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Seroconversion by EMS Personnel Vaccinated with HBV Recombinant DNA

Published online by Cambridge University Press:  28 June 2012

Max D. Koenigsberg ,
Sharon Ward ,
Linda Herman ,
Cary McDonald  and
Richard M. Feldman
Max D. Koenigsberg*
Affiliation:
Program in Emergency Medicine, University of Illinois College of Medicine, Chicago, Ill. Chicago North EMS System, Illinois Masonic Medical Center, Chicago, Ill.
Sharon Ward
Affiliation:
Chicago North EMS System, Illinois Masonic Medical Center, Chicago, Ill.
Linda Herman
Affiliation:
Program in Emergency Medicine, University of Illinois College of Medicine, Chicago, Ill. Chicago North EMS System, Illinois Masonic Medical Center, Chicago, Ill. EMS Fellow, University of Illinois College of Medicine, Chicago, Ill.
Cary McDonald
Affiliation:
Program in Emergency Medicine, University of Illinois College of Medicine, Chicago, Ill. Chicago North EMS System, Illinois Masonic Medical Center, Chicago, Ill. EMS Fellow, University of Illinois College of Medicine, Chicago, Ill.
Richard M. Feldman
Affiliation:
Program in Emergency Medicine, University of Illinois College of Medicine, Chicago, Ill. Chicago North EMS System, Illinois Masonic Medical Center, Chicago, Ill.
*
Illinois Masonic Medical Center—EMS, 836 West Wellington Ave., Chicago, IL 60657USA
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Abstract

Objective:

To evaluate the seroconversion rate of EMS personnel given the hepatitis B virus (HBV) recombinant deoxyribonucleic acid (DNA) vaccine series.

Design:

Retrospective review of paramedics and firefighters consecutively completing the HBV recombinant DNA vaccine program.

Setting:

Urban, non-prof it, private, regional EMS Resource Hospital. The Chicago North EMS System is under contract with the Chicago Fire Department. This contract allows for the voluntary vaccination of EMS personnel with recombinant DNA-HBV vaccine and treatment and follow-up of paramedics and firefighters possibly exposed to HBV.

Population:

Initial 68 EMS personnel completing HBV recombinant DNA vaccine program (48 primary prophylaxis and 20 post-exposure prophylaxis).

Intervention:

HBV recombinant DNA vaccine series was administered voluntarily to Chicago EMS System paramedics and firefighters per manufacturers recommendations. Two weeks after completion of the vaccination series, blood samples for HBV antibody titres were drawn to determine reactivity and the need for further immunization.

Results:

Of the 68 vaccinated individuals, only two had negative titres (3%). These two individuals were given a fourth dose of vaccine with successful seroconversion.

Conclusions:

Prehospital care personnel are known highrisk, health-care workers for acquiring HBV and should be vaccinated prophylactically. There is a high seroconversion rate (97%) utilizing HBV recombinant DNA vaccine. However, post-vaccination antibody titres must be performed to identify those rare individuals that do not seroconvert.

Keywords

antibody titresbooster-dosecirrhosisEMS personnelhepatitis Bhepatitisimmunizationliver cancerrecombinant DNA vaccineseroconversionvaccination
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 4 , December 1992 , pp. 373 - 379
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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References

