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Simon Dobson, MD; David Scheifele, MD; Alison Bell, MD, CM

JAMA. 1995;274(15):1209-1213.

Abstract
Objective.
—To assess a hepatitis B vaccination program offered to all grade 6 students in British Columbia in 1992.

Design.
—Cohort study.

Setting.
—British Columbia, Canada.

Participants.
—All grade 6 students were offered vaccine. Subsets of 454 and 259 students participated in studies of minor adverse events and seroresponse, respectively.

Intervention.
—The vaccine used was Engerix-B, 20 µg, given at intervals of 0, 1, and 6 months.

Main Outcome Measures.
—Province-wide acceptance and series completion rates and reports of severe adverse events. Minor adverse events and immunogenicity in subsamples.

Results.
—A total of 127 922 vaccine doses were administered. Initial enrollment totaled 43358 students or 95.4% of those eligible. The series was completed by 41 594 students (95.6%). Minor adverse events were infrequent in the cohort assessed: no absenteeism or physician visits resulted from vaccination. Sixty-nine reported severe adverse events met surveillance definitions, the major categories being injection site reactions (23% of reports), fainting (20%), and rashes (17%). There was one instance of anaphylaxis. Only 13 of these events resulted in recommendations to discontinue the series. Of students tested following the series, 98% had levels of antibody to hepatitis B surface antigen considered to be protective (10 IU/L), the geometric mean titer being 690 IU/L (95% confidence interval, 498 to 957 IU/L).

Conclusion.
—Our experience indicates that school-based programs for universal vaccination of preadolescents can be highly acceptable and efficient.

(JAMA. 1995;274:1209-1213)

Author Affiliations
From the Vaccine Evaluation Center, British Columbia's Children's Hospital (Dr Dobson and Dr Scheifele), and the Epidemiology Division, British Columbia Centre for Disease Control (Dr Bell), Vancouver.

Footnotes
Reprint requests to Vaccine Evaluation Center, 4500 Oak St, Room L427, Vancouver, British Columbia, Canada V5Z 4H4 (Dr Dobson).

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