Duration of Hepatitis B Immunity in Low Risk Children Receiving Hepatitis B Vaccinations from Birth

Kenneth M. Petersen, MD; Lisa R. Bulkow, MS; Brian J. McMahon, MD; Carolyn Zanis, BS; Marilyn Getty, RN; Helen Peters, RN; Alan J. Parkinson, PhD

Disclosures

Pediatr Infect Dis J. 2004;23(7) 

In This Article

Abstract and Introduction

Background: The duration of protection after hepatitis B vaccination of infants is unknown.
Methods: We determined antibody to hepatitis B surface antigen (anti-HBs) at 4-13 years of age in 363 low risk children who had been vaccinated starting at birth with hepatitis B vaccine. Those with nonprotective titers (<10 mIU/mL) received a booster dose. We similarly followed 16 children of hepatitis B surface antigen (HBsAg)-positive mothers.
Results: Of low risk infants receiving a plasma-derived vaccine, 41% (42 of 102) of those whose primary response was unknown and 24% (4 of 17) who had initially responded retained protective titers (≥10 mIU/mL) of anti-HBs at 9 and 13 years, respectively. Of those who did not have protective antibody titers, 61% (33 of 54) and 67% (8 of 12), respectively, responded to a booster dose. In children of HBsAg-positive mothers, 31% retained protective anti-HBs at 12 years, and 90% (9 of 10) with nonprotective titers responded to a booster. In low risk children initially receiving a recombinant vaccine, 12.5% (26 of 208) and none (0 of 36) retained protective anti-HBs titers at 5 and 7 years of age, respectively. Of those who did not have protective titers, 90% (120 of 134) and 91% (32 of 35), respectively, responded to a booster.
Conclusions: Anti-HBs disappeared by 5 years of age in most children who were vaccinated with hepatitis B vaccine from birth. Although most children showed immunologic memory, one-third failed to demonstrate an anamnestic response to a booster dose. Additional long term studies of low risk infants are needed to determine duration of protection and the necessity for or timing of booster doses.

Hepatitis B virus (HBV) is a major global health concern with >350 million people chronically infected.[1] The strategy for the control of HBV infection, as outlined by the World Health Organization and endorsed by the Advisory Committee on Immunization Practices (ACIP), is the introduction of hepatitis B immunization at birth.[2,3] This strategy is designed to reduce the risk of early childhood acquisition of HBV and reduce the number of chronic carriers in endemic populations. In lower risk populations, such as the United States, where transmission of HBV primarily occurs in older individuals, newborn immunization is also used to prevent the small number of cases transmitted in early childhood. Also when the hepatitis B vaccination is initiated at birth, there is an increased likelihood that the child will complete the series.[4,5]

The duration of hepatitis B vaccine protection has not been firmly established. Long term protection of 10-12 years appears to occur for those infants at high risk whose mothers were positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen.[6,7,8,9,10,11,12] However, the duration of protection in low risk infants whose mothers are negative for HBsAg and who receive hepatitis B vaccine from birth is unknown. In these populations, the risk of HBV increases during adolescence and early adulthood primarily because of the risk of sexual transmission.[3] Whether booster doses might eventually be necessary to extend protection through adulthood has not been established.

We examined the long term persistence of antibody to hepatitis B surface antigen (anti-HBs) in children ages 4-13 years whose mothers were HBsAg-negative and who originally received a course of hepatitis B vaccine starting at birth. We also assessed the status of immunologic memory for HBV by evaluating the response to a booster dose of a hepatitis B vaccine in those children whose serum anti-HBs had fallen below 10 mIU/mL, the accepted protective concentration.[6]

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