Hepatitis B virus vaccination booster does not provide additional protection in adolescents: a cross-sectional school-based study

Abstract

BackgroundCurrent consensus does not support the use of a universal booster of hepatitis B virus (HBV) vaccine because there is an anamnestic response in almost all children 15 years after universal infant HBV vaccination. We aimed to provide a booster strategy among adolescents as a result of their changes in lifestyle and sexual activity.MethodsThis study comprised a series of cross-sectional serological surveys of HBV markers in four age groups between 2004 and 2012. The seropositivity rates of hepatitis B surface antigen (HBsAg) and its reciprocal antibody (anti-HBs) for each age group were collected. There were two parts to this study; age-specific HBV seroepidemiology and subgroup analysis, including effects of different vaccine types, booster response for immunogenicity at 15 years of age, and longitudinal follow-up to identify possible additional protection by HBV booster.ResultsWithin the study period, data on serum anti-HBs and HBsAg in a total of 6950 students from four age groups were collected. The overall anti-HBs and HBsAg seropositivity rates were 44.3% and 1.2%, respectively. The anti-HBs seropositivity rate in the plasma-derived subgroup was significantly higher in both 15- and 18-year age groups. Overall response rate in the double-seronegative recipients at 15 years of age was 92.5% at 6 weeks following one recombinant HBV booster dose. Among the 24 recipients showing anti-HBs seroconversion at 6 weeks after booster, seven subjects (29.2%) had lost their anti-HBs seropositivity again within 3 years. Increased seropositivity rates and titers of anti-HBs did not provide additional protective effects among subjects comprehensively vaccinated against HBV in infancy.ConclusionsHBV booster strategy at 15 years of age was the main contributor to the unique age-related phenomenon of anti-HBs seropositivity rate and titer. No increase in HBsAg seropositivity rates within different age groups was observed. Vaccination with plasma-derived HBV vaccines in infancy provided higher anti-HBs seropositivity at 15–18 years of age. Overall booster response rate was 92.5% and indicated that intact immunogenicity persisted at least 15 years after primary HBV vaccination in infancy. Booster vaccination of HBV did not confer additional protection against HBsAg carriage in our study.

Hepatitis B virus surface antigen and antibody markers in children at a major paediatric hospital after the pentavalent DTP-HBV-Hib vaccination

“…In the face of the possibility of declining titres with age irrespective of the vaccination schedule of infants 5,17 , and the loss of immune memory 8,28 , it may be important to consider 100 mIU/ml as the desired response after vaccination since the use of either one or multiple vaccines from different manufacturers significantly contributed to that level of protection.…”

Predictors of Booster Response to Hepatitis B Vaccine at 15 years of age: A Cross-Sectional School-Based Study

“…In our previous study in 2014, 8 we studied 38 18-year-old individuals (birth cohort 1993e1994) who had studied in our senior high school prior to attending our university. Among the 25 booster recipients, 96% (24/25) regained protective levels of anti-HBs with a median anti-HBs titer of 353 mIU/ mL after one booster dose of HBV vaccine at age 15.…”

Characteristics of immune memory 10–15 years after primary hepatitis B vaccination

“…A typical anamnestic response is characterised by a rapid 10-100-fold increase in specific antibodies, which starts 5-8 days after the re-exposure to the antigen and peaks after about 14 days [2][3][4]. HBsAg-specific memory has been shown to persist for at least 15-17 years after immunisation [5][6][7]. Long-term follow-up studies have shown that clinical HBV-disease or HBsAg-carrier status rarely occur among successfully vaccinated individuals, even in the case of anti-HBs titres <10 IU/l [8].…”

“…Anti-HBs antibodies can be reliably measured by standardised tests, but no standardised method is yet available for measuring specific immune memory. In studies in which immune memory was shown by means of the increase in anti-HBs after booster vaccination, anti-HBs titres were mostly measured only once and at rather different time points, ranging from 10 days to 2 months post-booster [7,[18][19][20][21]. In addition, in some studies anamnestic response was defined as an increase in anti-HBs to ≥10 IU/l [21][22][23][24][25], in other studies as 4-fold increase in anti-HBs [5], and sometimes both criteria were applied [13,15,20,26].…”