Abstract
Advisory committees recommend hepatitis B (HBV) immunization for professional and student health‐care workers. However, the currently licensed vaccines are expensive, and previous surveys have shown that few students (14%) have been immunized in Canada. A low‐cost immunization program was offered to health‐care students in order to determine whether the effectiveness of HBV immunization could be improved by substantially reducing the vaccine cost to recipients. The immunogenicity, side effects, and 3‐dose completion rate of a low‐cost Korean HBV vaccine were compared with a similar U.S.‐made vaccine. A total of 922 postsecondary students enrolled in 6 health‐care disciplines in Ottawa, Canada were surveyed for hepatitis‐6 immunization status. Nonimmunized students were subsequently offered HBV vaccine at total cost of $15 (Canadian), randomly allocated t o receive 3 intramuscular doses of either Korean or U.S.‐made plasma‐derived HBV vaccine in a double‐blind fashion, surveyed about side effects, and tested for hepatitis B surface antibody seroconversion. Only 12% of the 922 surveyed students had been previously immunized when vaccine was obtainable only at high cost. However, 66% of those not immunized participated in the vaccine trial and paid the $15 fee. Hepatitis‐B surface antibody seroconversion (≥10 sample ratio units by radioimmunoassay) occurred in 291/311 (93.6%) and 299/310 (96.5%) of recipients of 3 doses of the Korean and U.S. vaccines, respectively (P = 0.10). There were no meaningful differences in vaccine adverse effects, and 92.6% of recipients of either vaccine completed 3 doses. These results support the view that HBV immunization would be more effective (vaccine acceptance rates higher, greater proportions of persons protected) if lower cost vaccines were marketed. © 1992 Wiley‐Liss, Inc.