Abstract
Hepatitis B was still a worldwide health problem. This study aimed to conducted a systematic review and meta-analysis to assess a more precise estimation of factors that influence the response to hepatitis B vaccine in adults. Our included studies examined seroprotection rates close to the end of vaccination schedules in healthy adult populations. This meta-analysis including 21053 adults in 37 articles showed that a significantly decreased response to hepatitis B vaccine appeared in adults (age ≥ 40) (RR:1.86, 95% CI:1.55–2.23), male adults (RR:1.40, 95% CI:1.22–1.61), BMI ≥ 25 adults (RR:1.56, 95% CI:1.12–2.17), smoker (RR:1.53, 95% CI:1.21–1.93), and adults with concomitant disease (RR:1.39, 95% CI:1.04–1.86). Meanwhile, we further found a decreased response to hepatitis B vaccine appeared in adults (age ≥ 30) (RR:1.77, 95% CI:1.48–2.10), and adults (age ≥ 60) (RR:1.30, 95% CI:1.01–1.68). However, there were no difference in response to hepatitis B vaccine both in alcoholic (RR:0.90, 95% CI:0.64–1.26) and 0-1-12 vs. 0-1-6 vaccination schedule (RR:1.39, 95% CI:0.41–4.67). Pooling of these studies recommended the sooner the better for adult hepatitis B vaccine strategy. More vaccine doses, supplemental/additional strengthening immunity should be emphasized on the susceptible population of increasing aged, male, BMI ≥ 25, smoking and concomitant disease. The conventional 0-1-6 vaccination schedule could be still worth to be recommended.
Highlights
Many countries have gradually adopted the HBV vaccine in national immunization programs since the World Health Organization (WHO) recommended vaccination for children in 1990s
To find all relevant publications that investigated the association between adult and hepatitis B vaccine and seroprotection, a systematic literature search was independently conducted by two individual investigators with the same method in PubMed, Embase and Cochrane Library using the keywords “hepatitis B vaccine”, “HBV”, “adult”, “anti-HBs” were used
When stratified by demographic features, our study showed a lower response in older adults, male adults and overweight adults (BMI ≥ 25), smoker and adults with concomitant disease after completion of vaccination against hepatitis B
Summary
Many countries have gradually adopted the HBV vaccine in national immunization programs since the World Health Organization (WHO) recommended vaccination for children in 1990s. HBV vaccination triggers antibody response and antibody to hepatitis B surface antigen (anti-HBs) levels ≥1 0 IU/L are usually regarded as seroprotection for most vaccinees. Vaccination efficacy among children has been widely studied, but there remains a large proportion of adult populations who are as yet unvaccinated. A previous meta-analysis in 2002 observed many factors influencing response to hepatitis B vaccine, especially a decrease response to recombinant HBV vaccine at higher ages[11], which suggested that earlier vaccination should be prioritized for prevention at the population level. Factors influencing immunologic response to hepatitis B vaccine in adults have been inconsistently examined in existing studies. We conducted a systematic review and meta-analysis to update and assess a more precise estimation of factors that influence the response to HBV vaccine
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