Hepatitis B vaccines: WHO position paper

Department of Immunization, Vaccines and Biologicals, World Health Organization, 20, Avenue Appia, 1211 Geneva 27, Switzerland.
Vaccine (Impact Factor: 3.62). 11/2009; 28. DOI: 10.1016/j.vaccine.2009.10.110
Source: PubMed


This article presents the WHO recommendations on the use of hepatitis B vaccines excerpted from the recently published Hepatitis B vaccines: WHO position paper. This document replaces the WHO position paper on hepatitis B vaccines published in the Weekly Epidemiological Record in July 2004. Footnotes to this paper provide a limited number of core references; their abstracts as well as a more comprehensive list of references may be found at Grading tables assessing the level of scientific evidence are also available through this link and are referenced in the position paper. In accordance with its mandate to provide guidance to Member States on health-policy matters, WHO is issuing a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with the current WHO position concerning their use in the global context. This updated paper reflects the recent recommendations of WHO's strategic Advisory Group of experts on immunization.

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    • "In line with some previous reports [13], [14], we found that only a small proportion (18.9%) of young adults who had received neonatal immunization remained positive for anti-HBs. The current view of World Health Organization is that these persons still retain memory immunity, and booster dose is not necessary in routine immunization program [7]. Our observation is in line with this, since despite a relatively low anti-HBs positive rate among the neonatal vaccinated cohort, anti-HBcore was negative in all except two carriers. "
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    ABSTRACT: BackgroundNewborns who have received hepatitis B immunization in 1980s are now young adults joining healthcare disciplines. The need for booster, pre- and post-booster checks becomes a practical question.AimsThe aim of this study is to refine the HBV vaccination policy for newly admitted students in the future.MethodsA prospective study on medical and nursing school entrants to evaluate hepatitis B serostatus and the response to booster doses among young adults.FindingsAmong 212 students, 17–23-year-old, born after adoption of neonatal immunization, 2 (0.9%) were HBsAg positive, 40 (18.9%) were anti-HBs positive. At 1 month after a single-dose booster for anti-HBs-negative students, 14.5% had anti-HBs <10 mIU/mL, 29.0% and 56.5% were 10–100 and >100 mIU/mL, respectively. The anti-HBs levels were significantly higher for females than males (mean [SD]: 431 [418] vs. 246 [339] mIU/mL, P = 0.047). At 2–4 month after the third booster dose, 97.1% had anti-HBs >100 mIU/mL and 2.9% had 10–100 mIU/mL.ConclusionsPre-booster check is still worthwhile to identify carriers among newly recruited healthcare workers born after adoption of neonatal immunization. A 3-dose booster, rather than a single dose, is required for the majority to achieve an anti-HBs level >100 mIU/mL, as memory immunity has declined in a substantial proportion of individuals. Cost-effectiveness of post-booster check for anti-HBs is low and should be further evaluated based on contextual specific utilization of results.
    PLoS ONE 09/2014; 9(9):e107163. DOI:10.1371/journal.pone.0107163 · 3.23 Impact Factor
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    • "Passive and active immunizations are the most effective measures to prevent HBV infection and its consequences. For the babies from HBsAg positive mothers, use of HB vaccine and HBIG after 12 hour of birth tremendously reduces the HBV infection rate [4]–[6]. However, despite the administration, the incidence of non-responders or low-responders, even immunoprophylaxis failure still remains [7]–[10]. "
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    ABSTRACT: Despite the use of hepatitis B (HB) vaccine and hepatitis B immunoglobulin (HBIG), a portion of infants are still non- or low-responders, or even immunoprophylaxis failure. We aimed to determine the immune response in the infants from the mothers being positive for hepatitis B surface antigen (HBsAg), by which the infants received three doses of HB vaccine in combination with two-dose 200 IU HBIG injections. In this retrospective study, 621 infants from HBsAg-positive mothers in Beijing YouAn Hospital between January 2008 and December 2009 were included. All the infants were given three doses of 10 µg HB vaccine (at 0, 1 and 6 months of age) and two-dose of 200 IU HBIG (at birth and in 2 weeks of age). Serum HBsAg and antibody to HBsAg (anti-HBs) in all the infants were determined at 7 months of age. Of the 621 infants, 2.9% were immunoprophylaxis failure (positive for HBsAg), 1.4% were non-responders (anti-HBs undetectable), 95.7% were responders. The 594 responders could be categorized into three subsets, 22 were 10 to 99 IU/L for anti-HBs levels, 191 were 100 to 999 IU/L, and 381 were ≥1000 IU/L. The immunoprophylaxis failure rate was at 0% and 5.2% for the infants of HBeAg-negative and HBeAg-positive mothers(P<0.001). Infants from mothers with detectable HBV DNA had higher incidence of immunoprophylaxis failure than those of mothers without detectable HBV DNA (P = 0.002). The factors including gender, birth weight, gestation weeks, the rates of maternal HBeAg-positive, and detectable HBV DNA did not contribute to the no response to HB vaccination. Through vaccination by three doses of HB and two-dose of HBIG, majority of the infants (95.7%) achieved a protective level of anti-HBs at 7 months of age. Maternal HBeAg-positive and HBV DNA detectable were associated with the immunoprophylaxis failure, but not contribute to the non- or low-response to HB vaccination.
    PLoS ONE 10/2011; 6(10):e26748. DOI:10.1371/journal.pone.0026748 · 3.23 Impact Factor
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    • "Intradermal (ID) delivery of vaccines has been shown to induce protective immunity against many diseases, including hepatitis B [1], [2], rabies [3], tuberculosis [4], measles [5], polio [6] and influenza [7], [8]. ID vaccination aims to exploit the abundance of antigen presenting cells (APCs) found within the skin; that is dermal dendritic cells (DDCs) in the dermis and LCs in the epidermis. "
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    ABSTRACT: There is a significant gap in our fundamental understanding of early morphological and migratory changes in human Langerhans cells (LCs) in response to vaccine stimulation. As the vast majority of LCs studies are conducted in small animal models, substantial interspecies variation in skin architecture and immunity must be considered when extrapolating the results to humans. This study aims to determine whether excised human skin, maintained viable in organ culture, provides a useful human model for measuring and understanding early immune response to intradermally delivered vaccine candidates. Excised human breast skin was maintained viable in air-liquid-interface organ culture. This model was used for the first time to show morphological changes in human LCs stimulated with influenza virus-like particle (VLP) vaccines delivered via intradermal injection. Immunohistochemistry of epidermal sheets and skin sections showed that LCs in VLP treated skin lost their typical dendritic morphology. The cells were more dispersed throughout the epidermis, often in close proximity to the basement membrane, and appeared vertically elongated. Our data provides for increased understanding of the complex morphological, spatial and temporal changes that occur to permit LC migration through the densely packed keratinocytes of the epidermis following exposure to vaccine. Significantly, the data not only supports previous animal data but also provides new and essential evidence of host response to this vaccination strategy in the real human skin environment.
    PLoS ONE 08/2010; 5(8):e12410. DOI:10.1371/journal.pone.0012410 · 3.23 Impact Factor
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