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Nonresponsiveness to Hepatitis B Vaccine in Health Care Workers: Results of Revaccination and Genetic Typings

DONALD E. CRAVEN, M.D.; ZUHEIR L. AWDEH, Ph.D.; LAUREEN M. KUNCHES, R.N., M.P.H.; EDMOND J. YUNIS, M.D.; JULES L. DIENSTAG, M.D.; BARBARA G. WERNER, Ph.D.; B. FRANK POLK, M.D.; DAVID R. SNYDMAN, M.D.; RICHARD PLATT, M.D.; CLYDE S. CRUMPACKER, M.D.; GEORGE F. GRADY, M.D.; and CHESTER A. ALPER, M.D.
[+] Article and Author Information

Grant support: in part by grant #HL-29583 from the National Institutes of Health, and by a grant from the Department of Virus and Cell Biology Research, Merck Sharp & Dohme Research Laboratories, West Point, Pennsylvania.

Presented in part at the meeting of the American Association for the Study of Liver Diseases, July 1984, Chicago, Illinois (abstracted in Hepatology. 1984;4:1077).

▸ Requests for reprints should be addressed to Donald E. Craven, M.D.; Boston City Hospital, ℅ Maxwell Finland Laboratory, 774 Albany Street, Room 315; Boston, MA 02118.


Ann Intern Med. 1986;105(3):356-360. doi:10.7326/0003-4819-105-3-356
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Twenty-eight health care workers who had a poor antibody response when initially vaccinated with hepatitis B vaccine were revaccinated with three additional 20-µg doses. Eight of the twenty nonresponders, who had levels of antibody to hepatitis B surface antigen (anti-HBs) of less than 8 estimated radioimmunoassay (RIA) units, and all 8 of the hyporesponders, who had anti-HBs levels of 8 or 16 RIA units, attained anti-HBs levels of 36 RIA units or more after revaccination. Tests for HLA-A, B, C, and DR; for complement proteins C2, C4A, C4B, and BF; and for the erythrocyte enzyme glyoxalase I were done in 17 nonresponders and 3 hyporesponders. Nine (45%) had HLA-DR7 and 8 (40%) had HLA-DR3, compared with an expected rate of 23% in the general population. At least one of two extended haplotypes (B44, DR7, FC31 or B8, DR3, SCOl) were detected in 6 of the 9 who did not respond to revaccination, compared with 2 of 11 who responded to a second course of vaccine. Poor responders to vaccine may benefit from revaccination, and genetic factors may modulate the immune response to vaccination.

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