HEPATITIS-B VACCINE RESPONSIVENESS IN CONNECTICUT PUBLIC SAFETY PERSONNEL

Objective.-To determine the level and determinants of vaccine response in recently inoculated public safety personnel. Design.-Prevalence su rvey. Participants.-Public safety personnel who had completed vaccinat ion 1 to 6 months prior to testing and had no serological evidence of previous exposure to hepatitis B virus. Main Outcome Measure.-An inade quate level of antibody to hepatitis B surface antigen was defined as less than 10 mIU/mL. Results.-All subjects in the study had been vacci nated using Recombivax HB, a recombinant hepatitis B vaccine. Of 528 i ndividuals, 11.9% were found to have no or inadequate levels of antibo dy. The frequency of inadequate level of antibody increased significan tly 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 compl eting the vaccine series (P<.01) were also associated with inadequate levels of antibody. These findings were confirmed by multivariate anal ysis using logistic regression. Conclusions.-Routine immunization of p ublic safety personnel should include selective use of postvaccine tes ting. Postvaccination testing optimally should be performed in the 30- to 90-day interval after the last vaccine dose. New vaccination strat egies are needed to improve response rates in persons with predictably poor response to hepatitis B vaccine.