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.
Highlights
Current 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
Part I: epidemiological study The study subjects of this epidemiological survey consisted of 6950 individuals (2901 were male and 4049 were female), all of whom were born after 1987, within the national infant HBV vaccination era of Taiwan
As compared with seroprevalence data of HBV markers by genders of all subjects, female individuals had a significantly higher anti-HBs seropositivity rate (p < 0.009) than male individuals, but this was not mirrored by hepatitis B surface antigen (HBsAg) (p = 0.439)
Summary
Current 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. Perinatal hepatitis B virus transmission is still the main cause for vaccine failure [2], horizontal and breakthrough infection may occur after waning or eventual loss of vaccine protectiveness in older children, especially with changes in lifestyle and sexual activity [9]. The role of the anamnestic response, indicating immune memory to HBsAg, was confirmed after anti-HBs levels had decreased to below the seroprotective level. A large-scale study provided evidence that an anamnestic anti-HBs response was absent in 10.1% of 15- to 18-yearold individuals in Taiwan, a country that had high endemicity of HBV [10]
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