Antibody Levels and Protection after Hepatitis B Vaccine: Results of a 30 year Follow-up Study and Response to a Booster Dose
Michael Bruce1, Dana J. Bruden1, Debby Hurlburt1, Carolyn Zanis1, Gail C. Thompson1, Lisa D. Rea1, Michele Toomey1, Lisa J. Townshend-Bulson2, Karen Rudolph1, Lisa Bulkow1, Philip Spradling3, Richard Baum1, Thomas W. Hennessy1, Brian J. McMahon2
1Arctic Investigations Program,Centers for Disease Control and Prevention, Anchorage, AK; 2Liver Disease and Hepatitis Program,, Alaska Native Tribal Health Consortium, Anchorage, AK; 3Epidemiology and Surveillance Branch', Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
Background. The duration of protection in children and adults resulting from hepatitis B vaccination is unknown. In 1981, after licensure of hepatitis B vaccine in the United States, we immunized a cohort of 1578 Alaska Native adults and children from 15 Alaska villages who were 6 months or older using 3 doses of plasma-derived hepatitis B vaccine. We performed yearly serologic testing for 11 years, and at 15 years. At 22 years, we performed serologic testing on participants living in 7 villages and administered a hepatitis B booster dose to persons with antibody to hepatitis B surface antigen (anti-HBs) <10 mlし/ml. To determine the protection afforded by hepatitis B vaccine, Alaska Native persons who had received plasmaderived hepatitis B vaccine were tested for anti-HBs levels 30 years after receiving the primary series. Methods. Those with levels <10 mlU/ml received 1 dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days post-booster. Objectives: At 30 years after vaccination: 1)Determine the proportion of persons with protective anti-HBs levels (> 10 mIU/ml), 2) Evaluate response to a booster dose among persons with antibody levels <10 mlU/ml, 3) Compare characteristics of persons with and without protective antibody levels. Results. 〇f 433 participants, 63 (14%) had received a booster dose at 22 years (Group 1), 129 (30%) did not receive a booster dose at 22 years (because their anti-HBs levels were > 10 mlU/ml, Group , and 241(56%) persons did not participate in the 22 year study (Group 3). Among participants in Groups 1, 2 and 3: 9 (14%), 85 (66%), and 123 (51%) had an anti-HBs level > 10 mlU/ml, respectively. A booster dose was administered to Group 2 and 3 participants with anti-HBs levels <10 mlU/ml according to study protocol. Among Group 2 and 3 participants who were available for follow-up, 33/36 (92%) and 75/85 (88%), responded to a booster dose with an anti-HBs level > 10 mIU/ml at 30 days, respectively. Initial anti-HBs level after the primary series was correlated with higher anti-HBs levels at 30 years. Based on the 241 Group 3 persons, including persons at 30 years with an anti-HBs level > 10 mlU/ml and potential booster recipients of whom 88% were predicted to respond to the booster dose,, we estimate > 90% of participants were protected. No symptomatic acute or chronic hepatitis B virus infections were identified during the 30 year follow-up. Conclusions. The protection afforded by primary immunization with plasma-derived hepatitis B vaccine during childhood and adulthood lasts at least 30 years. Booster doses are not needed.
The following people have nothing to disclose: Michael Bruce, Dana J. Bruden, Debby Hurlburt, Carolyn Zanis, Gail C. Thompson, Lisa D. Rea, Michele Toomey, Lisa J. Townshend-Bulson, Karen Rudolph, Lisa Bulkow, Philip Spradling, Richard Baum, Thomas W. Hennessy, Brian J. McMahon