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Abstract
All employees of St. Jude Children's Research Hospital who were at risk for occupational
exposure to hepatitis B virus were considered appropriate candidates for immunization
when the vaccine was licensed in November 1981. Because a high prevalence of hepatitis
B immunity was expected among the staff, preimmunization screening was undertaken
in the belief that it would be cost effective. Of 315 candidates screened for antibody
to the hepatitis B surface antigen (anti-HBs), 79 (25%) had detectable levels and
48 (15%) had titers of ≥10 ratio units (RU). The highest rates of anti-HBs positivity
were found among housekeepers (40%), nursing assistants (35%), physicians (31%), clinical
laboratory workers (29%), and ward clerks (27%); nurses had the lowest rate (16%).
An evaluation of potential risk factors implicated age >30 years as having greatest
importance. Serum samples were collected from 221 employees 3 months after their third
dose of vaccine and tested for anti-HBs; 218 (98.6%) were seropositive. Eighteen employees
who had detectable anti-HBs in the range of 2.1 to 9.9 RU before immunization responded
well to the vaccine; the titers rose from an average of 4 RU before vaccination to
an average of 313 RU 3 months after the third dose. The findings indicate that preimmunization
screening of all health care workers identified as candidates for vaccination may
not be necessary or economically feasible. If a screening program is undertaken, however,
anti-HBs testing of only those persons >30 years of age would increase the program's
cost effectiveness.
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© 1984 Published by Elsevier Inc.
