Published online July 16, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. e373-e381 (doi:10.1542/peds.2007-0131)
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ARTICLE

Differences in Response to a Hepatitis B Vaccine Booster Dose Among Alaskan Children and Adolescents Vaccinated During Infancy

Taraz Samandari, MD, PhDa,b, Anthony E. Fiore, MD, MPHa, Susan Negus, RNc, James L. Williams, CNPc, Wendi Kuhnert, PhDa, Brian J. McMahon, MDc and Beth P. Bell, MD, MPHa

a Division of Viral Hepatitis
b Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
c Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, Alaska

BACKGROUND. The duration of protection provided by hepatitis B vaccination is unknown, but the presence of immune memory can be evaluated indirectly by measuring the immune response to a booster dose of vaccine.

METHODS. Participants included 74 adolescents (aged 11.7–14.9 years) who had received a plasma-derived 3-dose primary vaccine series and 138 adolescents (aged 10.0–14.7 years) and 166 children (aged 5.0–7.0 years) who received a recombinant 3-dose primary vaccine series. All were born to hepatitis B surface antigen–negative mothers and had received the first dose of hepatitis B vaccine within 7 days of birth. The proportion of participants with serologic evidence of protective immunity (antibody to hepatitis B surface antigen ≥10 mIU/mL) at baseline (prebooster), the proportion who developed an anamnestic response (increase to ≥10 mIU/mL or at or more than fourfold increase in antibody to hepatitis B surface antigen to >10 mIU/mL), and the geometric mean concentration by 1, 2, and 4 weeks after a 5-µg recombinant vaccine booster dose were determined.

RESULTS. No participant had evidence of chronic hepatitis B virus infection. Overall, 99% of the group of children who received recombinant hepatitis B vaccine, 83% of the group of adolescents who received recombinant hepatitis B vaccine, and 69% of the group of adolescents who received the plasma-derived vaccine had an anamnestic response to a booster dose; among responders, the geometric mean concentration at 2 weeks postbooster was 3360 and 128 mIU/mL among adolescents who received plasma-derived vaccine with antibodies to hepatitis B surface antigen ≥10 and <10 mIU/mL at baseline, respectively, compared with 1283 and 369 mIU/mL among adolescents who received recombinant hepatitis B vaccine and 5091 and 696 mIU/mL for children who received recombinant hepatitis B vaccine. The anamnestic response rate at 2 weeks postbooster among participants with antibodies to hepatitis B surface antigen <10 mIU/mL at baseline was inversely associated with age; 97% of 5-year-olds responded compared with 60% of 14-year-olds.

CONCLUSIONS. Although most participants responded to a booster dose of hepatitis B vaccine, the significance of the increased proportion of nonresponses among older adolescents might indicate waning immune memory.

Key Words: hepatitis B • vaccination • adolescence • antibody • protective immunity

Abbreviations: HBV—hepatitis B virus • HBsAg—hepatitis B surface antigen • anti-HBs—antibody to hepatitis B surface antigen • ANMC—Alaska Native Medical Center • CR—children who received recombinant hepatitis B vaccine • AR— adolescents who received recombinant hepatitis B vaccine • AS—adolescents who received plasma-derived vaccine • GMC—geometric mean concentration

Accepted Apr 3, 2007.


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