Assessment of a universal, school-based hepatitis B vaccination program

JAMA. 1995 Oct 18;274(15):1209-13.


Objective: To assess a hepatitis B vaccination program offered to all grade 6 students in British Columbia in 1992.

Design: Cohort study.

Setting: British Columbia, Canada.

Participants: All grade 6 students were offered vaccine. Subsets of 454 and 259 students participated in studies of minor adverse events and seroresponse, respectively.

Intervention: The vaccine used was Engerix-B, 20 micrograms, given at intervals of 0, 1, and 6 months.

Main outcome measures: Province-wide acceptance and series completion rates and reports of severe adverse events. Minor adverse events and immunogenicity in subsamples.

Results: A total of 127,922 vaccine doses were administered. Initial enrollment totaled 43,358 students or 95.4% of those eligible. The series was completed by 41,594 students (95.6%). Minor adverse events were infrequent in the cohort assessed: no absenteeism or physician visits resulted from vaccination. Sixty-nine reported severe adverse events met surveillance definitions, the major categories being injection site reactions (23% of reports), fainting (20%), and rashes (17%). There was one instance of anaphylaxis. Only 13 of these events resulted in recommendations to discontinue the series. Of students tested following the series, 98% had levels of antibody to hepatitis B surface antigen considered to be protective (> or = 10 IU/L), the geometric mean titer being 690 IU/L (95% confidence interval, 498 to 957 IU/L).

Conclusion: Our experience indicates that school-based programs for universal vaccination of preadolescents can be highly acceptable and efficient.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • British Columbia
  • Child
  • Cohort Studies
  • Hepatitis B / prevention & control*
  • Hepatitis B Surface Antigens / biosynthesis
  • Hepatitis B Vaccines / administration & dosage*
  • Hepatitis B Vaccines / adverse effects
  • Hepatitis B Vaccines / immunology
  • Humans
  • Immunization Programs*
  • Immunization Schedule
  • Program Evaluation
  • School Health Services
  • Vaccination / adverse effects
  • Vaccines, Synthetic / administration & dosage*
  • Vaccines, Synthetic / adverse effects
  • Vaccines, Synthetic / immunology


  • Engerix-B
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines
  • Vaccines, Synthetic