Study of hepatitis B (HB) vaccine non-responsiveness among health care workers from an endemic area (Taiwan)


Sheng-Nan Lu, MD, MPH, PhD, Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Kaohsiung 833, Taiwan.
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Abstract: Objective: To evaluate the etiology of non-responsiveness to hepatitis B (HB) vaccination in adults from an endemic area.

Methods: A total of 250 subjects who were HBsAg negative and anti-HBs<10 mIU/ml received three-dose HB-vaccine series. Anti-HBs ‘negative’ was defined as a level<1.5 mIU/ml. ‘Weakly’ positive was defined as 1.5–10 mIU/ml at pre-vaccination testing. Anti-HBs response was defined as a level >10 mIU/ml at post-vaccination testing. Among non-responders who were anti-HBc positive, serum anti-HBe and hepatitis B virus (HBV) DNA were tested.

Results: Three variables were associated with non-responsiveness by univariate analysis: anti-HBc positive, male gender, and age >40 years. Multivariate analysis additionally showed that anti-HBs negative was associated with non-responsiveness. Among 23 non-responders in anti-HBc positive subjects, post-vaccination serum was available in 16 subjects. HBV-DNA in all subjects was under detectable level by PCR assay. Anti-HBe positive were found in 13 of 16 subjects and were assumed to be occult HBV infection.

Conclusion: Male gender, age >40 years and anti-HBc positive are associated with non-responsiveness to HB vaccination. Most of non-responders among anti-HBc positive subjects were assumed to be occult HBV infection. Subjects with weakly positive anti-HBs were associated with responsiveness which may be the effect of immune memory.