Global uptake of complete hepatitis B vaccination among nurses: a systematic review and meta-analysis.

BACKGROUND

Hepatitis B virus (HBV) represents a persistent occupational hazard for nurses, who face disproportionately high rates of exposure to infectious body fluids. Despite World Health Organization recommendations for universal immunization of healthcare workers, global coverage estimates remain fragmented.

OBJECTIVES

We aimed to estimate the global prevalence of complete HBV vaccination among nurses, analyse temporal trends, and identify barriers to uptake.

METHODS

We searched PubMed, Web of Science, Scopus, and Embase from database inception to 1st February 2026 for observational studies reporting uptake of the complete (≥3-dose) HBV vaccine series among hospital-based nurses. No language or date restrictions were applied. We pooled prevalence estimates using a random-effects meta-analysis and assessed heterogeneity using subgroup analysis.

FINDINGS: We identified 56 eligible studies comprising 1,326,944 nurses across 30 countries. The global pooled prevalence of complete HBV vaccination was 44.8% (95% confidence interval: 35.1-55.0, I2 = 99.1%). Coverage was significantly higher in high-income countries (72.1%) than in low- and middle-income countries (39.3%; P = 0.003), with the lowest regional uptake in Africa (27.5%). Temporal trend analysis revealed no significant improvement in vaccination rates over the study period (P = 0.923). The primary reported barriers were structural, including vaccine unavailability (33.8%) and financial costs (24.4%).

CONCLUSION

Less than half of the global nursing workforce is adequately protected against HBV, a deficit that has stagnated for two decades. The disparity is driven by systemic failures in access and funding rather than vaccine hesitancy. Current passive guidelines are insufficient; implementing mandatory, fully funded hospital-based immunization programs is essential to close this critical occupational safety gap, particularly in resource-limited settings.