1. West, DJ: The risk of hepatitis B infection among health care professionals in the United States: A review. Am J Med Sci 1984;287:26–33.CrossRefGoogle ScholarPubMed
2. Centers for Disease Control, US Department of Health and Human Services: Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-care and Public-Safety Workers. MMWR 1989;38(S-6): 1–38.Google Scholar
3. Mulley, AG, Silverstein, MD, Deinstag, JL: Indications for use of hepatitis B vaccine, based on cost-effectiveness analysis. N Engl J Med 1982;307:644–652.CrossRefGoogle ScholarPubMed
4. Hamilton, JD: Hepatitis B virus vaccine: An analysis of its potential use in medical workers. JAMA 1983;250:2145–2150.CrossRefGoogle ScholarPubMed
5. Cyldulka, RK, Mathews, JJ, Born, M, et al. : Paramedics: Knowledge base and attitudes towards AIDS and hepatitis. J Emerg Med 1991;9;37–43.CrossRefGoogle Scholar
6. Peters, CJ, Purcell, RH, Lander, JJ, Johnson, KM: Radioimmunoassay for antibody to hepatitis B surface antigen shows transmission of hepatitis B virus among household contacts. J Infect Dis 1976;134:218–223.CrossRefGoogle ScholarPubMed
7. Hollinger, FB, Troisi, CL, Pepe, PE: Anti-HBs responses to vaccination with a human hepatitis B vaccine made by recombinant DNA technology in yeast. J Infect Dis 1986;153:156–159.CrossRefGoogle ScholarPubMed
8. Poiesz, B, Tomar, R, Lehr, B, Moore, J: Hepatitis B vaccine: Evidence confirming lack of AIDS transmission. MMWR 1984;33:685–687.Google Scholar
9. Stevens, CE, Taylor, PE, Rubinstein, P, et al. : Safety of the hepatitis B vaccine. N Engl J Med 1985;312:375–376.Google ScholarPubMed
10. Deinhardt, F: Aspects of vaccination against hepatitis B: Passive active immunization schedules and vaccination responses in different age groups. Scand J Inject Dis 1982;38:17–23S.Google Scholar
11. Fagan, EA, Tolley, P, Smith, HM, et al. : Hepatitis B vaccine: Immunogenicity and follow-up including two year booster doses in high risk health care personnel in a London teaching hospital. J Med Virol 1987; 21:49–56.CrossRefGoogle Scholar
12. Cockcroft, A, Soper, P, Insall, C, et al. : Antibody response after hepatitis B immunization in a group of health care workers. Brit J Industrial Med 1990;47:199–202.Google Scholar
13. Centers for Disease Control: Suboptimal response to hepatitis B vaccine given by injection into the buttock. MMWR 1985;34:105–108,113.Google Scholar
14. Campbell, AD, Hambling, MH, Pinnington, PA, Lees, E: Efficacy of hepatitis B vaccine. J Soc Occup Med 1988;38:46–47.CrossRefGoogle ScholarPubMed
15. Nowicki, MJ, Tong, MJ, Bohman, RE: Alterations in the immune response to non-responders to the hepatitis B vaccine. J Infect Dis 1985;152:1245–1248.CrossRefGoogle Scholar
16. Kunches, LM, Craven, DE, Werner, BG, Jacobs, LM: Hepatitis B exposure in emergency medical personnel: Prevalence of serologic markers and need for immunization. Am J Med 1983;75:269–272.CrossRefGoogle ScholarPubMed
17. Pepe, PE, Hollinger, FB, Trois, CL, Heiberg, D: Viral hepatitis risk in urban emergency medical services personnel. Ann Emerg Med 1986;15:454–457.CrossRefGoogle ScholarPubMed
18. Advisory Committee on Immunization Practice: Recommendations for protection against viral hepatitis. MMWR 1985;34:314–335.Google Scholar
19. Szmuness, W, Stevens, CE, Harley, EJ, et al. : Hepatitis B vaccine: Demonstration of efficacy in a controlled clinical trail in a high-risk population in the United States. N Engl J Med 1980;303:833–841.CrossRefGoogle Scholar
20. Szmuness, W, Stevens, CE, Zang, EA, et al. : A controlled clinical trial on the efficacy of the hepatitis B vaccine (Heptovax B): A final report. Hepatology 1981;5:377–385.CrossRefGoogle Scholar
21. Francis, DP, Hadler, SC, Thompson, SE, et al. : The prevention of hepatitis B with vaccine: Report of the Centers for Disease Control multi-center efficacy trial among homosexual men. Ann Intern Med 1982;97:362–366.CrossRefGoogle ScholarPubMed
22. McAleer, WJ, Buynak, EB, Maigetter, RZ, et al. : Human hepatitis B vaccine from recombinant yeast. Nature 1984;307:178–180.CrossRefGoogle ScholarPubMed
23. Halliday, ML, Rankin, JG, Bristow, NJ, et al. : A randomized double-blind clinical trial of a mammalian cell-derived recombinant DNA hepatitis B vaccine compared with a plasma-derived vaccine. Arch Intern Med 1990;150:1195–1200.CrossRefGoogle ScholarPubMed
24. Centers for Disease Control, US Department of Health and Human Services: Update on Hepatitis B Prevention: Recommendations of the Immunization Practices Advisory Committee. Ann Intern Med 1987;107:353–357.CrossRefGoogle Scholar
