To determine the level and determinants of vaccine response in recently inoculated public safety personnel.DESIGN
Public safety personnel who had completed vaccination 1 to 6 months prior to testing and had no serological evidence of previous exposure to hepatitis B virus.MAIN OUTCOME MEASURE
An inadequate level of antibody to hepatitis B surface antigen was defined as less than 10 mIU/mL.RESULTS
All subjects in the study had been vaccinated using Recombivax HB, a recombinant hepatitis B vaccine. Of 528 individuals, 11.9% were found to have no or inadequate levels of antibody. The frequency of inadequate level of antibody increased significantly relative to age, from 2.8% among those younger than 30 years to 42.1% among those older than 60 years (P<.0001). Smoking (odds ratio (OR), 3.6; 95% confidence interval (CI), 2.0 to 6.4), extreme obesity (OR, 13.3; 95% CI, 3.8 to 49.1), and increasing time interval since completing the vaccine series (P<.01) were also associated with inadequate levels of antibody. These findings were confirmed by multivariate analysis using logistic regression.CONCLUSIONS
Routine immunization of public safety personnel should include selective use of postvaccine testing. Postvaccination testing optimally should be performed in the 30- to 90-day interval after the last vaccine dose. New vaccination strategies are needed to improve response rates in persons with predictably poor response to hepatitis B vaccine.