Experience with hepatitis B vaccination in nurses in a hospital for the mentally handicapped.

The extent of HBV infection in the staff of a large hospital for the mentally handicapped was investigated. Nurses with direct patient contact were identified as a particular risk group and hepatitis B vaccination was offered to them. Of the 500 who received a full course of vaccination 96% had detectable antibodies 9 months after starting vaccination. High titres (over 1000 IU/l) were found in 59.4%. Females responded better than males and the response was age-dependent. In only 2 of 20 non-responders did lasting immunity develop with a fourth dose of vaccine. Antibody titre decreased rapidly in all vaccinees followed up. In vaccinees with an initial titre above 100 IU/l the decrease in titre could be reversed by a booster dose. Those with a titre below 100 IU/l had a variable response to the booster dose and lasting immunity developed in only a few. A recall system was started that predicts when a booster dose will be required to maintain a protective level of antibody. Servicing such a vaccination programme is not easy.