Vaccine 30 (2012) 3147–3150 Contents lists available at SciVerse ScienceDirect Vaccine jou rn al h om epa ge: www.elsevier.com/locate/vaccine Brief report Hepatitis B vaccination of susceptible elderly residents of long term care facilities during a hepatitis B outbreak Roxanne E. Williams a , Arlene C. Sena b,c , Anne C. Moorman a,* , Zack S. Moore d , Umid M. Sharapov a , Jan Drobenuic a , Dale J. Hu a , Hattie W. Wood b , Jian Xing a , Philip R. Spradling a a Division of Viral Hepatitis, Centers for Disease Control, Prevention, Atlanta, GA, United States b Durham County Health Department, Durham, NC, United States c University of North Carolina at Chapel Hill, Chapel Hill, NC, United States d North Carolina Department of Health and Human Services, United States a r t i c l e i n f o Article history: Received 24 January 2012 Received in revised form 20 February 2012 Accepted 27 February 2012 Available online 13 March 2012 Keywords: Hepatitis B HBV Vaccination Elderly Diabetic a b s t r a c t Protection of older persons, particularly those with diabetes, against hepatitis B virus (HBV) infection is of growing concern because of increased reports of outbreaks among long-term care facility residents receiving assisted blood glucose monitoring. We evaluated hepatitis B vaccine immunogenicity among residents immunized in response to two such outbreaks in skilled nursing facilities during June 2009–July 2010. One hundred forty-eight (71%) of 209 residents were found to be susceptible to HBV infection. Of 105 patients who began a vaccination series with Twinrix ® (0-, 1-, 6-month dosing), 86 (82%) completed the series and postvaccination testing. Of these, most were elderly (median age 79.5 years; range 45–101), female (56%), and African-American (51%). Twenty-nine (34%) vaccinated residents had post-vaccination hepatitis B surface antibody levels ≥10 mIU/ml. There were no significant differences in vaccine response by age, gender, race, diabetes status, body mass index, or current smoking status. Our findings indicate that a low proportion of skilled nursing facility residents achieved a seroprotective response after hepatitis B vaccination. Published by Elsevier Ltd. 1. Introduction Protection of elderly persons against hepatitis B virus (HBV) infection is of growing concern due to continued occurrence of out- breaks in long-term care facilities such as assisted living facilities and skilled nursing facilities. During a 15-year period (1996–2011), 29 outbreaks of acute HBV infection among residents at US long- term care facilities were reported to the Centers for Disease Control and Prevention (CDC), 25 (86%) of which were linked to breaks in infection control practices during assisted blood glucose mon- itoring [1–3]. Infection control resources and monitoring are often lacking in long-term care facilities and other nonhospital health care settings [2]. These outbreaks require considerable expenditure of already limited financial and personnel resources at the facilities, as well as at the state and local health departments conducting the out- break investigations. More importantly, they result in preventable illnesses and even deaths among residents. Although deaths due to acute HBV infection are generally uncommon even among * Corresponding author. E-mail address: acm4@cdc.gov (A.C. Moorman). residents in long-term care settings [2], mortality rates as high as 75% have been reported [4]. The populations at risk for both HBV infection and diabetes are predicted to become greater as the US population ages and more persons enter long-term care [5] and require diabetes care [6]. Vaccination of hepatitis B susceptible residents has been sug- gested as one strategy to prevent or control outbreaks in long-term care facilities. The combined hepatitis A and hepatitis B vaccine (Twinrix ® ) has been shown to be safe, well-tolerated and highly immunogenic in children, adolescents and adults [7–9]. There is limited information in the literature on the immunogenicity of either Twinrix ® or monovalent hepatitis B vaccine among elderly populations [8,10,11]. Therefore, we evaluated seroprotection after hepatitis B vaccination of residents during hepatitis B outbreaks in two skilled nursing facilities in North Carolina. 2. Methods 2.1. Study population and vaccine administration During July 2009–June 2010, public health officials from the Durham County Health Department, the North Carolina Depart- ment of Health and Human Services and CDC investigated hepatitis 0264-410X/$ – see front matter. Published by Elsevier Ltd. doi:10.1016/j.vaccine.2012.02.078