January 1994

Assessment of Hepatitis B Virus Immunization Status Among North American Surgeons

Author Affiliations

From the Department of Surgery, Cornell University, New York, NY (Dr Barie); the Department of Surgery, University of Washington, Seattle (Dr Dellinger); the Department of Surgery, Texas Tech Univeristy, El Paso (Dr Dougherty); the Department of Surgery, Harvard University, Boston, Mass (Dr Fink); and the Scientific Studies Committee, Surgical Infection Society (Drs Barie, Dellinger, Dougherty, and Fink).

Arch Surg. 1994;129(1):27-32. doi:10.1001/archsurg.1994.01420250039004

Objective:  We hypothesized that many surgeons have not been vaccinated against hepatitis B virus (HBV), despite the existence of effective recombinant vaccines. Prevalence of HBV vaccination among surgeons, attitudes of those not vaccinated, estimated HBV infection rates, and respondents' knowledge of the epidemiology of HBV exposure were determined.

Design:  Survey conducted by mail just before implementation of mandatory HBV vaccination for health care workers.

Setting:  Private and academic general surgical, trauma and transplantation practices.

Participants:  Two thousand one hundred twenty-five surgeons received the survey. Response rates are as follows: in the Surgical Infection Society, 196 (50%) of 393 surgeons; in the American Association for the Surgery of Trauma, 223 (52%) of 433 surgeons; in the American Society of Transplant Surgeons, 194 (44%) of 438 surgeons; and among the Fellows of the American College of Surgeons, 403 (47%) of 861 surgeons.

Main Outcome Measures:  Prevalence of HBV exposure and active immunization by specialty and society.

Results:  Prevalence of HBV exposure was 19.6%, was higher among trauma and transplantation surgeons compared with general surgeons (P<.0001), and increased significantly with age in all groups (P<.05). Despite greater exposure, probable immunity was lower at an older age because young surgeons (age, <46 years) are more likely to be vaccinees (P<.05). Most surgeons (55%) were vaccinated more than 5 years ago; many recipients of recombinant vaccines (26%) received an inadequate amount of vaccine or were improperly vaccinated. Knowledge of the epidemiology was uniformly poor, with rates of correct responses to the three questions below 50%.

Conclusions:  Vaccination does not equal immunity. Between 38% and 50% of practicing surgeons may not have adequate immunity to HBV.(Arch Surg. 1994;129:27-32)