Waning Immunity To Plasma–Derived Hepatitis B Vaccine and the Need for Boosters 15 Years After Neonatal Vaccination

Lu, Chun‐Yi; Chiang, Bor‐Luen; Chi, Wei-Kuang; Chang, Mei–Hwei; Ni, Yen‐Hsuan; Hsu, Hsu‐Mei; Twu, Shiing-Jer; Su, Ih‐Jen; Huang, Li‐Min; Lee, Chin‐Yun

doi:10.1002/hep.20490

Cited by 159 publications

(117 citation statements)

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“…Otherwise, the higher immunogenicity, safety, efficacy of the recombinant DNA-derived hepatitis B vaccines than plasma-derived vaccine was reported by other researchers [Hayashi et al, 1988;Most et al, 1992;Soyletir et al, 1992]. Lu et al [2004] who found unacceptably high rates of undetectable anti-HBs among children who had received four doses of plasma-derived hepatitis B vaccine as the neonatal immunization 15 years previously. They results suggest that one or more booster immunizations are needed in seronegative subjects by at least 15 years following neonatal immunization with plasma-derived hepatitis B vaccine.…”

Section: Discussionmentioning

confidence: 88%

Seroepidemiology of hepatitis A, B, C, and E viruses infection among preschool children in Taiwan

Lin

Chen

et al. 2005

Journal of Medical Virology

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Taiwan was a hyperendemic area for hepatitis A and B viruses (HAV and HBV) infection before late 1980s. To study the seroprevalence of hepatitis A, B, C, and E viruses (HCV and HEV) infection among preschool children in Taiwan, a community‐based survey was carried out in 54 kindergartens in 10 urban areas, 10 rural areas, and 2 aboriginal areas randomly selected through stratified sampling. Serum specimens of 2,538 preschool children were screened for the hepatitis A, C, and E antibodies by a commercially available enzyme immunoassay and for HBV markers by radioimmunoassay methods. The multivariate‐adjusted odd ratios (OR) with their 95% confidence intervals (CI) were estimated through the multiple logistic regression analysis. Females had a statistically significantly higher HAV seroprevalence than males. The seroprevalence of HCV infection increased significantly with age. The larger the sibship size, the higher the seroprevalence of HBV infection. Aboriginal children had a significantly higher seroprevalence of HBV and HEV infection and lower seroprevalence of HCV infection than non‐aboriginal children. A significantly higher seroprevalence of HBV infection was found in rural children than urban children. There was no significant association between serostatus of HAV and HEV infection and between serostatus of HBV and HCV infection among preschool children in Taiwan. The poor environmental and hygienic conditions in the aboriginal areas might play a role in infection with HBV and HEV. J. Med. Virol. 78:18–23, 2006. © 2005 Wiley‐Liss, inc.

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Section: Discussionmentioning

confidence: 88%

Seroepidemiology of hepatitis A, B, C, and E viruses infection among preschool children in Taiwan

Lin

Chen

et al. 2005

Journal of Medical Virology

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“…natural boosting by close contact to the carrier mother during infancy is believed to be instrumental. 7,11,21,22,[29][30][31][32]35,37,38 the association between longer gap time between the last and preceding dose of primary vaccination has been discussed in several other studies. 29,33,[44][45][46] this may be explained by a more mature immune system in older infants 31,33 and maturation of the immune memory during the longer interval between the last 2 doses as shown for polio, hepatitis B and hepatitis a vaccine in children and adults.…”

Section: Discussionmentioning

confidence: 99%

“…4,8,11,19,28,[31][32][33][34][35][36][37] Finally, both parameters may also be influenced by the prevalence of hepatitis B infection in the population and the HBsag carrier status of the mothers in the country. 6,7,11,21,22,[28][29][30][31][32][33]35,37,38 all these studies, however, are difficult to compare because results are influenced by a mixture of causes as well as by different follow-up periods.Based on a systematic review on studies providing information on the duration of anti-HBs ≥ 10 miu/ml persistence after hepatitis B vaccination started within the first 6 months of life and on the response to booster vaccination in individuals with antiHBs concentrations <10 miu/ml, we performed meta-analyses to identify relevant factors for duration of protection. a prognostic model to predict the proportion of vaccinated individuals likely to be protected is presented.…”

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confidence: 99%

“…[44][45][46] differences in the protective effect of plasma versus recombinant vaccines have been under debate for a while. 4,8,11,19,28,34,35,37,47 Comparison of plasma and recombinant vaccines needs to take account of age at follow-up time, vaccination schedules and dosage. in our analysis, we did account for these confounding factors and could not identify differences between plasma and recombinant vaccines.…”

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confidence: 99%

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Determinants of Long-term Protection After Hepatitis B Vaccination in Infancy

