Knowledge Level of Hepatitis B and its Prevalance in Policemen Working in Adiyaman

Aim of this study to investigate the level of knowledge about hepatitis B and prevalence of HBsAg carriage in police and other security staff. Hepatitis B knowledge of police and other staff working for Adiyaman police department were measured using a questionnaire. This questionnaire was prepared after a literature search and was applied to 683 subjects before an education seminar. Fully and regularly filled 437 questionnaires were selected for evaluation. HBsAg and Anti HBs values of subjects were measured. Data were recorded to SPSS 16.0 package program. Chi square test was used for data analyses. Of all the study subjects 406 (92.9%) were males and 31 (7.1%) were females. Three hundred sixty subjects (82.3%) were police staff, 60 (13.7%) were public serveants, 15 (3.4%) were commissaries and 2 (0.05%) were nightmen. Mean age was 34.5 ± 7. Fifty four subjects gave correct answers to the question about transmission ways of hepatitis B. Three hundred eighty four subjects didn’t have enough knowledge about transmission ways of this virus. HBsAg positivity was detected in 34 (7.7%) subjects. Three hundred twenty five (51,4%) subjects had adequate antibody level for immunity. As a result, we detected that knowledge level was inadequate and increased risk for infection in this profession. It was concluded that security staff should be educated regarding risks and screened for bloodborne diseases.

was used for data analysis and p<0.05 was accepted as statistically significant.HBsAg and Anti-HBs values of 437 subjects who admitted to Adıyaman State Hospital Infectious Diseases clinic were measured using Macro ELISA (Abbott AXSYM, SYSTEM, Germany).Positive cut-off values for HBsAg and anti-HBs are ≥0.05IU/ml and ≥10 mIU/ml, respectively.These were matched with 437 subjects who appropriately and completely filled the questionnaire and their HBsAg and Anti-HBs values.

INTRODUCTION
Hepatitis B virus (HBV) infection is the most common bloodborne, transmissible infectious disease.This disease can be transmitted via percutaneous, horizontal, perinatal, and sexual routes.Risk groups include hemodialysis patients, intravenous drug abusers, prostitutes, homosexuals, healthcare personnel, household contacts of a patient or carrier, patients using blood or blood products and people working with these products, and residents of public places (1,2).HBsAg positivity rates were reported to range between 3.2-12.5% in our country (3).Many studies carried out in order to detect HBsAg positivity in various risk groups in our country.
HBV infection causes disease presentations at a wide clinical range from asymptomatic infection to hepatocellular cancer (4).That's why educational activities to increase knowledge level, and periodic screenings are very important for security staff who are frequently get injured and exposed to blood contacts during their work to minimize infection risk, to prevent transmission, and to establish appropriate preventive measures (5,6).Literature search showed very few studies investigating knowledge level of the security staff and appropriate precautions they are supposed to exercise for the prevention of bloodborne diseases.
Aim of this study was to investigate the knowledge level of police and other security staff about hepatitis B, and prevalence of HBsAg carriers among them, and to increase their knowledge level with informative seminars.

MATERIALS AND METHODS
This study was carried on police and other security staff working at Adiyaman police department.Six hundred eighty three subjects, who attended to a joint educational programme organized by State Health Directorate and State Police Departments, were offered to fill in the questionaire 30 minutes before the seminar.This questionnaire included 20 questions on topics such as professional risks, general knowledge level about hepatitis B, transmission routes of this disease, and ways of protection.
Questionnaires were returned by 601 subjects and 437 questionnaires which were appropriately and completely filled were found to be eligible for evaluation.Data were recorded to SPSS 16.0 package program.Chi square test

DISCUSSION
Hepatitis B virus infection is an important disease group that has an important role in the etiology of acute and chronic liver disease.Approximately 350 million people are infected with chronic hepatitis B worldwide (2,3).
One of the most common risk factors for HBV exposure is professional contact.Security staff is among the high risk groups like healthcare staff.Risk of transmission can be decreased by utilizing preventive measures.
Awareness and being informed are important issues for prevention from diseases.We detected that 54% of the policemen were previously informed about hepatitis B and the most common way was through the world wide web.Bonoli et al (7) reported that 58.6% of police subjects got information about bloodborne diseases by specific booklets prepared for them, 47.5% verbally, and 35.2% from posters.Ocak et al (8) reported that 30.4% of police college students stated to get information about sexually transmitted diseases including hepatitis B from visual and written media, 19.8% from friends, 11.3% from school, 8.9% from family, and 8.1% from seminars and congresses.In this study only 54 (12.3%) subjects knew all the transmission routes of hepatitis B. Ocak et al (8) reported that 49.4% of police college students involved in their study knew that hepatitis B is a sexually transmitted disease.
Bonoli et al (7) detected that 27% of their study subjects knew what to do (hand hygiene) after the first contact.Same study found that during body search 44% of the subjects allways, 33% sometimes and 26 % never used gloves.
In our study 173 (39.5%) subjects stated that they wash their hands after exposure to blood, 160 (36.6%) subjects said they wear gloves during situations with a possibility of exposing to blood and 86 (19,6%) subjects stated that they do nothing.Sonder et al (9) detected 112 risky injuries in last four years in Amsterdam police force and each of HBsAg and AntiHIV was positive in 4%, and Anti HCV was positive in 18% of the sources.With hepatitis B immunoglobulin application at first 44 hours no personnel transmitted hepatitis B. In our study 175 participants described exposure to blood during their professional life.From those, 173 said (39,5%) they wash their hands, 160 (36.6%) stated that they wear gloves during situations with a possibility of exposing to blood and 86 (19,6%) subjects stated that they do nothing.In studies which conducted in different countries, hepatitis B prevalence in security staff wasn't higher then prevalence in general population (9)(10)(11).HBsAg positivity in general public has found to be between 1.7-21% in our country (12).Prevalance of hepatitis B was detected as 4.2 % in Şanlıurfa which is in the same region with our city (13).In this cohort HBsAg positivity was found to be 6.9%.HBsAg positivity rate in police college students found to be 3.17% by Demirci et al (1) , 3.4% by Sirmatel et al ( 14), 6.9% by Akbulut et al (15), and 2.61% by Kalayci et al (4).In the present cohort study, vaccination rate was found to be 65.2%.Our findings are consistent with the previous report by Bonoli (7).
In conclusion, there were a few studies searching the knowledge level of police about transmission routes of hepatitis B and post-contact preventive measures.In our study it was observed that knowledge level of these professional groups about bloodborne diseases was inadequate.We believe that security staff should be educated about professional risks and they should be screened for bloodborne diseases.

Table 1 .
Demographic features of the subjects.

Table 2 .
Answers to some of the questions