Long-term protection provided by hepatitis B vaccine and need for booster dose: A meta-analysis

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Vaccine (Impact Factor: 3.49). 10/2009; 28(3):623-31. DOI: 10.1016/j.vaccine.2009.10.068
Source: PubMed

ABSTRACT The duration of protection provided by hepatitis B vaccine is still unknown but can be estimated through long-term follow-up studies. Electronic databases and conference databases to December 2008 were searched. Reference lists of articles were screened and the studies authors and manufacturers were contacted for additional unpublished references. Randomized clinical trials and prospective cohort studies addressing the long-term protective effect of hepatitis B vaccine were included in this meta-analysis. We assessed 42 separate cohorts involving overall 11,090 subjects; 34 cohorts involving 9356 subjects were included in the final meta-analysis. Results indicate that the overall cumulative incidence of HBV breakthrough infection 5-20 years post-primary vaccination was 0.007 [95% CI: 0.005 to 0.010] with a variation among studies from 0 to 0.094. Available data do not allow us to exclude an increased risk for infection with time since vaccination. We conclude that the protection provided by three or four doses of monovalent HB vaccine persists for at least two decades in the great majority of immunocompetent individuals. Additional studies are needed for assessing vaccine efficacy for longer periods of time and the need of booster doses in different subgroups of population.

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Available from: Reza Majdzadeh, Aug 19, 2015
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    • "Several studies have shown levels of hepatitis B surface antibody (anti-HBs) below 10 IU/L in vaccinated populations (Zanetti et al., 2005; Chongsrisawat et al., 2006; Lu et al., 2006; Voigt et al., 2010; Livramento et al., 2011; Tonial et al., 2011; Scaraveli et al., 2011; Passos et al., 2011). Nevertheless, the need for booster doses against hepatitis B in individuals with anti-HBs less than 10 IU/L has still to be determined (Kane et al., 2000; Poorolajal et al., 2010). "
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    ABSTRACT: The study of the human immune response to hepatitis B virus (HBV) has been hampered by the lack of an adequate model to evaluate the hepatitis B surface antigen (HBsAg) specific cell response. Thus, this study was conducted to perform an in vitro analysis of the antigenic properties of recombinant HBsAg and demonstrate the influence of variables such as culture time, antigen concentration and cell density on lymphocyte proliferation. Peripheral blood mononuclear cells (PBMCs) were isolated from the venous blood of vaccinated individuals, and in vitro cellular immune responses were evaluated using an HBsAg-specific proliferation assay. Lymphoproliferative responses were detected in culture systems, despite the lack of serum antibodies. Optimal results were obtained when lymphocytes were stimulated at a seeding density of 4×10(6) cells/mL, with 50ng/mL of recombinant HBsAg protein vaccine for 3 days. Data from the present study may contribute to the development of an adequate system to evaluate the cellular immune responses to HBsAg in vaccine recipients.
    Journal of virological methods 08/2013; 193(2). DOI:10.1016/j.jviromet.2013.07.043 · 1.88 Impact Factor
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    • "Based on the above evidence, routine HAV and HBV vaccinations are recommended for all infants, including those with CF and chronic liver disease [11] [12] [13]. Hepatitis B surface antibody (anti-HBs) is an imperfect marker of HBV protection, and while controversy exists over the utility of HBV vaccine boosters, post-vaccination anti-HBs levels ≥10 mIU/mL do successfully prevent active HBV infection [14] [15] [16]. However, vaccine seroconversion rates may be reduced in patients with pre-existing liver disease, including children with biliary atresia [17] [18] [19] [20]. "
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    ABSTRACT: OBJECTIVES: Hepatitis A (HAV) and Hepatitis B (HBV) infections can cause serious morbidity in patients with liver disease, including cystic fibrosis associated liver disease (CFALD). HAV and HBV vaccinations are recommended in CFALD, and maintenance of detectable antibody levels is also recommended with chronic liver disease. A better understanding of factors predicting low HAV and HBV antibodies may help physicians improve protection from these viruses in CFALD patients. METHODS: We examined HAV and HBV vaccine protection in children at risk for CFALD. Clinical and vaccine histories were reviewed, and HAV and HBV antibody titers measured. Those with no vaccination history or low HAV or HBV titers received primary or booster vaccinations, and responses were measured. RESULTS: Thirty-four of 308 children were at risk for CFALD per project criteria. Ten had previous HAV vaccination, of which 90% had positive anti-HAV antibodies. Thirty-three of 34 had previously received primary HBV vaccination (most in infancy), but only 12 (35%) had adequate anti-HBs levels (≥10mIU/mL). Children with adequate anti-HBs levels were older at first HBV vaccine (median 2.3 vs. 0.1 years, p<0.01), and at final HBV vaccine (median 4.0 vs. 0.8 years, p=0.01). Fourteen of 19 (74%) responded to HBV boosters. Z-scores for BMI at HBV booster were significantly lower in booster non-responders (p=0.04). CONCLUSIONS: Children at increased risk of CFALD have inadequate HAV and HBV antibody levels, and HBV antibody protection can be enhanced through vaccine boosters. HBV antibody titers should be assessed in CFALD patients with a history of vaccination, particularly in those who received HBV vaccines in infancy or who are malnourished.
    Vaccine 12/2012; 31(6). DOI:10.1016/j.vaccine.2012.12.004 · 3.49 Impact Factor
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    • "Initially, two laboratories produced recombinant hepatitis B vaccines using Saccharomyces cerevisiae as an expression system to obtain the HBsAg particles (Shouval 2003). These vaccines are highly immunogenic and safe and induce protection against hepatitis B infections for at least 20 years (But et al. 2008, Poorolajal et al. 2010). Today, highly immunogenic hepatitis B vaccines comprising recombinant HBsAg generated using different yeast expression systems are available, but there are no data on anti-HBs persistence (Ioshimoto et al. 1999, Hieu et al. 2002, Vijayakumar et al. 2004, Zhang et al. 2011). "
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    ABSTRACT: The protective anti-HBs titres were examined six-year post-immunisation with the Brazilian recombinant hepatitis B vaccine. After the primary vaccination, all adolescents (n = 89) responded with protective anti-HBs titres and had a geometric mean titre (GMT) of 4031.8 mIU/mL. In 2010, 94.5% maintained protective anti-HBs (> 10 mIU/mL) antibodies, with a GMT of 236.0 mIU/mL. A positive correlation was observed between the anti-HBs titres after the primary vaccination and the titres at the six-year follow-up (p < 0.01). Eleven subjects showed anti-HBs titres suggestive of a natural booster. Prostitution and tattoos/piercings were marginally associated with natural boosters in the multivariate analysis. This study showed the first data on anti-HBs persistence following the Brazilian hepatitis B vaccine in sexually active individuals and highlights its effectiveness in the medium term.
    Memórias do Instituto Oswaldo Cruz 12/2012; 107(8):1060-3. DOI:10.1590/S0074-02762012000800016 · 1.57 Impact Factor
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