25. Valenzuela, TD, Hook, EW, Copass, MK, Corey, L: Occupational exposure to hepatitis B in paramedics. Arch Intern Med 1985;45:1976–1978.CrossRefGoogle Scholar
26. Fligner, DJ, Wigder, HN, Harter, PM, et al. : The prevalence of hepatitis B serologic markers in suburban paramedics. J Emerg Med 1989;7;41–45.CrossRefGoogle ScholarPubMed
27. Clawson, JJ, Jacobson, JA: Prevalence of antibody to hepatitis B surface antigen in emergency medical personnel in Salt Lake City, Utah. Ann Emerg Med 1986;15:183–184.CrossRefGoogle ScholarPubMed
28. Hankins, DG, Karess, DE, Siebold, CM, et al. : Hepatitis B vaccine and hepatitis B markers: Cost-effectiveness of screening prehospital personnel. Am J Emerg Med 1987;5:205–206.CrossRefGoogle ScholarPubMed
29. Menegazzi, J: A meta-analysis of hepatitis B serologic marker prevalence in EMS personnel. Prehospital and Disaster Medicine 1991;6:299–302.CrossRefGoogle Scholar
30. Bock, KB, Tong, MJ, Bernstein, S: The risk of accidental exposure to hepatitis B virus via blood contamination in medical students. J Infect Dis 1981;144:604.CrossRefGoogle ScholarPubMed
31. Lahaye, D, Baleux, C, Strauss, P, VanGanse, W: Costbenefit analysis of hepatitis B vaccination. Lancet 1987;1:441–442.CrossRefGoogle Scholar
32. US Department of Labor, US Department of Health and Human Services. Joint Advisory Notice: Protection against occupational exposure to hepatitis B virus (HBV) and human immunodeficiency virus (HW). Federal Register 1987;52:41818–41824.Google Scholar
33. Jilg, W, Schmidt, M, Deinhardt, F: Four-year experience with a recombinant hepatitis B vaccine. Infection 1989;17:70–76.CrossRefGoogle ScholarPubMed
34. Crovari, P, Gueneo-Crovari, P, Icardi, GC, et al. : Immunization of young adults with two yeast-derived hepatitis B vaccines. In Zuckerman, AJ, ed. Viral Hepatitis and Liver Disease: Proceeding of the International Symposium on Viral Hepatitis and Liver Disease, 1987. New York: Alan R Liss Inc., 1988, pp 1071–1073.Google Scholar
35. Heijtink, RA, van der Velda-Laegendijk, MA, Weber, YAM, et al. : Hepatitis B vaccination in mentally retarded patients: Recombinant vaccine versus plasma-derived vaccine. In Zuckerman, AJ, ed. Viral Hepatitis and Liver Disease: Proceedings of the International Symposium on Viral Hepatitis and Liver Diease, 1987. New York: Alan R Liss Inc., 1988, pp 1068–1070.Google Scholar
36. Jilg, W, Lorbeer, B, Schmidt, M, et al. : Clinical evaluation of a recombinant hepatitis B vaccine. Lancet 1984;2:1174–1175.CrossRefGoogle ScholarPubMed
37. Just, M, Berger, R, Just, V: Reactogenicity and immunogenicity of a recombinant hepatitis B vaccine compared with a plasma-derived vaccine in young adults. Postgrad Med J 1987;63(suppl 2):121–123.Google ScholarPubMed
38. Jilg, W, Deinhardt, F: Results of immunization with a recombinant yeast-derived hepatitis B vaccine. J Infect 1986;13(suppl A):47–51.CrossRefGoogle ScholarPubMed
39. Wismans, PJ, Van Hattum, J, Mudde, GC, et al. : Is booster injection widi hepatitis B vaccine necessary in healthy responders? A study of the immune response. J Hepatology 1989:8:236–240.CrossRefGoogle Scholar
40. Amborsch, F, Couroucé, AM, Coursaget, T, et al. : Immunization against hepatitis B. Lancet 1988;1:875–876.Google Scholar
41. Alper, CA, Kroskall, MS, Marcus-Bagley, D, et al. : N Engl J Med 1989;321:708–712.CrossRefGoogle Scholar
42. Hadler, SC, Francis, DP, Maynard, JE, et al. : Longterm immunogenicity and efficacy of hepatitis B vaccine in homosexual men. N Engl J Med 1986:315:209–214.CrossRefGoogle ScholarPubMed
43. Coursaget, P, Yvonnet, B, Chotard, J, et al. : Seven-year study of hepatitis B vaccine efficacy in infants from an endemic area (Senegal). Lancet 1986;2:1143–1145.CrossRefGoogle ScholarPubMed
44. Coursaget, P, Yvonnel, B, Gilks, WR, et al. : Scheduling of revaccination against hepatitis B virus. Lancet 1991;337:1180–1183.CrossRefGoogle ScholarPubMed
45. Rawal, BK, Krutz, JB: Timing of booster doses of hepatitis B vaccine. Lancet 1989;2:1274.Google Scholar
46. Wainwright, RB, McMahon, BJ, Bulkow, LR, et al. : Duration of immunogenicity and efficacy of hepatitis B vaccine in a Yupik Eskimo population. JAMA 1989;261:2362–2366.CrossRefGoogle Scholar
47. Pasko, MT, Beam, TR: Persistence of anti-HBs among health care personnel immunized with hepatitis B vaccine. Am J Pub Health 1990;80:590–593.CrossRefGoogle ScholarPubMed
48. Krugman, S, Davidson, M: Hepatitis B vaccine: Prospects for duration of immunity. Yale J Biology Med 1987;60:333–338.Google ScholarPubMed
49. Advisory Committee on Immunization Practice: Update on hepatitis B prevention. MMWR 1987;36:353–366.Google Scholar