Vaccination against hepatitis B: Results of the analysis of 2000 population members in Croatia

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Abstract
The results of the analysis of vaccination against hepatitis B performed in 2,000 persons of high-risk groups in Croatia are described. All susceptible non-immunocompromised persons (HBsAg, anti-HBs, and anti-HBc negative) received either plasma-derived vaccine (HB-Vax MSD, 20 µg per dose) or recombinant HB vaccine (ENGERIX-B, SKB, 20 µg per dose) according to a 0,1 and 6-month schedule. Hemodialysis patients received four doses of HB vaccine (40 µg per dose). Seroconversion occurred in 98% of health care workers, 98.5% of family members of HBsAg chronic carriers, 98% of infants born to HBsAg carrier-mothers and 92% of hemodialysis patients. The percentage of poor-responders (titer of anti-BHs=1−10 mIU/ml) for the groups was 2, 2, 8 and 20%, respectively, while low-responders (titer of anti-BHs=10.1−100 mIU/ml) were 5, 4.5, 12 and 26%, respectively. A significant prevalence of non-responders, poor-responders and low-responders among male health care workers was noticed (p=0.01, 0.026 and 0.002, respectively). Females significantly prevailed among excellent-responders (p=0.0039). In hemodialysis patients, there were 8% non-responders, 19.5% poor-responders, and 26% low-responders. A significant difference between the percentage of good-responders (titer of anti-HBs=101−1,000 mIU/ml) and excellent-responders (titer of anti-HBs over 1,000 mIU/ml) among health care workers and hemodialysis patients was documented (91% versus 46.5%,pp=0.0241). Out of 20 initially non-responders, seroconversion occurred in 11 of them (54%) after two ‘booster’ doses of Engerix-B (20 µg per dose). By the use of the same procedure, a raised titer of anti-BHs was present in 92% of initially poor-responders and 100% of initially low-responders. Needle-stick exposure to HBsAg-positive blood occurred in 9 health care workers in the course of their vaccination and in 14 who had completed vaccination. Neither manifest nor subclinical HBV infections have developed among them. On the contrary, two surgeons who omitted the third dose of vaccine developed acute icteric hepatitis B two years later. Thus, complete vaccination (at 0, 1 and 6 months − 20 µg per dose) for non-immunocompromised persons gave good or excellent response in over 90% of recipients. In hemodialysis patients, the results are poorer irrespective of more and higher doses of HB vaccine.