Vaccination of Health Care Workers

To the Editor. —  In a recent article, Murray et al¹ appropriately note the failure of professional health care training programs to provide effective hepatitis B virus (HBV) vaccine strategies for immunization of future health care workers. Current Occupational Safety and Health Administration proposed standards,² soon to be mandatory, call for hospitals to offer free HBV vaccination to all employees at "substantial risk." In this regard, whether health care students involved in direct patient care qualify as employees is not clear.The incidence of HBV infection continues to rise in this country³ despite the widespread availability of safe and effective vaccines. For this reason, the Immunization Practices Advisory Committee of the Public Health Service has recently agreed in principle to recommend universal immunization of all newborns with HBV vaccine. Formal recommendations will likely be published later this year. Even highly effective implementation of this strategy will have