Reasons given by 78 renal units as to why dialysis patients are not routinely vaccinated for hepatitis B before starting dialysis and during dialysis. Values are numbers (percentages) of units Reason Before dialysis During dialysis Logistics of administration and monitoring 34 (44) 35 (45) Low perceived risk (outbreaks rare) 26 (33) 38 (49) Awaiting revised guidelines from units committee 24 (31) 26 (33) Effectiveness of universal precautions and screening of blood donors and patients 23 (29) 28 (36) Poor efficacy of vaccine in patients receiving dialysis 22 (28) 35 (45) Should be done in primary care 21 (27) 20 (26) Not cost effective 19 (24) 22 (28) Lack of awareness of higher dose (40 µg) vaccine 14 (18) 16 (21)