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Background: Health care workers (HCWs) are at increased risk of exposure to hepatitis B virus (HBV). The most effective prevention measure is vaccination, with a serum hepatitis B surface antibody (HBsAb) titre > 10 mIU/ml considered protective. To date, the sociodemographic and occupational characteristics related to HBV serosusceptibility and factors associated with booster hesitancy remain unclear. Therefore, this study aimed to identify factors associated with maintaining a protective HBsAb titre in a large sample of HCWs and to evaluate factors potentially associated with hesitancy towards vaccine boosters., Methods: A cross-sectional study was conducted among HCWs who underwent a health surveillance visit between 2017 and 2022. If the serum HBsAb titre was < 10 MIU/ml, a vaccine booster dose was offered. Based on their willingness to be vaccinated, employees were classified into three groups: acceptance, hesitation, and refusal. Uni- and multivariable analyses were performed to assess the association of demographic and occupational characteristics with serosusceptibility and attitudes towards vaccination., Results: A total of 1632 (27%) employees were shown to be nonimmune. A lower median age and being a physician were significantly associated with a protective HBsAb titre. A total of 706 nonimmune employees (43.3%) accepted the vaccination, 865 (53%) hesitated, and 61 (3.7%) refused. The median age of those who refused vaccination was significantly higher than that of those who hesitated and those who were vaccinated. Acceptance of vaccination was significantly higher among nurses, while nurse aides hesitated more; among nonmedical graduate staff both hesitation and refusal were higher than expected. In the multivariable analysis, higher age, female sex, and employment as an allied health care professional were shown to be significantly associated with hesitation/refusal, while being born abroad turned out to be protective., Conclusions: Our study showed that approximately a quarter of HCWs were not immune to HBV infection, and of these, more than half were hesitant towards or refused the booster dose. The risk of hesitation/refusal was higher with age in women and among allied health care staff. Based on these findings, further studies are needed to prospectively evaluate HBV seroprevalence, vaccination adherence, factors associated with hesitancy, and the effectiveness of health surveillance strategies in a high-risk population susceptible to infection., Competing Interests: Declaration of Competing Interest We have no conflict of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: We report a case of a 30 years old Indian sailor with microcytic anemia (Hb 9.9), persistent abdominal pain, emesis, dark stool, hyperchromic urine, latent jaundice and asthenia. Lead intoxication was confirmed (blood lead value of 102 μg/dL). The patient assumed Ayurvedic medicines in the previous months. Ayurveda is an ancient form of Indian traditional popular medicine aiming to re-establish health and body function through herbal preparations, heavy metals are often added. Our purpose was to treat the patient and to establish the source of poisoning., Methods: After testing blood and urine lead concentration of other 3 crew members and analyzing over than 150 products used on the ship professional exposure was excluded. We analyzed the two Ayurvedic drugs assumed by the patient with an Inductively Coupled Plasma Mass Spectrometry. The patient underwent three chelation cycles with Calcium Disodium Ethylenediaminetetraacetic acid (EDTA) while monitoring blood and urinary lead levels., Results: The final blood lead level at discharge, after three chelation cycles, was 36.27 μg/dL. One of the two drugs contained extremely high concentrations of lead and mercury. The three different mixtures of this preparation showed lead concentrations of 12,638.54 mg/kg (Sample 2A), 23,043.02 mg/kg (Sample 2B), 21,352.97 mg/kg (Sample 2C); these levels are much higher than the highest values reported in literature for the indian soil (32 mg/kg)., Conclusions: This case and similar cases raise the safety alert on complementary and alternative medicines; Ayurvedic medicine users should be carefully informed about potential risks and signs of poisoning.