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Hepatitis B and admission to medical school: an audit of British medical school policy

BMJ 1996; 313 doi: http://dx.doi.org/10.1136/bmj.313.7061.856 (Published 05 October 1996) Cite this as: BMJ 1996;313:856
  1. Gordon Parker, university occupational physiciana,
  2. Susan Jenkins, university student health physiciana
  1. a Centre for Occupational Health, School of Epidemiology and Health Sciences, The University of Manchester, Manchester M13 9PT
  1. Correspondence to: Dr Parker.
  • Accepted 17 May 1996

In 1993 the health departments in the United Kingdom issued guidance on hepatitis B,1 requiring all healthcare workers (including medical students) who perform exposure prone procedures to be vaccinated against hepatitis B and to have their serological response to the vaccine checked. Healthcare workers who perform invasive procedures and who do not respond to vaccination must be tested for hepatitis B carrier status. Those who are found to be positive for surface antigen without “e” markers (HBsAg positive) need not be excluded from any work. Workers who have “e” markers (HBeAg positive) should be excluded from invasive procedures.

In 1994 the Committee of Vice Chancellors and Principals agreed guidelines for universities on the fitness of students to practise medicine.2 They recommended that “all successful applicants for entry into medical school should produce satisfactory evidence of non-infectivity and immunisation against hepatitis B by the time of registration as a medical student.” The advice was expanded to say: “All applicants should be screened for hepatitis B virus and antibody, and subsequently immunised if necessary, before entry to medical school.”

These guidelines do not specify which tests should be performed or what antigenic status is incompatible with medical school entry.

Subjects, methods, and results

To ascertain how British medical schools interpreted the guidance, we sent a questionnaire to all 27 medical school deans in Britain in October 1995. The questionnaire asked what policy the medical school adopted for the 1995 student entry and the requirements of the policy.

Valid replies were received from 23 medical schools (85%). Two deans replied but declined to answer any of the questions, and no reply was received from two medical schools.

All respondents had a policy on hepatitis screening and vaccination for prospective students. Twelve medical schools expected students to have started a course of vaccination, but only four expected them to have completed the course by registration. A variety of hepatitis screening tests were sought (table 1), but only two medical schools adopted the conventional approach of looking for surface antigen and “e” markers only in students who fail to seroconvert after hepatitis B vaccine. Two medical schools are asking for tests for hepatitis C, ahead of anticipated guidance.

Table 1

Combinations of hepatitis B screening tests specifically requested by 23 medical schools in Britain before registering a new student

View this table:

Deans were asked: “Under what circumstances would you refuse a student, or remove one from your degree course?” Two medical schools seemed to confuse hepatitis B surface antibody and antigen, and would refuse a student who was antibody positive. Five medical schools are prepared to reject students who are positive for hepatitis B surface antigen, without consideration of “e” markers. Twelve schools would refuse or remove a student who was positive for “e” marker, two said they would not remove any students, and two did not answer the question.

Careers counselling of a hepatitis positive student would involve a specialist occupational physician in only 12 of the 23 medical schools and a virologist in six.

Comment

Testing prospective medical students for hepatitis B carrier status—particularly before entry and before the results of vaccination are known—has been criticised as an expensive exercise with limited benefit to patient care.3 4 There have been criticisms of the screening tests used.5

At the start of the 1995–6 academic year, British medical schools had interpreted the available guidelines in various ways. Policies may have changed in respect of the 1996 intake, but no clarification has been issued by the Committee of Vice Chancellors and Principals.

The setting of a consistent and achievable policy on the screening of medical and dental students before entry is vital to avoid inappropriate testing, inappropriate exclusion of potential students, and inconsistencies between medical schools.

Footnotes

  • Funding University of Manchester.

  • Conflict of interest None.

References

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