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: 3.62). 10/2009; 28(3):623-31. DOI: 10.1016/j.vaccine.2009.10.068
Source: PubMed


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 Reference lists of articles were screened and the studies authors and manufacturers were contacted for additional unpublished references.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
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    • "Moreover, the protection provided by a full course of vaccine beginning at early infancy lasted for at least two decades. To determine vaccine efficacy for longer periods and possible need of booster dose, additional studies were recommended (37, 38). Fifteen to 20 years after primary infant HB immunization, some vaccinees engaged in risky behaviors and/or occupation that might put them at risk of more exposure to HB infection. "
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    ABSTRACT: The epidemiological impact and the duration of protection provided by infant hepatitis B (HB) vaccination are unknown. This study was designed to determine the hepatitis B virus (HBV) infection seromarkers in young adults who have been vaccinated against HBV as the first group of Iranian neonates during 1993 and 1994. We recruited 510 young adults with a history of complete HB vaccination at birth. HBV seromarkers (HB surface antigen (HBs Ag), antibody against HBs Ag (Anti-HBs), and antibody against HB core antigen (Anti-HBc) were measured using ELISA method. Anti-HBs titers ≥ 10 IU/L were considered protective and titers more than 300 IU/L were indicative of a natural boosting. Positive results for Anti-HBc and HBs Ag were considered as breakthrough infection and possible vaccine failure, respectively. The history of acute symptomatic clinical hepatitis was also investigated. Anti-HBs seropositivity rate was detected in 224 of 510 [95% CI: 39-47] young adults. Breakthrough infection (positive sera for Anti-HBc without chronic infection) was observed in 18 [95% CI: 2.5-3.5] subjects. There were neither HBs Ag positive results nor symptomatic hepatitis cases. The study results indicated that the neonatal HBV immunization induced a long-term protection against HBV and was very efficacious in reducing chronic HBV infection rate in vaccinated young adults in Iran.
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    • "Although several studies have established vaccine efficacy into adolescence, most are in Asia where the predominant HBV serotypes differ from those in Africa and some 40% of chronic infection is acquired perinatally from the mother, whereas in Africa child-to-child transmission predominates [22-24]. It has not been established whether protection by infant vaccination continues into adult life, when repeated sexual exposure is likely. "
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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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