Immunization is one of the most effective public health interventions for preventing vaccine-preventable diseases (VPDs) and reducing morbidity and mortality among healthcare workers and the general population. Medical students, as future healthcare providers, are at increased occupational risk of exposure to infectious diseases such as hepatitis B, influenza, measles, mumps, rubella, varicella, and tetanus due to frequent contact with patients, biological samples, and clinical environments [1]. Adequate immunization of medical students is therefore essential not only for their personal protection but also to prevent nosocomial transmission and safeguard patient safety [2]. Globally, outbreaks of vaccine-preventable diseases among healthcare workers and medical trainees continue to be reported, often linked to incomplete or undocumented immunization status. Studies from different countries have demonstrated significant gaps in vaccination coverage among medical students, particularly for hepatitis B booster doses, influenza vaccination, and varicella immunity [3,4]. The World Health Organization emphasizes that healthcare personnel, including students in clinical training, should be fully immunized according to national and institutional guidelines to minimize occupational health risks [5]. In India, medical students begin clinical exposure early in their training, often during the first or second year of undergraduate education. Despite national immunization recommendations and institutional advisories, vaccination coverage among medical students remains inconsistent, with considerable variation across regions and institutions [6]. Several Indian studies have reported suboptimal coverage for hepatitis B, influenza, and adult booster vaccines, largely due to lack of awareness, non-availability of vaccination records, perceived low risk, and absence of mandatory immunization policies at the institutional level [7,8]. Gujarat, one of the rapidly developing states in western India, has a growing number of medical colleges and healthcare institutions. However, region-specific data on the immunization status of medical students, particularly in North Gujarat, are limited. Understanding the current vaccination coverage and identifying gaps is crucial for planning targeted interventions, strengthening institutional immunization policies, and ensuring occupational safety for medical trainees [9]. In this context, the present cross-sectional study was undertaken to assess the immunization status of Indian medical students in North Gujarat province. The findings of this study are expected to provide valuable insights into existing immunization gaps, raise awareness among medical students and administrators, and support the development of structured immunization programs within medical colleges to enhance healthcare worker safety and infection control practices [10]. The present study aims to assess the immunization status of Indian medical students studying in medical colleges of North Gujarat province. The objectives of the study are to determine the coverage of recommended vaccines among medical students, to identify gaps in vaccination status and documentation, and to assess awareness regarding occupationally recommended immunizations for healthcare workers. The outcomes of this study are expected to provide baseline region-specific data on immunization coverage among medical students, help identify areas requiring policy reinforcement or targeted vaccination programs, and support the development of institutional immunization guidelines to enhance occupational safety, infection control, and overall public health preparedness among future healthcare professionals.

This cross-sectional study was conducted among undergraduate medical students enrolled in medical colleges of North Gujarat province, India, over a period of one year. The study population comprised MBBS students from different academic years who were actively attending the course during the study period. Students who provided informed consent and were willing to participate were included in the study, while interns, postgraduate students, students who were absent during data collection, or those unwilling to participate were excluded. A total sample size of 250 medical students was included in the study. The sample size was determined based on feasibility, availability of students during the study period, and to ensure adequate representation across different academic years. Participants were selected using a convenient sampling method from the eligible student population. Data were collected using a pre-designed, pre-tested, semi-structured questionnaire. The questionnaire captured information on socio-demographic characteristics, history of immunization against vaccines recommended for healthcare workers—such as hepatitis B, tetanus-diphtheria/booster doses, measles, mumps, rubella, varicella, influenza, and COVID-19—as well as awareness regarding occupational exposure to vaccine-preventable diseases. Immunization status was primarily assessed based on self-reported vaccination history and was verified with vaccination cards or medical records wherever available. Data collection was carried out in classroom and hostel settings after obtaining permission from institutional authorities. Participants were informed about the objectives of the study, and confidentiality of the collected information was ensured. Ethical principles were followed throughout the study period. The collected data were entered into Microsoft Excel and analyzed using appropriate statistical software. Descriptive statistics such as frequencies and percentages were used to assess immunization coverage and awareness levels among medical students. Associations between immunization status and selected variables were evaluated using suitable tests of significance, and a p-value of less than 0.05 was considered statistically significant. The findings were presented in the form of tables and graphical representations for clarity and interpretation.

