Ethnicity and response to primary three-dose hepatitis B vaccination in employees in the Netherlands, 1983 through 2017

Ozgor M. Koc*, Charlotte Menart, Jemimah Theodore, Cecile Kremer, Niel Hens, Ger H. Koek, Astrid M. L. Oude Lashof

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Web of Science)


Background and Aims Hepatitis B virus (HBV) vaccination is recommended to all employees who have an occupational risk in the Netherlands. This study assessed the determinants of the immune response to primary standard three-dose HBV vaccination (0, 1, 6 months), with the main focus on ethnicity. Methods Out of 76 239 individuals who received HBV vaccination between April 1983 and December 2017, 11 567 persons with a known country of birth and complete vaccination schedule were included in this study. Weighted multiple logistic regression with Firth's bias adjustment was used to assess the determinants of nonresponse (anti-HBs <10 mIU/mL) and low response (anti-HBs 10-99 mIU/mL). Results Baseline characteristics of the study population (n = 11 567) were as follows: mean age 27.5 years (95% confidence interval [CI], 27.23-27.72), 99.4% born in the Netherlands and 93.5% of Western European origin. Of all identified subjects, 180 (1.6%) were HBV vaccine nonresponders and 549 (4.8%) were low responders. When compared with individuals aged 40 years in comparison with those younger than 40 years, P <.001. All nonresponders were born in the Netherlands. Although no significant association was found between nonresponse and individuals of Western European origin (adjusted odds ratio [aOR] = 1.20; 95% CI, 0.66-2.44; P = .163), low response to HBV vaccination was significantly associated with Western European origin (aOR = 2.21; 95% CI, 1.41-3.86; P = .001). Significant determinants for nonresponse were older age at vaccination (aOR = 1.06; 95% CI, 1.06-1.07; P <.001) and male gender (aOR = 2.51; 95% CI, 1.97-3.22; P <.001). Conclusions The nonresponse rate was low in our study population. Our findings suggest that the vaccines being used for the primary vaccination are probably less immunogenic for older individuals, males, and persons of Western European origin.

Original languageEnglish
Pages (from-to)309-316
Number of pages8
JournalJournal of Medical Virology
Issue number3
Early online date29 Oct 2019
Publication statusPublished - Mar 2020


  • determinant
  • ethnicity
  • healthcare workers
  • hepatitis B
  • nonresponse

Cite this