Risk factors for lack of detectable antibody following hepatitis B vaccination of Minnesota health care workers

JAMA. 1993 Dec 22-29;270(24):2935-9.


Objective: To assess the presence of antibody to hepatitis B surface antigen (anti-HBs) at postvaccination testing in Minnesota health care workers receiving recombinant hepatitis B vaccines, and to identify risk factors for lacking anti-HBs following hepatitis B vaccination.

Design: Retrospective cohort study.

Setting: Ten acute care hospitals in Minnesota.

Participants: A total of 595 health care workers who had received hepatitis B vaccine (Recombivax HB or Engerix-B) between June 1987 and December 1991 and who underwent postvaccination testing for anti-HBs within 6 months after receiving the third dose of vaccine.

Main outcome measure: Presence or absence of anti-HBs following hepatitis B vaccination.

Results: Five variables were independently associated with lacking anti-HBs by multivariate analysis: vaccine brand, smoking status, gender, age, and body mass index. Stratifying by vaccine brand demonstrated that age (P = .01), body mass index (P < .01), and smoking status (P < .01) were associated with lacking anti-HBs only for Recombivax HB recipients; and gender (P = .03) was associated with lacking anti-HBs only for Engerix-B recipients. After controlling for smoking status, age, gender, and body mass index, recipients of Recombivax HB were more likely to lack anti-HBs than recipients of Engerix-B (relative risk, 2.3; 95% confidence interval, 1.1 to 4.7; P = .02).

Conclusions: Results indicate that certain populations of health care workers are at increased risk of not responding to hepatitis B vaccination. Further studies evaluating immunogenicity of currently available recombinant hepatitis B vaccines in persons at high risk for primary vaccine failure are needed.

MeSH terms

  • Adult
  • Female
  • Hepatitis B / prevention & control*
  • Hepatitis B Antibodies / biosynthesis*
  • Hepatitis B Vaccines / immunology*
  • Humans
  • Male
  • Middle Aged
  • Minnesota
  • Multivariate Analysis
  • Occupational Health* / statistics & numerical data
  • Personnel, Hospital* / statistics & numerical data
  • Risk Factors
  • Treatment Failure
  • Vaccines, Synthetic / immunology*


  • Engerix-B
  • Hepatitis B Antibodies
  • Hepatitis B Vaccines
  • Recombivax HB
  • Vaccines, Synthetic