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December 22, 1993

Hepatitis B Vaccine Responsiveness in Connecticut Public Safety Personnel

Author Affiliations

From the Epidemiology Section, Connecticut Department of Public Health and Addiction Services, Hartford (Drs Roome, Cartter, and Hadler), and Department of Community Medicine, University of Connecticut Health Center, Farmington (Dr Walsh).

JAMA. 1993;270(24):2931-2934. doi:10.1001/jama.1993.03510240043029

Objective.  —To determine the level and determinants of vaccine response in recently inoculated public safety personnel.

Design.  —Prevalence survey.

Participants.  —Public safety personnel who had completed vaccination 1 to 6 months prior to testing and had no serological evidence of previous exposure to hepatitis B virus.

Main Outcome Measure.  —An inadequate level of antibody to hepatitis B surface antigen was defined as less than 10 mlU/mL.

Results.  —All subjects in the study had been vaccinated using Recombivax HB, a recombinant hepatitis B vaccine. Of 528 individuals, 11.9% were found to have no or inadequate levels of antibody. The frequency of inadequate level of antibody increased significantly relative to age, from 2.8% among those younger than 30 years to 42.1% among those older than 60 years (P<.0001). Smoking (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.0 to 6.4), extreme obesity (OR, 13.3; 95% CI, 3.8 to 49.1), and increasing time interval since completing the vaccine series (P<.01) were also associated with inadequate levels of antibody. These findings were confirmed by multivariate analysis using logistic regression.

Conclusions.  —Routine immunization of public safety personnel should include selective use of postvaccine testing. Postvaccination testing optimally should be performed in the 30- to 90-day interval after the last vaccine dose. New vaccination strategies are needed to improve response rates in persons with predictably poor response to hepatitis B vaccine.(JAMA. 1993;270:2931-2934)