ASSESSMENT OF A UNIVERSAL, SCHOOL-BASED HEPATITIS-B VACCINATION PROGRAM

Objective.-To assess a hepatitis B vaccination program offered to all grade 6 students in British Columbia in 1992. Design.-Cohort study. Setting.-British Columbia, Canada. Participants.-All grade 6 students were offered vaccine. Subsets of 454 and 259 students participated in studies of minor adverse events and seroresponse, respectively. Intervention.-The vaccine used was Engerix-B, 20 mu g, given at intervals of 0, 1, and 6 months. Main Outcome Measures.-Province-wide acceptance and series completion rates and reports of severe adverse events. Minor adverse events and immunogenicity in subsamples. Results.-A total of 127 922 vaccine doses were administered. initial enrollment totaled 43 358 students or 95.4% of those eligible. The series was completed by 41 594 students (95.6%). Minor adverse events were infrequent in the cohort assessed: no absenteeism or physician visits resulted from vaccination. Sixty-nine reported severe adverse events met surveillance definitions, the major categories being injection site reactions (23% of reports), fainting (20%), and rashes (17%). There was one instance of anaphylaxis. Only 13 of these events resulted in recommendations to discontinue the series. Of students tested following the series, 98% had levels of antibody to hepatitis B surface antigen considered to be protective (greater than or equal to 10 IU/L), the geometric mean titer being 690 IU/L (95% confidence interval, 498 to 957 IU/J). Conclusion.-Our experience indicates that school-based programs for universal vaccination of preadolescents can be highly acceptable and efficient.