In the present cross-sectional study conducted among 250 medical students in North Gujarat, the majority of participants were aged between 21–22 years (41.6%), with a male predominance (56.8%). Students from all academic years were included, with the highest representation from the 3rd MBBS phase (29.6%). Most students were hostel residents (66.8%), reflecting typical residential patterns of undergraduate medical training in the region. Assessment of immunization status revealed variable coverage across recommended vaccines. Complete immunization was highest for COVID-19, with 232 students (92.8%) fully vaccinated. Tetanus/Td booster coverage was observed in 196 students (78.4%), followed by Hepatitis B vaccination in 178 students (71.2%). Moderate coverage was noted for MMR vaccination, with 162 students (64.8%) being fully immunized. In contrast, comparatively lower coverage was observed for Varicella vaccination, with only 118 students (47.2%) fully immunized, while Influenza vaccination showed the lowest uptake, with just 74 students (29.6%) reporting complete immunization. Analysis of factors associated with Hepatitis B immunization status demonstrated statistically significant associations. Female students showed higher complete Hepatitis B immunization (77.8%) compared to male students (66.2%) (p = 0.040). Students in clinical years had significantly higher vaccination coverage (80.0%) than those in pre-clinical years (61.7%) (p = 0.007). Awareness regarding occupational risk of infections emerged as a strong determinant, with 78.0% of aware students being completely immunized compared to only 52.9% among those not aware (p < 0.001). Graphical analysis further highlighted the substantial influence of awareness on vaccination uptake. Overall, the results indicate satisfactory coverage for selected vaccines but reveal important gaps in adult and occupational immunization among medical students, underscoring the need for targeted institutional interventions. Table 1: Demographic Characteristics of Study Participants (n = 250) Variable Category Frequency (n) Percentage (%) Age group (years) ≤ 20 78 31.2 21–22 104 41.6 ≥ 23 68 27.2 Gender Male 142 56.8 Female 108 43.2 Academic year 1st MBBS 62 24.8 2nd MBBS 58 23.2 3rd MBBS (Part I & II) 74 29.6 Final MBBS 56 22.4 Residence Hostel 167 66.8 Home / PG 83 33.2 Table 2: Immunization Status of Medical Students (Outcomes Related to Objectives) (n = 250) Vaccine Fully immunized n (%) Partially immunized n (%) Not immunized n (%) Hepatitis B 178 (71.2) 42 (16.8) 30 (12.0) Tetanus / Td booster 196 (78.4) 34 (13.6) 20 (8.0) MMR 162 (64.8) 41 (16.4) 47 (18.8) Varicella 118 (47.2) 36 (14.4) 96 (38.4) Influenza (annual) 74 (29.6) — 176 (70.4) COVID-19 232 (92.8) 11 (4.4) 7 (2.8) Any vaccine record available 143 (57.2) — 107 (42.8) Table 3: Association Between Selected Variables and Complete Hepatitis B Immunization (Test of Significance) Variable Completely immunized n (%) Not / partially immunized n (%) χ² value p-value Significance Gender 4.21 0.040 Significant Male (n=142) 94 (66.2) 48 (33.8) Female (n=108) 84 (77.8) 24 (22.2) Academic year 9.86 0.007 Significant Pre-clinical (n=120) 74 (61.7) 46 (38.3) Clinical (n=130) 104 (80.0) 26 (20.0) Awareness about occupational risk 18.54 <0.001 Highly significant Yes (n=182) 142 (78.0) 40 (22.0) No (n=68) 36 (52.9) 32 (47.1) Figure 1: Complete Immunization Coverage Among Medical Students Figure 2: Association Between Awareness of Occupational Risk and Hepatitis B Immunization

