The low risk of hepatitis B in rural hospitals.

To the Editor.— The conclusions reached and recommendations made by Harris et al 1 following their seroepidemiologic survey for hepatitis B virus (HBV) markers in rural hospital personnel in Washington State are worrying. The investigators reported that only 96 (4.7% ) of 2,064 employees who volunteered to be tested had positive markers and concluded that they could not currently recommend routine vaccination of these rural hospital employees, even those with extensive exposure to blood. When assessing the risk of HBV infection for employees in a rural hospital, what constitutes the best basis for comparison? Certainly the exposure can be compared with that of employees in an urban hospital setting, but it should also be contrasted with the background frequency of HBV infection in rural areas. Even though these background rates are not specified by the investigators, it is mentioned that the incidence of HBV reporting in the seven urban counties is