title: Impact and long-term protection of hepatitis B vaccination: 17 years after universal hepatitis B vaccination in Tunisia.
abstract: Hepatitis B virus (HBV) vaccination has been part of the Expanded Programme of Immunization (EPI) in Tunisia since 1995. The aim of this study was to evaluate, for the first time, the impact of mass vaccination in Tunisia 17 years after this programme was implemented, and in parallel, assess the long-term persistence of anti-HBs antibody in the vaccinated Tunisian population. A total of 1422 students were recruited (703 vaccinated, 719 non-vaccinated). HBV seromarkers were checked. None of the students from either group had positive HBsAg. The overall prevalence of anti-HBc was 0·8%. A Significantly higher prevalence of anti-HBc was noted in unvaccinated students than in vaccinated (1·4% vs. 0·3%, P = 0·02). The overall seroprotection rate (anti-HBs titre ⩾10 mIU/ml) was 68·9% in vaccinated subjects. Seroprotection rates and geometric mean titres decreased significantly with increasing age, reflecting waning anti-HBs titre over time. No significant difference was detected between seroprotection rates and gender or students' area of origin. Incomplete vaccination was the only factor associated with an anti-HBs titre <10 mIU/ml. This study demonstrates the excellent efficacy of the HBV vaccination programme in Tunisia 17 years after its launch. However, a significant decline of anti-HBs seroprotection has been observed in ⩾15-year-old adolescents which places them at risk of infection. Additional studies are needed in hyperendemic regions in Tunisia.
authors.affiliation: Department of Infectious Diseases,University Hospital Farhat Hached,Sousse,Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Chaouch
authors.affiliation: Department of Infectious Diseases,University Hospital Farhat Hached,Sousse,Tunisia.
authors.forename: W
authors.initials: W
authors.lastname: Hachfi
authors.affiliation: LR14SP02;Laboratory of Microbiology,University Hospital Sahloul,Sousse,Tunisia.
authors.forename: I
authors.initials: I
authors.lastname: Fodha
authors.affiliation: LR14SP02;Laboratory of Microbiology,University Hospital Sahloul,Sousse,Tunisia.
authors.forename: O
authors.initials: O
authors.lastname: Kallala
authors.affiliation: LR14SP02;Laboratory of Microbiology,University Hospital Sahloul,Sousse,Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Saadi
authors.affiliation: Viral Hepatitis Research Unit (UR12SP35),University Hospital Farhat Hached,Sousse,Tunisia.
authors.forename: A
authors.initials: A
authors.lastname: Bousaadia
authors.affiliation: Viral Hepatitis Research Unit (UR12SP35),University Hospital Farhat Hached,Sousse,Tunisia.
authors.forename: F
authors.initials: F
authors.lastname: Lazrag
authors.affiliation: Department of Community Medicine,University of Sousse,Sousse,Tunisia.
authors.forename: I
authors.initials: I
authors.lastname: Bougmiza
authors.affiliation: Laboratory of Infectious Diseases and Biological Agents,Faculty of Pharmacy,University of Monastir,Monastir,Tunisia.
authors.forename: M
authors.initials: M
authors.lastname: Aouni
authors.affiliation: LR14SP02;Laboratory of Microbiology,University Hospital Sahloul,Sousse,Tunisia.
authors.forename: A
authors.initials: A
authors.lastname: Trabelsi
authors.affiliation: Viral Hepatitis Research Unit (UR12SP35),University Hospital Farhat Hached,Sousse,Tunisia.
authors.forename: E
authors.initials: E
authors.lastname: Ben Jazia
authors.affiliation: Department of Infectious Diseases,University Hospital Farhat Hached,Sousse,Tunisia.
authors.forename: A
authors.initials: A
authors.lastname: Letaief
keywords: Anti-HBs antibody; Tunisia; hepatitis B vaccine; protective immunity