Hepatitis E vaccination status, knowledge, attitude, and practice among university freshmen: A cross-sectional study in China

Nian-Nian Bi¹Axin Wang²Lei Gong¹Shuang Nie¹Yuanfang Sun¹Hongyuan Wei¹Wanwan Ma¹Sai Hou¹Jiabing Wu^1,2Yongkang Xiao^1*

• ¹Anhui Center of Disease Control and Prevention, Hefei, Anhui Province, China
• ²Bengbu Medical College, Bengbu, Anhui Province, China

Background: Hepatitis E virus (HEV) is a major global public-health threat. University students are at high risk of HEV infection. This study aimed to assess the knowledge, attitude, and practice (KAP) levels regarding hepatitis E among university freshmen and their willingness to receive HEV vaccination. Methods: A cross-sectional study was conducted from September to December, 2023, among 3,276 freshmen from six universities in Anhui Province, China. Data were collected using structured questionnaires. A stratified cluster random sampling method was used to select participants. Multivariate logistic regression was performed to identify factors associated with KAP levels. Data were analyzed with SPSS version 23.0. Results: The health practice level of rural students was 1.288 times higher (OR = 1.288, 95%CI: 1.088-1.524) compared to urban students. Of the 3,276 questionnaires distributed, 3,120 were valid, with a response rate of 95.2%. Only 9.0% of participants had received the HEV vaccine. The overall correct knowledge rate of HEV was 50.8%. A positive attitude was reported by 59.9% of students, and 60.9% demonstrated good practices related to HEV. Multivariate analysis showed that vaccinated students had significantly higher knowledge levels than non-vaccinated students (OR = 1.999, 95% CI: 1.536-2.602). Female students (OR = 1.193, 95% CI: 1.029-1.382) and those from Wuhu (OR = 1.571, 95% CI: 1.299-1.900) also had higher knowledge levels. Medical students were more likely to have a positive attitude than non-medical students (OR = 1.367, 95% CI: 1.161–1.610). Students from rural areas (OR = 1.336, 95% CI: 1.148–1.553) and Wuhu (OR = 1.317, 95% CI: 1.088–1.594) showed higher levels of positive attitude. Rural students also reported better health practices than urban students (OR = 1.288, 95% CI: 1.088– 1.524). The result also showed both knowledge (r = 0.042, P = 0.020) and attitude (r = 0.049, P = 0.006) exhibited statistically significant but weak positive correlation with practice. Conclusions: Over half of the university freshmen demonstrated good KAP levels regarding HEV. However, the vaccination rate remained low. Therefore, determinants identified will guide health promotion and vaccine advocacy.