Public Health

Protection against hepatitis B virus infection may wane after 15 years

Last Updated: 2008-10-23 12:21:20 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Protection against hepatitis B virus infection appears to have waned in adolescents vaccinated with recombinant hepatitis B vaccine beginning at birth, according to a report in the October issue of The Pediatric Infectious Disease Journal.

In 105 adolescents who had received the recombinant hepatitis B vaccine series starting at birth 15 years earlier, Dr. Stephanie R. Bialek from the US Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues evaluated the prevalence of breakthrough infections, the persistence of protective levels of anti-hepatitis B surface antigen (anti-HBs), and the serologic response to a booster dose of hepatitis B vaccine.

Only 8 of the 105 participants (7.6%) showed evidence of new HBV infection, as indicated by anti-hepatitis B core (anti-HBc) positive status, since baseline testing at age 35 months, the authors report, and no participant was chronically infected. Three of the 8 had shown protective levels of anti-HBs at baseline.

Only 7 of the 97 participants (7.3%) who were anti-HBc-negative at the 15-year follow-up had prebooster dose anti-HBs concentrations of at least 10 mIU/mL, and only 2 participants had concentrations above 99 mIU/mL.

Less than half (46/96, 47.9%) of the participants who elected to receive a booster dose of hepatitis B vaccine had an antibody response at 14 days, including the 7 who had protective anti-HBs concentrations before the booster, the researchers note.

Responses were more common among the participants with protective anti-HBs concentrations at the time of baseline testing at age 35 months (27/42, 64.3%) than among those without protective anti-HBs concentrations at baseline (19/54, 35.2%).

"At this point in time, we do not have any evidence from our surveillance systems of breakthrough hepatitis B virus infections occurring among vaccinated adolescents and therefore do not recommend additional doses of hepatitis B vaccine for adolescents or children who already received three doses of hepatitis B vaccine," Dr. Bialek told Reuters Health.

"There are no assays available to measure cellular immunity resulting from hepatitis B vaccination," she said. "The failure to mount an anamnestic response does not necessarily mean that an individual is no longer protected against hepatitis B."

"We need to continue to continue surveillance for hepatitis B among vaccinated adolescents and consider conducting a larger study among young adults in the United States who were vaccinated beginning at birth to provide data for making decisions about whether the additional doses of hepatitis B vaccine should be recommended in the future," Dr. Bialek concluded.

Pediatr Infect Dis J 2008;27:881-885.