Antibody levels and protection after hepatitis B vaccination: Results of a 15-year follow-up

Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, and the Alaska Native Medical Center, Anchorage, Alaska 99508, USA.
Annals of internal medicine (Impact Factor: 17.81). 04/2005; 142(5):333-41.
Source: PubMed


The duration of protection afforded by hepatitis B vaccination is unknown.
To determine antibody persistence and protection from hepatitis B virus (HBV) infection.
Prospective cohort study.
15 villages in southwest Alaska.
1578 Alaska Natives vaccinated at age 6 months or older.
During 1981-1982, participants received 3 doses of plasma-derived hepatitis B vaccine. This cohort was followed annually over the first 11 years, and 841 (53%) persons were tested at 15 years.
Antibody to hepatitis B surface antigen (anti-HBs), markers of HBV infection, and testing to identify HBV variants.
Levels of anti-HBs in the cohort decreased from a geometric mean concentration of 822 mIU/mL after vaccination to 27 mIU/mL at 15 years. Initial anti-HBs level, older age at vaccination, and male sex were associated with persistence of higher anti-HBs levels at 15 years when analyzed by a longitudinal linear mixed model. After adjustment for initial anti-HBs level and sex, those vaccinated at age 6 months to 4 years had the lowest anti-HBs level at 15 years. Asymptomatic breakthrough infections were detected in 16 participants and occurred more frequently in persons who did not respond to vaccination than those who responded (P = 0.01). Among infected persons with viremia, 2 were infected with wild-type HBV and 4 had HBV surface glycoprotein variants, generally accompanied by wild-type HBV.
The loss of participants to follow-up at 15 years was 47%. However, characteristics of persons tested were similar to those of persons lost to follow-up.
Hepatitis B vaccination strongly protected against infection for at least 15 years in all age groups. Antibody levels decreased the most among persons immunized at 4 years of age or younger.

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    • "The high viral load related to HBeAg-positivity seems to be the most important factor for breakthrough infection [25] [31]. Moreover, when the mother is infected by genotype C HBV, intrauterine infection may occur before vaccination can be administred, in addition to hyporesponsivness to vaccination [31] [32]. When the mother is a chronic carrier, vaccination at birth is not sufficient to avoid vertical transmission, and concurrent intramuscular administration of 0.5 ml of hepatitis B immunoglobulin (HBIG) is recommended to give immediate passive immunity to the newborn [26] [33]. "
    Journal of Hepatology 10/2013; 59(4):814-829. DOI:10.1016/j.jhep.2013.05.016 · 11.34 Impact Factor
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    • "Our findings were in line with other studies which suggested long-term protection of HB vaccine albeit with shorter follow-up durations. Persistence of serum protective antibody level was shown in older children or adolescents who received vaccination at infancy [6] [7] [8]. Moreover, anamnestic response was demonstrated in those who had lost protective antibody level, years after vaccination [9]. "
    Journal of Hepatology 08/2013; 59(6). DOI:10.1016/j.jhep.2013.08.021 · 11.34 Impact Factor
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    • "Since universal vaccination against hepatitis B virus (HBV) was introduced, the persistence of protective antibodies after the primary series has been the major issue given the scarce data regarding the duration of immunity, especially in low endemicity countries [1] [2]. According to international standards, antibodies values higher than 10 IU/l have to be considered as protective [3] [4]. "
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    ABSTRACT: Vaccination of infants, children and adolescents against the hepatitis B virus (HBV) is mandatory in Italy. It is crucial to assess whether vaccinated subjects have protective antibody level during adulthood when the risk of HBV infection increases due to lifestyle or occupational exposure. Two groups of students attending to University of Padova Medical School were enrolled between 2004 and 2011 and HBV antibodies and antigens were measured. The first group (Group A) comprised students vaccinated at three months of age and the second group (Group B) comprised students vaccinated after the first year of life. The follow-up was 18.0 (Group A) and 17.9 (Group B) years. The students vaccinated at three months of age had a higher rate of non-protective antibodies (47.2%) comparing to those vaccinated after the first year of life (17.0%, P<0.0001) with a significantly lower antibody level (P<0.001). The rate of non-protective antibodies was inversely related to vaccination age. The results clearly show that children vaccinated after the first year of life are better protected against HBV. On the other hand, both groups show a good immunological memory as evidenced by the achievement of protective antibody level after the booster dose in 97.8% of subjects.
    Vaccine 02/2013; 31(13). DOI:10.1016/j.vaccine.2013.01.046 · 3.62 Impact Factor
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