title: Hepatitis B vaccine immunogenicity among adults vaccinated during an outbreak response in an assisted living facility--Virginia, 2010.
abstract: BACKGROUND
  Failure to adhere to infection control guidelines, especially during assisted monitoring of blood glucose, has caused multiple hepatitis B outbreaks in assisted living facilities (ALFs). In conjunction with the response to such an outbreak at an ALF ("Facility X") where most residents had neuropsychiatric disorders, we evaluated seroprotection rates conferred by hepatitis B vaccine and assessed the influence of demographic factors on vaccine response.
  
  
  METHODS
  Residents were screened for hepatitis B and C infection, and those susceptible were vaccinated against hepatitis A and hepatitis B with one dose of TWINRIX™ (GSK) given at 0, 1, and 7 months. Blood samples were collected 1-2 months after receipt of the third vaccine dose to test for antibody to hepatitis B surface antigen (anti-HBs).
  
  
  RESULTS
  Of the 27 residents who had post-vaccination blood specimens collected, 22 (81%) achieved anti-HBs concentrations ≥10 mIU/mL. Neither age nor neuropsychiatric comorbidity was a significant determinant of seroprotection. Geometric mean concentration was lower among residents aged 60-74 years (74.3 mIU/mL) than among residents aged 46-59 years (105.3 mIU/mL) but highest among residents aged ≥75 years (122.5 mIU/mL). The effect of diabetes on vaccination response could not be examined because 16/17 (94%) diabetic residents had HBV infection by the time of investigation.
  
  
  CONCLUSIONS
  Adult vaccine recipients of all ages, even those over 60 years of age, demonstrated a robust capacity for achieving hepatitis B seroprotection in response to the combined hepatitis A/hepatitis B vaccine. The role for vaccination in interrupting HBV transmission during an outbreak remains unclear, but concerns about age-related response to hepatitis B vaccine may be insufficient to justify foregoing vaccination of susceptible residents of ALFs.
authors.affiliation: Epidemic Intelligence Service Program, The Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control, Atlanta, GA, United States.
authors.forename: Thomas John
authors.initials: TJ
authors.lastname: Bender
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Umid
authors.initials: U
authors.lastname: Sharapov
authors.affiliation: Virginia Department of Health, Richmond, VA, United States.
authors.forename: Okey
authors.initials: O
authors.lastname: Utah
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Jian
authors.initials: J
authors.lastname: Xing
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Dale
authors.initials: D
authors.lastname: Hu
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Rybczynska
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Jan
authors.initials: J
authors.lastname: Drobeniuc
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Saleem
authors.initials: S
authors.lastname: Kamili
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Spradling
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, United States. Electronic address: amoorman@cdc.gov.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Moorman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014611:Vaccination / Q000706:statistics & numerical data; D014768:Virginia
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines
keywords: Age; HBV; Hepatitis B; Neuropsychiatric; Vaccination