Schedules for hepatitis B vaccination of risk groups: balancing immunogenicity and compliance.
BACKGROUND
Vaccination is an important tool in hepatitis B prevention. However, several vaccine doses are required to induce long-term protection. Several at-risk groups have difficulties in adhering to the standard vaccination schedule.


OBJECTIVE
This paper aims to review the use of accelerated hepatitis B vaccination schedules, in terms of immunogenicity and compliance.


RESULTS
Accelerated schedules (0.1.2.12 months) or super-accelerated schedules (0.7.21.360 days) have been shown to result in higher proportions of healthy vaccinees reaching anti-HBs antibody levels >or=10 IU/l more rapidly. A fourth completing dose is required to lift antibody levels to an equal height, as does a standard (0.1.6 months) schedule. Accelerated schedules do also increase the uptake of hepatitis B vaccine, that is the proportion of vaccinees who receive three doses. However, completing the schedule with a fourth dose is usually more difficult than completing a standard 0.1.6-month schedule. Several additional tools can help to increase the compliance (eg, reminder systems, outreach services and incentive schemes).


CONCLUSIONS
For rapid seroconversion and almost immediate protection in the short term, a (super)accelerated schedule could be used in at-risk groups. As long-term protection data with these (super) accelerated schedules have not been documented yet, a fourth dose at month 12 is still required. A shortened schedule (0.1.4 months) might be an alternative worth considering compared with the standard 0.1.6, as it convenes to internationally accepted minimum dose intervals and offers earlier protection. There is a clear need to study the long-term protection and effectiveness of the primary part of (super)accelerated schedules.
Van Herck
K
K
Centre for the Evaluation of Vaccination, WHO Collaborating Centre for Prevention and Control of Viral Hepatitis, Department Epidemiology and Social Medicine, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium. koen.vanherck@ua.ac.be
Leuridan
E
E
Van Damme
P
P
D006509:Hepatitis B / Q000097:blood / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007115:Immunization Schedule; D014611:Vaccination / Q000706:statistics & numerical data*
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines