Challenge with hepatitis B vaccine in children previously vaccinated with a hepatitis B-containing combination vaccine

Abstract

The World Health Organization (WHO) recommends universal infant hepatitis B virus (HBV) vaccination as the most effective preventive measure against HBV-induced disease in endemic areas. More than 160 countries have followed the WHO recommendations to incorporate HBV vaccination in their national infant immunization programs. While antibodies to hepatitis B surface antigen (anti-HBs) concentrations progressively decrease following vaccination in infancy, protection persists, probably due to lasting immune memory. Hence, it is thought that future exposure to wild-type virus or HBV vaccine will induce a protective secondary immune response. Children aged 7-8 years old who had been vaccinated in infancy with a hexavalent DTacP-IPV-HB-Hib vaccine (Hexavac(R); Sanofi Pasteur MSD, Lyon, France) and children aged 7-9 years vaccinated in infancy with a DT-HB vaccine (Primavax(R); Sanofi Pasteur MSD), whose anti-HBs concentrations had fallen below the seroprotective threshold of 10 mIU/mL at age 4.5-6 years, received a challenge dose of monovalent HBV vaccine (HBVAXPRO(R); Sanofi Pasteur MSD) to assess persistence of protection. One month postchallenge, 54 of 61 (88.5%) Hexavac-primed seronegative children and 34 of 40 (85.0%) Primavax-primed seronegative children had anti-HBs concentrations > or =10 mIU/mL. The percentage of protected children would have been even higher if the children who still had protective antibody levels (who were not included in this challenge study) had been assessed (42.1% with Hexavac, 55.4% with Primavax). Vaccination with a HBV-containing multivalent vaccine during infancy induces a lasting immune memory that can be boosted, even in children with a decline in anti-HBs concentrations. The present results confirm that the full primary vaccination schedule in infancy seems to confer long-term protection via immune memory and that an additional HBV dose is not generally required.