Seroresponse to hepatitis B vaccine in patients and staff of renal dialysis centers, Wisconsin.

Since June 1982, the Wisconsin Chronic Renal Disease Program has provided reimbursement for hepatitis B virus vaccine and pre- and postvaccine serologic testing for patients and staff in all Wisconsin renal dialysis centers. Between July 1, 1982 and June 30, 1984, 444 dialysis patients in 22 renal dialysis centers and 128 staff from nine renal dialysis centers each received three doses of hepatitis B virus vaccine and were tested more than 14 days after the third dose. Antibody response (antibody to hepatitis B surface antigen) occurred in 208 (47%) patients and was age-dependent; the rate of antibody response ranged from 86% (for those aged less than 30 years) to 32% (for those aged over 70 years). Among staff, the rate of antibody response ranged from 96% (for those aged less than 35 years) to 71% (for those aged over 45 years). Results of a multiple logistic regression analysis showed that within age groups, antibody response in dialysis patients was positively associated with length of time on dialysis prior to receipt of vaccine (p = 0.014) and negatively associated with the time interval between the third dose and postvaccine testing (p = 0.0003). Variables that did not enter the regression equation were dialysis mode and frequency, transplant status, concurrent medication use, and injection site. Given the low rates of post-hepatitis B virus vaccine antibody response observed in renal dialysis center patients reported here, the authors recommend that hepatitis B virus vaccine plus alternative hepatitis B virus preventive methods be used. Consideration should be given to a schedule for testing of all vaccinated patients and staff aged over 40 years to ascertain postvaccine susceptibility to hepatitis B virus infection.