Objective: To determine the level and determinants of vaccine response in recently inoculated public safety personnel.

Design: Prevalence survey.

Participants: Public safety personnel who had completed vaccination 1 to 6 months prior to testing and had no serological evidence of previous exposure to hepatitis B virus.

Main outcome measure: An inadequate level of antibody to hepatitis B surface antigen was defined as less than 10 mlU/mL.

Results: All subjects in the study had been vaccinated using Recombivax HB, a recombinant hepatitis B vaccine. Of 528 individuals, 11.9% were found to have no or inadequate levels of antibody. The frequency of inadequate level of antibody increased significantly relative to age, from 2.8% among those younger than 30 years to 42.1% among those older than 60 years (P < .0001). Smoking (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.0 to 6.4), extreme obesity (OR, 13.3; 95% CI, 3.8 to 49.1), and increasing time interval since completing the vaccine series (P < .01) were also associated with inadequate levels of antibody. These findings were confirmed by multivariate analysis using logistic regression.

Conclusions: Routine immunization of public safety personnel should include selective use of postvaccine testing. Postvaccination testing optimally should be performed in the 30- to 90-day interval after the last vaccine dose. New vaccination strategies are needed to improve response rates in persons with predictably poor response to hepatitis B vaccine.