids or the occurrence of accidental exposure were highlighted by 12.7% respondents and among the vehicles of exposure being highlighted were accidents with skin-piercing instruments (34.3%) and contact with saliva (31.4%) (Table 3). The lack of experience of students increases the occupational risk, justifying the immunization of this group as early as possible (18). Most students (88.2%) presented an incomplete vaccination table, there being no significant difference between courses (P=0.06) (Table 4). Overall, the deficiency in vaccination coverage among students has been reported in the literature (9,19). It is emphasized that there are no specific rules guiding the Higher Education Institutions concerning the vaccination coverage of students with training in health area, it being perceived, in fact, that there are difficulties in maintaining this control.

The main reasons highlighted by students who did not take all doses of vaccines were the lack of time (27%) and forgetfulness (22.2%), there being no significant difference between courses (P=0.33) (Table 4). These reasons are also cited in other studies to justify the vaccine table failure as well as the fear by side effects, lack of vaccines and doubts about its effectiveness (20,21).

With regard to the means of contamination of occupational infections, most students (74.5%) claimed to know these vehicles (P=0.01). Dentistry Students had a higher percentage of positive responses (85.7%), followed by Pharmacy (83.9%) and Nursing (73.4%) (Table 4). The use of skin-piercing instruments and the increased contact with body fluids probably influenced this result (17).

No association was observed between age, gender, marital status, occupation status, residence with parents, type of course and immunization coverage (Table 5). This result emphasizes specific deepening through new studies in courses and different communities. Studies using the qualitative methodology would greatly contribute to the deepening of the subject and provide guidelines for building more effective vaccination programs directed at this population.

This study has limitations that should be recognized. Data was collected through personal report, the vaccination card was not required. However, this method was also used in other studies (2,5,17). In the institution surveyed, not all the courses in the health area were covered which prevented the completion of a survey covering a larger number of health areas. Nevertheless, it is believed that the results would not change depending on the course, since when the five courses were compared there was no statistically significant difference.

The features observed in this study demonstrate that there are still gaps in the knowledge of students attending the health area courses about infectious diseases, occupational risk and immune-preventable diseases. Moreover, vaccination coverage is still sporadic, this being a problem similar to other national (1,2,5) and international (9,10) institutions. Some considerations can be made from these results. The discussion about occupational risk and immunization must be conducted in depth by the Health Care and Educational institutions, requiring greater focus on the subject throughout the course. Thus, disciplines on biosafety and occupational risk should be incorporated into the curriculum, with a different methodology and a practical-theoretical approach aimed at strengthening the knowledge and awareness of the subject importance (22,23). The vigilance about infection control should also be adopted by those responsible for curriculum components taught in clinical activities. With this perspective, it is warned that simple guidance for the students about the need for immunization is not enough (24), and that mandatory vaccination (21), awareness and motivation to participate in vaccination programs and ease of access (25), accompanied by continuous educational campaigns can contribute to an increase in immunization coverage.



The knowledge of occupational diseases and vaccination coverage was poor, reflecting the need for motivational policies, through activities for clarification and expansion of vaccination coverage.



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Ana Flávia Granville-Garcia
Rua Capitão João Alves de Lira 1325/410, Bela Vista
Campina Grande, PB – Brazil

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