Ms Susan Micallef1
1Western Health, Footscray, Australia
Biography:
Susan is a compassionate Registered Nurse with 26 years’ experience and a Master of Public Health. After community nursing, she rejoined Western Health in 2017, working in Infection Prevention and Infectious Diseases, specialising in immunisation, exposure management, and onboarding staff, with a focus on occupational health and safety.
Abstract:
Healthcare workers who fail to achieve protective immunity following standard hepatitis B vaccination remain at ongoing occupational risk of exposure to hepatitis B virus.
A hepatitis B vaccine non-responder is defined as a person who is not infected with hepatitis B virus and has an anti-hepatitis B surface antibody (anti-HBs) level <10 mIU/mL measured 4–8 weeks after completing an appropriate vaccination course and subsequent booster dose.
Within a Victorian Public Hospital Staff Clinic, non-responders were identified through comprehensive assessment of documented vaccination history and serological results, in consultation with a staff health nurse and an infectious diseases physician.
As a risk mitigation strategy, an intradermal hepatitis B vaccination program was introduced for eligible non-responders. Informed consent obtained prior to administration. The intradermal technique was selected to enhance immunogenicity through targeted delivery to dermal antigen-presenting cells. Follow-up serology was conducted 4–8 weeks post-vaccination to assess for seroconversion.
Implementation of this approach demonstrated improved seroconversion rates among previous non-responders, reducing occupational risk and improving workforce safety. A formal procedure was developed to standardise practice, supported by an education package to train immunisation nurses working within the Staff Clinic, the intradermal administration technique.
Preliminary outcomes from the project are demonstrating encouraging seroconversion rates and highlighting potential intradermal vaccination pathways to improve workforce protection while supporting safer healthcare environments.
This initiative demonstrates the value of tailored immunisation strategies for at-risk healthcare workers. This initiative highlighted the importance of multidisciplinary assessment, targeted vaccination approaches to achieve seroprotection, and structured education to support safe, consistent, and sustainable clinical practice.