Abstract
Hepatitis B is an old disease and the possibility to successfully vaccinate against infection by hepatitis B virus (HBV) was first shown 36 years ago in a convincing trial (Szmuness et al., 1980). Thus, it may appear unspectacular when in this issue of EBioMedicine, a small clinical trial with a new type of hepatitis B vaccine is described (Cornelius et al., 2016). Do we really need this? But the significance of the paper should not be underestimated. The classical hepatitis B vaccine is produced in genetically transformed yeast cells and consists of 20-nm-large particles formed by the small (S) protein of hepatitis B surface antigen (HBsAg). The antibodies against conformational epitopes of HBsAg (anti-HBs) neutralize the infectivity of hepatitis B virus (HBV) in vitro and indicate protection in vivo. However, the classical vaccine has some shortcomings. In spite of multiple injections some persons remain unprotected, particularly those with a weakened immune response. Furthermore, asymptomatic infections by heterologous HBV genotypes with transient viremia are frequent in vaccinated subjects with low or moderate anti-HBs titers (for review see Gerlich, 2015). While the WHO, public health authorities and the main producers of hepatitis B vaccines still consider these drawbacks as insignificant, an enhanced protective capacity against a wider HBV genotype spectrum would not hurt.
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