Schönberger

Riedel²,

Rückinger³

et al. 2013

Pediatric Infectious Disease Journal

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Background: the duration of protection after hepatitis B vaccination in early infancy is unclear and may be related to vaccination schedule, dosage, vaccine type and population characteristics. Factors potentially influencing waning immunity were assessed. Methods: a systematic review was performed. the main outcomes were prevalence of anti-hepatits B antibodies ≥ 10 miu/ml after primary or booster vaccination. Factors potentially influencing protection were assessed in an adjusted random-effects meta-analysis model by age for both outcomes. results of both meta-analyses were combined in a prognostic model. Results: Forty-six studies reporting on the anti-hepatits B antibodies ≥ 10 miu/ml 5 to 20 years after primary immunization and 29 on booster response were identified. the adjusted meta-analyses identified maternal carrier status (odds ratio [Or]: 2.37 [1.11; 5.08]), lower vaccine dosage than presently recommended (Or: 0.14 [0.06; 0.30]) and gap time between last and preceding dose of the primary vaccine series (Or: 0.44 [0.22; 0.86]) as determinants for persistence of anti-hepatits B antibodies ≥ 10. a lower vaccine dosage was also associated with failure to respond to booster (Or: 0.20 [0.10; 0.38]). the prognostic model predicted long-term protection of 90% [77%; 100%] at the age of 17 years for offspring of noncarrier mothers vaccinated with a presently recommended dose and vaccination schedule. Conclusions: Based on meta-analyses, predictors of waning immunity after hepatitis B vaccination in infancy could be identified. a prognostic model for long-term protection after hepatitis B vaccination in infancy was developed.Key Words: hepatitis B, infant vaccination, booster, long-term protection, determinants of protection (Pediatr Infect Dis J 2013;32: 307-313) A lthough hepatitis B vaccination is highly effective, vaccination failures leading to acute [1][2][3][4][5] and sometimes chronic infection [5][6][7][8] have been observed. although infections occurring within a short time interval after vaccination are likely to reflect primary vaccination failure 1,4 due to nonresponse, those occurring after decades are likely to reflect secondary vaccination failure due to waning immunity. anti-hepatits B antibodies [anti-HBs] ≥ 10 miu/ ml either after primary vaccination or as response to booster if the antibody concentrations have fallen below are widely accepted marker of protection after hepatitis B vaccination. 9-11 immunity against hepatitis B gives protection against infection and protection against disease. 12-14 Protection against infection is based on the presence of anti-HBs ≥ 10 miu/ml. after vaccination against hepatitis B, the proportion of individuals with anti-HBs ≥10 miu/ ml is highly dependent on the time elapsed since primary vaccination. individuals whose anti-HBs concentrations dropped below a level of 10 miu/ml are not protected any more against infection with hepatitis B virus. However, they are not at risk of hepatic disease as long as they have hepatitis B surface antigen (HBsag)-spe...

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“…Among a cohort of adolescents with maternal HBeAg positivity and who had developed protective levels of anti-HBs during infancy, the anti-HBc-positive rate was 33.3% at 15 years of age. 10 The anti-HBc-positive rates of the first decade in children of HBeAg-positive mothers were 9.5% and 14.3%, respectively, for whom with and without booster vaccination was at 5 years of age. 11 For their second decade of life, these rates were 22.2% and 28.6%, respectively.…”

Section: Replymentioning

confidence: 92%

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Lin

Wang

2013

Hepatology

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et al. 1 reported that a significant proportion of adolescents born to hepatitis B surface antigen (HBsAg)-positive mothers, who had postnatal hepatitis B immune globulin (HBIG) and hepatitis B vaccine, lost immune memory and developed a HBsAg carrier state. Having maternal hepatitis B e antigen (HBeAg) positivity was the most important determinant for developing chronic hepatitis B.Vaccination has proved to be highly effective in preventing and controlling hepatitis B, carrier rate, and hepatitis B virus (HBV)-related mortality worldwide. Long-term protection studies indicate that vaccine-induced anti-HBs concentrations decline over time, with antibody (Ab) levels falling below the protective threshold (10 mIU/mL) in one third to one half of vaccinees 10-20 years later; however, immunological memory usually persists. 2,3 This is because Ab maintenance after vaccination depends on the number of longlived plasma cells, whereas booster response is a function of memory B cells. Evidence indicates that memory B cells effectively respond to antigen challenge even when Ab falls below the protective level. 4 Thus, booster doses are not needed in immunocompetent individuals to maintain long-term protection.However, failure to develop postbooster anamnestic response has been reported, raising concern that immune memory may wane during the second decade postvaccination. 5,6 In his study, Wu et al. show that 15% of adolescents born to HBsAg/HBeAgpositive mothers who received primary infantile vaccination developed chronic HBV infection. In addition, one sixth of vaccinees were unable to respond to booster vaccination, having lost immunological memory.Individuals who lost immunological memory may become vulnerable to HBV infection, especially in highly endemic regionssuch as some Asiatic countries-where HBsAg carriers are often positive for HBeAg, then highly infectious. Thus, need for a booster in this setting, where risk of acquiring infection and becoming chronic is high, should be considered. If this were the policy, booster should be given before loss of immunological memory occurs.

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Waning Immunity To Plasma–Derived Hepatitis B Vaccine and the Need for Boosters 15 Years After Neonatal Vaccination

Abstract: Neonatal immunization with hepatitis B (HB) vaccine is

Cited by 159 publications

References 31 publications

Seroepidemiology of hepatitis A, B, C, and E viruses infection among preschool children in Taiwan

Seroepidemiology of hepatitis A, B, C, and E viruses infection among preschool children in Taiwan

Determinants of Long-term Protection After Hepatitis B Vaccination in Infancy

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