We appreciate the interest and comments from Dr Datta and colleagues regarding our article titled "Serologic Hepatitis B Immunity in Vaccinated Health Care Workers." We agree that immune responsiveness to hepatitis B should be documented 1 to 2 months after completion of the vaccination protocol. However, our study showed that postvaccination testing is not routinely practiced. We found that only 40% of HCWs had their titers checked after vaccination. Twenty-nine percent (45/154) of the HCWs whom we tested did not have detectable hepatitis B antibody levels 4.7 years after vaccination. The majority of these subjects (33/45) never underwent postvaccination testing 1 to 2 months after receiving vaccine, and only 16% (7/45) had documented immunity. This leaves a large group (38/45) whose response to vaccination is unknown. Although large proportions of these subjects probably have anamnestic potential, we cannot distinguish them from nonresponders. We believe that it would be prudent to give this group a booster dose of vaccine to identify true nonresponders from anamnestic responders, because these groups will need to be treated differently in the event of exposure. The true nonresponders would require hepatitis B immune globulin alone, whereas the anamnestic responders without detectable antibody would need only a vaccine booster. If we follow the recommendations of Dr Datta and coworkers, an inordinate number of subjects may unnecessarily receive hepatitis B immune globulin, with the associated increased costs. We agree with Dr Datta and colleagues that this dilemma can be avoided if postvaccination antibody testing is performed 1 to 2 months after vaccination. If the initial response to postvaccination testing is positive, then we agree that periodic testing and booster vaccination are not necessary. In the absence of a positive titer antibody after vaccination, HCWs should consider undergoing a booster hepatitis B vaccination.
Barash C, Conn MI, DiMarino AJ, Marzano J, Allen ML. Routine Booster Doses of Hepatitis B Vaccine for Health Care Workers Are Not Necessary—Reply. Arch Intern Med. 2000;160(20):3171. doi: