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]. "

    Full-text · Article · Oct 2013 · Journal of Hepatology
    • "Fortunately, the prevalence of HBV infection has decreased significantly since the implementation of routine childhood vaccination programs in endemic areas, including Saudi Arabia [Al-Faleh, 2003; Fitzsimons et al., 2008]. However, it has also been shown that HBV vaccine failure rates may reach up to 10% [Zuckerman, 2006], and anti-HBs titers have been shown to decline with increasing age [Struve et al., 1992; Liao et al., 1999; Yuen et al., 2004; McMahon et al., 2005]. Therefore, this study evaluated the need for boosters and re-vaccination in this high-risk population. "
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    ABSTRACT: Chronic infection with hepatitis B virus (HBV) is a global health problem. In an attempt to control infection, worldwide HBV vaccination programs have been established. Saudi Arabia, an endemic area for HBV infection, established an HBV immunization program in 1989. This cross-sectional study evaluates the long-term protection of HBV vaccination 14-24 years after primary immunization in a high-risk group (clinical year medical students) at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. All participants had complete HBV immunization at birth or in early childhood. Hepatitis B surface antibody (anti-HBs) levels were obtained. An anti-HBs titer of <10 mIU/ml indicated no protection, while a titer of >10 mIU/ml was considered to represent protective immune status. A total of 238 students were included; they were predominantly females (n = 182, 76.5%). Mean age was 22.2 ± 1.1 years. Duration since primary vaccination was 19.8 ± 2.3 years. Female students were more likely to maintain long-term protection compared to males (62.1% and 58.8%, respectively). Anti-HBs levels were significantly low in many students after primary immunization. Testing medical students for anti-HBs levels may be warranted as they represent a high-risk population. The higher rate of vaccine failure in males than females requires further investigation as it may explain the higher prevalence of HBV in the male population. J. Med. Virol. 85:1518-1522, 2013. © 2013 Wiley Periodicals, Inc.
    No preview · Article · Sep 2013 · Journal of Medical Virology
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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]. "

    Preview · Article · Aug 2013 · Journal of Hepatology
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