Hepatitis B vaccination program at a New York City hospital: Seroprevalence, seroconversion, and declination

Background: Despite implementation of hepatitis B vaccination programs, 2 problems have prevented full vaccine-induced protection of health care workers (HCWs). About 10% to 12% of vaccinated HCWs do not develop antibody, and many HCWs continue to decline vaccination. To determine the effectiveness of our hepatitis B vaccine program, we studied rates of postvaccination seroconversion and vaccine declination. Methods: Employee health service records were used to determine demographic features, hepatitis B surface antibody serostatus at baseline, serologic response to vaccine, and declination or acceptance of vaccine. Results: About 26% of HCWs were seropositive at baseline, including those vaccinated before employment. Higher seroprevalence rates were seen among those born outside the United States, nurses, and laboratory workers. Seroconversion occurred in only 79% of HCWs who completed a 3-vaccine series. Increasing age was the only significant risk for failure to convert. Declination rates overall were about 45% and were lowest in HCWs who have jobs that included potential exposure to blood. Conclusion: Hepatitis B seroprevalence among HCWs at our hospital is higher than in many other urban hospitals in the United States; our postvaccination seroconversion rate is substantially lower; and our declination rate of 45% resembles other published series. Declination of vaccine and failure to respond to vaccine continue to thwart achievement of full control of this preventable occupational infection.