Hepatitis B vaccine boosters: Is there a clinical need in high endemicity populations?

Abstract

The Steering Committee for the Prevention and Control of Infectious Diseases in Asia recently conducted a survey of primary-care physicians in Asia, which revealed that many physicians administer boosters in their clinical practice and that there is considerable variation and uncertainty among physicians regarding this practice. This paper serves as a response to physicians' uncertainties by reviewing the literature regarding the administration of hepatitis B vaccine boosters in high endemicity areas and presenting the Steering Committee's guidelines for booster administration. While there are few data to support a need for routine hepatitis B vaccine boosters as a public health measure, they help to provide reassurance of immunity against breakthrough infection in certain risk groups. In clinical practice, primary-care physicians must exercise their judgment regarding the need for booster vaccination on an individual basis. This paper examines the available literature on the administration and value of hepatitis B vaccine boosters, explores the differences between the public health approach and clinical practice, and provides guidelines for those who use boosters in high endemicity Asian populations. Relevant articles were identified through searches of MEDLINE (1975MEDLINE ( -2003 and the Cochrane Library, using 'hepatitis B' and 'booster' as primary search terms. Guidelines for those who decide to administer hepatitis B vaccine boosters include: boosting approximately 10-15 years after primary vaccination; boosting rather than not when monitoring of antibody levels is not feasible; boosting immunocompromised patients when the antibody to hepatitis B surface antigen titer falls below 10 mIU/mL; and boosting healthcare workers based on the endemicity of the particular country.

Age-specific prevalence of hepatitis B virus infection in young pregnant women, Hong Kong Special Administrative Region of China

“…Moreover, there is growing evidence that the antibody titre declines with age, especially after the age of 15 years 12 , 24 – 27 , 47 . The latest guidelines of the Steering Committee for the Prevention and Control of Infectious Diseases in Asia recommend a booster dose of HBV vaccine: (i) 10 to 15 years after primary vaccination in Asian populations where the virus is highly endemic and where it is not feasible to monitor antibody levels; (ii) in immunocompromised patients when the antibody titre falls to below10 mIU/mL; and (iii) in health-care workers 48 . A booster dose was also suggested for individuals who have a poor response to the vaccine and for high-risk adolescents 49 .…”

Seroprevalence of hepatitis B and immune response to hepatitis B vaccination in Chinese college students mainly from the rural areas of western China and born before HBV vaccination integrated into expanded program of immunization

“…Currently, international public health authorities did not recommend a booster for immune competent people after primary immunization because of the robust anamnestic response to HBV in most people for many years after priming, even when antibodies were undetectable upon exposure. [20][21][22][23] Nevertheless, some studies in Taiwan have revealed the absence of an anamnestic anti-HBs response Table 2. anti-HBs response after HB vaccination given at month 0, 1, and 6 among participants seronegative for HBsag, anti-HBs, and anti-HBc at baseline in approximately 25% adolescents after one booster dose.…”

Strategy vaccination against Hepatitis B in China

“…In highrisk groups, anti-HBs monitoring is significant and a booster dose of vaccine should be given if anti-HBs are lower than 10 mIU/ml. 17 In Beijing, local governments or medical facilities have granted HBV immunization of health care workers. 18 However, in most areas in China, the expenses of HBV vaccine immunization of high-risk populations should be covered by personal payment.…”