The present cross-sectional study assessed the immunization status of 250 medical students in North Gujarat and revealed variable coverage across vaccines recommended for healthcare workers. While overall coverage was satisfactory for certain vaccines, important gaps were identified, particularly for adult and optional vaccines. These findings are significant because medical students represent a high-risk occupational group with early and repeated exposure to patients, blood, and body fluids. In this study, Hepatitis B vaccination coverage was 71.2%, which, although better than some earlier Indian reports, remains suboptimal for a mandatory occupational vaccine emphasized for healthcare workers. A study by Patil et al. (2017) reported Hepatitis B complete immunization among only 58–62% of medical students in South India, which is lower than the coverage observed in the present study [11]. Similarly, Chhabra et al. (2014) documented a coverage of 63% among medical students in Delhi, highlighting persistent gaps despite long-standing recommendations [12]. In contrast, studies from developed settings report much higher coverage; Loulergue et al. observed Hepatitis B vaccination rates exceeding 90% among medical students in France, reflecting the impact of strict institutional policies [13]. The relatively higher coverage in this study may be attributed to improved awareness after the COVID-19 pandemic and better access to vaccines in Gujarat, though the absence of universal coverage remains concerning. Coverage for Td/Tetanus booster vaccination (78.4%) in this study was comparable to findings from other Indian studies, where coverage ranged between 70–85% [14]. However, adult booster compliance continues to decline with advancing age, as also noted by Singhal et al., who emphasized poor booster dose adherence among healthcare trainees despite childhood immunization [15]. The MMR vaccination coverage of 64.8% observed in the present study is consistent with earlier Indian literature. Sharma et al. reported MMR coverage of 60–65% among undergraduate medical students, largely dependent on childhood vaccination recall rather than documented records [16]. This highlights the limitation of relying on self-reported history and the need for serological screening or documentation-based verification in medical colleges. A major gap identified in this study was Varicella vaccination, with only 47.2% of students fully immunized. Similar low coverage has been reported in multiple Indian studies, with rates ranging from 30% to 50%, largely due to the non-inclusion of varicella vaccine in the Universal Immunization Programme (UIP) and lack of institutional mandates [17]. In contrast, studies from Europe and the United States report coverage exceeding 85%, driven by mandatory vaccination or immunity proof before clinical postings [13]. Influenza vaccination coverage was the lowest (29.6%) in this study, a finding that aligns closely with previous Indian studies reporting uptake as low as 10–35% among medical students and healthcare workers [18]. Low perceived risk, lack of annual vaccination reminders, and limited institutional promotion are frequently cited barriers. This is in stark contrast to global recommendations, where annual influenza vaccination is strongly advised for all healthcare workers. The COVID-19 vaccination coverage of 92.8% was the highest among all vaccines, reflecting strong national policy implementation, mandatory certification requirements, and heightened risk perception during the pandemic. Similar high coverage has been reported across Indian medical colleges, often exceeding 90%, indicating that strong policy enforcement can significantly improve vaccine uptake [11]. Importantly, this study demonstrated a statistically significant association between awareness of occupational risk and Hepatitis B immunization status, with 78.0% coverage among aware students versus 52.9% among those not aware (p < 0.001). This finding is supported by Maltezou et al., who emphasized awareness as a key determinant of vaccine acceptance among healthcare personnel [18]. The association underscores the critical role of structured education and orientation programs in improving immunization coverage. Overall, when compared with national and international studies, the present study highlights modest improvements in mandatory vaccine coverage but persistent deficiencies in adult and optional vaccines. These findings reinforce the need for institution-level immunization policies, routine documentation, and regular awareness programs to ensure comprehensive protection of future healthcare professionals.

The present cross-sectional study highlights that while immunization coverage among medical students in North Gujarat is satisfactory for certain vaccines such as COVID-19, tetanus/Td booster, and Hepatitis B, important gaps persist for other recommended vaccines. Coverage for Hepatitis B, although better than several earlier Indian studies, was still incomplete, exposing a proportion of students to preventable occupational risk. Vaccines such as MMR, varicella, and especially influenza showed suboptimal uptake, indicating insufficient emphasis on adult and occupational immunization beyond childhood schedules. The study also demonstrated a significant association between awareness of occupational risk and Hepatitis B vaccination status, underscoring the importance of education and institutional policies in improving vaccine compliance. Overall, the findings emphasize the need for a structured and uniform immunization strategy for medical students to ensure their safety and prevent healthcare-associated transmission. LIMITATIONS This study has certain limitations. Immunization status was largely based on self-reported history, which may be subject to recall bias, particularly for vaccines received during childhood. Vaccination records were not available for all participants, limiting objective verification. The cross-sectional design restricts causal inference between awareness and immunization uptake. Additionally, the study was conducted in medical colleges of North Gujarat, and therefore the findings may not be generalizable to all medical students across India. Serological testing to confirm immunity was not performed, which could have provided a more accurate assessment of protective status. RECOMMENDATIONS Based on the findings, it is recommended that medical colleges implement mandatory pre-admission or pre-clinical immunization screening and documentation for all medical students. Institutional vaccination policies should include routine administration of Hepatitis B, Td boosters, MMR, varicella, and annual influenza vaccines. Regular awareness programs and orientation sessions focusing on occupational risk and vaccine-preventable diseases should be conducted to improve compliance. Maintaining a centralized digital immunization record system within medical colleges may help ensure timely boosters and follow-up. Further multicentric studies with serological assessment are recommended to generate comprehensive national data and guide policy formulation for healthcare worker immunization in India.

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