PROGRESS TOWARD THE ELIMINATION OF HEPATITIS-B VIRUS TRANSMISSION AMONG HEALTH-CARE WORKERS IN THE UNITED-STATES

Background: Hepatitis B virus (HBV) infection is a well-recognized occ upational risk for health care workers (HCWs). Vaccination coverage, d isease trends, and the need for booster doses after hepatitis B vaccin ation of adults have been the subject of intense study during the 15 y ears of the vaccine's availability. Methods: Vaccination coverage of H CWs was determined from a review of medical records on a sample of emp loyees from 113 randomly selected hospitals. The number of HBV infecti ons among HCWs and the general US population for 1983 through 1995 was estimated from national surveillance data. Studies on long-term prote ction after hepatitis B vaccination of adults were reviewed. Results: A total of 2837 employee medical records were reviewed; 2532 employees (90%) were eligible to receive hepatitis B vaccine, and 66.5% of them (95% confidence interval, 61.9%-70.9%) had received 3 doses of hepati tis B vaccine. Vaccination coverage was highest (75%) for personnel wi th frequent exposure to infectious body fluids (phlebotomists, laborat ory personnel, and nursing staff) and lowest (45%) for employees at lo w risk for exposure (dietary and clerical staff). The number of HBV in fections among HCWs declined from 17000 in 1983 to 400 in 1995. The 95 % decline in incidence observed among HCWs is 1.5-fold greater than th e reduction in incidence in the general US population. Studies on long -term protection demonstrate that vaccine-induced protection persists at least 11 years even when titers of antibody to hepatitis B surface antigen decline below detectable levels. Conclusions: Although a high percentage of HCWs have been fully vaccinated with hepatitis B vaccine , efforts need to be made to improve this coverage. There has been a d ramatic decrease in the number of HBV infections among HCWs who are no w at lower risk of HBV infection than the general US population. Vacci ne-induced protection persists at least 11 years and booster doses are not needed at this time for adults who have responded to vaccination.