Durability of antibody response against hepatitis B virus in healthcare workers vaccinated as adults.
BACKGROUND
Follow-up studies of recipients of hepatitis B vaccine from endemic areas have reported loss of antibody to hepatitis B surface antigen (anti-HBs) in a high proportion of persons vaccinated at birth. In contrast, the long-term durability of antibody in persons vaccinated as adults in nonendemic areas is not well defined. We aimed to assess the durability of anti-HBs among healthcare workers (HCWs) vaccinated as adults and response to a booster among those without protective levels of antibody.


METHODS
Adult HCWs aged 18-60 at the time of initial vaccination were recruited. All were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and anti-HBs level. HCWs with anti-HBs <12 mIU/mL were offered a booster and levels were measured 1, 7, and 21 days afterward.


RESULTS
Anti-HBs levels were <12 mIU/mL in 9 of 50 (18%), 13 of 50 (26%), and 14 of 59 (24%) HCWs 10-15, 16-20, and >20 years postvaccination, respectively, (P = ns). Four HCWs were anti-HBc positive; none had HBsAg. By logistic regression, older age at vaccination was the only predictor of inadequate anti-HBs level (P = .0005). Thirty-four of 36 subjects with inadequate anti-HBs levels received a booster and 32 (94%) developed levels >12 mIU/mL within 3 weeks.


CONCLUSIONS
Anti-HBs levels decrease after 10-31 years and fall below a level considered protective in approximately 25% of cases. The rapid and robust response to a booster vaccine suggests a long-lasting amnestic response. Hepatitis B vaccination provides long-term protection against hepatitis B and booster vaccination does not appear to be necessary in HCWs. Clinical Trials Registration. NCT01182311.
Liver Diseases Branch.
Naveen
N
Gara
Liver Diseases Branch.
Adil
A
Abdalla
Liver Diseases Branch.
Elenita
E
Rivera
Biostatistics, Intramural Research.
Xiongce
X
Zhao
Liver Diseases Branch.
Jens M
JM
Werner
Liver Diseases Branch.
T Jake
TJ
Liang
Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
Jay H
JH
Hoofnagle
Liver Diseases Branch.
Barbara
B
Rehermann
Liver Diseases Branch.
Marc G
MG
Ghany
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D022362:Hepatitis A Vaccines / Q000276:immunology*; D006509:Hepatitis B / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000097:blood* / Q000276:immunology; D006512:Hepatitis B Core Antigens / Q000097:blood / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000276:immunology*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006801:Humans; D007117:Immunization, Secondary; D007156:Immunologic Memory; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008875:Middle Aged; D012044:Regression Analysis; D012698:Serologic Tests; D013997:Time Factors; D014611:Vaccination; D017778:Vaccines, Combined / Q000276:immunology; D055815:Young Adult
D022362:Hepatitis A Vaccines; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D017778:Vaccines, Combined; C433226:twinrix
booster vaccination; chronic hepatitis B; healthcare workers; hepatitis B vaccine