title: The hepatitis B vaccine protects re-exposed health care workers, but does not provide sterilizing immunity.
abstract: OBJECTIVE
  Infection with hepatitis B virus (HBV) can be prevented by vaccination with HB surface (HBs) antigen, which induces HBs-specific antibodies and T cells. However, the duration of vaccine-induced protective immunity is poorly defined for health care workers who were vaccinated as adults.
  
  
  METHODS
  We investigated the immune mechanisms (antibody and T-cell responses) of long-term protection by the HBV vaccine in 90 health care workers with or without occupational exposure to HBV, 10-28 years after vaccination.
  
  
  RESULTS
  Fifty-nine of 90 health care workers (65%) had levels of antibodies to HBs antigen above the cut-off (>12 mIU/mL) and 30 of 90 (33%) had HBs-specific T cells that produced interferon-gamma. Titers of antibodies to HBs antigen correlated with numbers of HBs-specific interferon-gamma-producing T cells, but not with time after vaccination. Although occupational exposure to HBV after vaccination did not induce antibodies to the HBV core protein (HBcore), the standard biomarker for HBV infection, CD4(+) and CD8(+) T cells against HBcore and polymerase antigens were detected. Similar numbers of HBcore- and polymerase-specific CD4(+) and CD8(+) T cells were detected in health care workers with occupational exposure to HBV and in patients who acquired immunity via HBV infection. Most of the HBcore- and polymerase-specific T cells were CD45RO(+)CCR7(-)CD127(-) effector memory cells in exposed health care workers and in patients with acquired immunity. In contrast, most of the vaccine-induced HBs-specific T cells were CD45RO(-)CCR7(-)CD127(-) terminally differentiated cells.
  
  
  CONCLUSIONS
  HBs antigen vaccine-induced immunity protects against future infection but does not provide sterilizing immunity, as evidenced by HBcore- and polymerase-specific CD8(+) T cells in vaccinated health care workers with occupational exposure to HBV. The presence of HBcore- and HBV polymerase-specific T-cell responses is a more sensitive indicator of HBV exposure than detection of HBcore-specific antibodies.
authors.affiliation: Immunology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
authors.forename: Jens M
authors.initials: JM
authors.lastname: Werner
authors.forename: Adil
authors.initials: A
authors.lastname: Abdalla
authors.forename: Naveen
authors.initials: N
authors.lastname: Gara
authors.forename: Marc G
authors.initials: MG
authors.lastname: Ghany
authors.forename: Barbara
authors.initials: B
authors.lastname: Rehermann
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology; D005260:Female; D006282:Health Personnel; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000276:immunology / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007109:Immunity / Q000276:immunology*; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D013997:Time Factors
chemical_list: D000914:Antibodies, Viral; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines
keywords: DMSO; FCS; HBV; HBV core protein; HBV polymerase; HBVpol; HBcore; HBsAg; HDV; IFN; Immune Response; Immunization; PBMC; PBS; PE; PHA-M; T Cell; Virus; anti-HBs; antibody to hepatitis B surface antigen; dimethyl sulfoxide; fetal calf serum; hepatitis B surface antigen; hepatitis B virus; hepatitis D virus; interferon; peripheral blood mononuclear cells; phosphate-buffered saline; phycoerythrin; phytohemagglutinin
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