Abstract
Objectives: To assess risk factors for decreased immunogenicity among adults vaccinated
with hepatitis B vaccine and to determine the importance of differences in immunogenicity
between vaccines among health care workers (HCWs).
Design: Randomized clinical trial and decision analysis.
Participants: HCWs.
Main Outcome Measures: Development of seroprotective levels of antibody to hepatitis
B surface antigen (anti-HBs) and the number of expected chronic hepatitis B virus
(HBV) infections associated with lack of protection.
Results: Overall, 88% of HCWs developed seroprotection. Risk factors associated with
failure to develop seroprotection included increasing age, obesity, smoking, and male
gender (P < .05). Presence of a chronic disease was associated with lack of seroprotection
only among persons ≥40 years of age (P < .05). The two vaccines studied differed in their overall seroprotection rates (90%
vs. 86%; P < .05), however, this difference was restricted to persons ≥40 years of age (87%
vs. 81%; P < .01). Among HCWs ≥40 years of age, the decision analysis found 44 (0.34/100,000
person-years) excess chronic HBV infections over the working life of the cohort associated
with use of the less immunogenic vaccine compared to the other.
Conclusions: Hepatitis B vaccines are highly immunogenic, but have decreased immunogenicity
associated with increasing age, obesity, smoking, and male gender; and among older
adults, the presence of a chronic disease. One of the two available vaccines is more
immunogenic among older adults; however, this finding has little clinical or public
health importance. Hepatitis B vaccines should be administered to persons at occupational
risk for HBV infection early in their career, preferably while they are still in their
training.
Keywords
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References
- Hepatitis B immunization.in: Remington J.S Swartz M.N Current clinical topics in infectious diseases. 12. Blackwell Scientific Publications, Boston1992: 282-308
- Summary of worldwide experience with HB-Vax (R) (B, MSD).J Infect. 1983; 7: 95-104
- Clinical experience with hepatitis B vaccines.Am J Infect Control. 1989; 17: 172-180
- Summary of safety and efficacy data on a yeast-derived hepatitis B vaccine.Am J Med. 1989; 87: 14S-20S
- Hepatitis B vaccine responsiveness in Connecticut Public Safety personnel.JAMA. 1993; 270: 2931-2934
- Risk factors for lack of detectable antibody following hepatitis B vaccination of Minnesota Health Care Workers.JAMA. 1993; 270: 2935-2972
- Effect of anatomic injection site, age, and smoking on the immune response to hepatitis B vaccination.Vaccine. 1989; 7: 425-430
- Obesity as a predictor of poor antibody response to hepatitis B plasma vaccine.JAMA. 1985; 254: 3187-3189
- Increasing serum creatinine and age reduce the response to hepatitis B vaccine in renal failure patients.J Hepatology. 1994; 21: 450-454
Centers for Disease Control. Inactivated hepatitis B virus vaccine. MMWR 1982;26:317–22, 327–8.
- Occupational exposure to bloodborne pathogens.Federal Register. 1991; 56: 64004-64182
- Impact of bloodborne pathogens standards on vaccination of healthcare workers with hepatitis B vaccine.Infect Control Hosp Epidemiol. 1995; 16: 287-291
- Immunogenicity of two recombinant hepatitis B vaccines in older individuals.Am J Med. 1993; 95: 584-588
- Long-term immunogenicity and efficacy of hepatitis B vaccine in homosexual men.N Engl J Med. 1986; 215: 209-214
- Protection provided by hepatitis B vaccine in a Yupik Eskimo population.Arch Intern Med. 1991; 151: 1634-1636
- Occupational risk of hepatitis B infection in hospital workers.Infect Control. 1985; 6: 24-31
- Prevalence and incidence of viral hepatitis in health care workers in the pre-hepatitis B vaccination era.Am J Epidemiol. 1992; 136: 603-610
- Hepatitis Surveillance Report. 1994; 55: 27-34
- Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among hospital-based surgeons.J Am Coll Surg. 1995; 180: 16-24
- Prevention of hepatitis B virus infection among health-care workers.in: Ellis R.W Hepatitis B vaccines in clinical practice. Marcel Dekker Inc, New York1993: 295-307
U.S. Bureau of the Census. Statistical Abstract of the United States, 113th edition. Washington, DC; 1993.
- Hepatitis B virus.Cancer. 1988; 61: 1942-1956
- Age at first establishment of chronic hepatitis B virus infection and hepatocellular carcinoma risk.Am J Epidemiol. 1992; 136: 1115-1121
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© 1998 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
