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Risk Factors for Lack of Detectable Antibody Following Hepatitis B Vaccination of Minnesota Health Care Workers
Rachel C. Wood, MD, MPH;
Kristine L. MacDonald, MD, MPH;
Karen E. White, MPH;
Craig W. Hedberg, PhD;
Margaret Hanson, MT;
Michael T. Osterholm, PhD, MPH
JAMA. 1993;270(24):2935-2939.
Abstract
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Objective.
—To assess the presence of antibody to hepatitis B surface antigen (anti-HBs) at postvaccination testing in Minnesota health care workers receiving recombinant hepatitis B vaccines, and to identify risk factors for lacking anti-HBs following hepatitis B vaccination.
Design.
—Retrospective cohort study.
Setting.
—Ten acute care hospitals in Minnesota.
Participants.
—A total of 595 health care workers who had received hepatitis B vaccine (Recombivax HB or Engerix-B) between June 1987 and December 1991 and who underwent postvaccination testing for anti-HBs within 6 months after receiving the third dose of vaccine.
Main Outcome Measure.
—Presence or absence of anti-HBs following hepatitis B vaccination.
Results.
—Five variables were independently associated with lacking anti-HBs by multivariate analysis: vaccine brand, smoking status, gender, age, and body mass index. Stratifying by vaccine brand demonstrated that age (P=.01), body mass index (P<.01), and smoking status (P<.01) were associated with lacking anti-HBs only for Recombivax HB recipients; and gender (P=.03) was associated with lacking anti-HBs only for Engerix-B recipients. After controlling for smoking status, age, gender, and body mass index, recipients of Recombivax HB were more likely to lack anti-HBs than recipients of Engerix-B (relative risk, 2.3; 95% confidence interval, 1.1 to 4.7; P=.02).
Conclusions.
—Results indicate that certain populations of health care workers are at increased risk of not responding to hepatitis B vaccination. Further studies evaluating immunogenicity of currently available recombinant hepatitis B vaccines in persons at high risk for primary vaccine failure are needed.
(JAMA. 1993;270:2935-2939)
Author Affiliations
From the Acute Disease Epidemiology Section, Division of Disease Prevention and Control, Minnesota Department of Health, Minneapolis (Drs Wood, MacDonald, Hedberg, and Osterholm and Ms White), and the Memorial Blood Center of Minneapolis (Ms Hanson). Dr Wood was assigned to the Minnesota Department of Health from the Epidemic intelligence Service, Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga.
Footnotes
Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the US Department of Health and Human Services.
Reprint requests to Acute Disease Epidemiology Section, Minnesota Department of Health, 717 Delaware St SE, PO Box 9441, Minneapolis, MN 55440-9441 (Dr Osterholm).
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