Immunogenicity of hepatitis B Vaccines. Implications for persons at occupational risk of hepatitis B virus infection.
OBJECTIVE
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).


METHODS
Randomized clinical trial and decision analysis.


METHODS
HCSw.


METHODS
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 > or = 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 > or = 40 years of age (87% vs. 81%; P < .01). Among HCWs > or = 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
He patitis 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.
Averhoff
F
F
Hepatitis Branch World Health Organization Collaborating Center for Research and Reference in Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
Mahoney
F
F
Coleman
P
P
Schatz
G
G
Hurwitz
E
E
Margolis
H
H
D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D003661:Decision Support Techniques; D005260:Female; D006282:Health Personnel; D006306:Health Surveys; D006509:Hepatitis B / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000276:immunology* / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016037:Single-Blind Method; D017211:Treatment Failure; D014614:Vaccines, Synthetic / Q000276:immunology / Q000592:standards
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic