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Immunogenicity of Hepatitis B vaccines

Implications for persons at occupational risk of Hepatitis B virus infection
  • Francisco Averhoff
    Correspondence
    Address correspondence to: Francisco Averhoff, National Immunization Program, MS E-52, National Center for Disease Control and Prevention, Atlanta, Georgia 30333
    Footnotes
    Affiliations
    Hepatitis Branch (World Health Organization Collaborating Center for Research and Reference in Viral Hepatitis), National Center for Infectious Diseases, Centers for Disease Control and Prevention, (Averhoff, Mahoney, Coleman, Schatz, Margolis) Atlanta, Georgia, USA 30333
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  • Frank Mahoney
    Affiliations
    Hepatitis Branch (World Health Organization Collaborating Center for Research and Reference in Viral Hepatitis), National Center for Infectious Diseases, Centers for Disease Control and Prevention, (Averhoff, Mahoney, Coleman, Schatz, Margolis) Atlanta, Georgia, USA 30333
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  • Patrick Coleman
    Affiliations
    Hepatitis Branch (World Health Organization Collaborating Center for Research and Reference in Viral Hepatitis), National Center for Infectious Diseases, Centers for Disease Control and Prevention, (Averhoff, Mahoney, Coleman, Schatz, Margolis) Atlanta, Georgia, USA 30333
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  • Gary Schatz
    Footnotes
    Affiliations
    Hepatitis Branch (World Health Organization Collaborating Center for Research and Reference in Viral Hepatitis), National Center for Infectious Diseases, Centers for Disease Control and Prevention, (Averhoff, Mahoney, Coleman, Schatz, Margolis) Atlanta, Georgia, USA 30333
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  • Eugene Hurwitz
    Affiliations
    National Center for Infectious Diseases, Centers for Disease Control and Prevention (Hurwitz) Atlanta, Georgia, USA 30333
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  • Harold Margolis
    Affiliations
    Hepatitis Branch (World Health Organization Collaborating Center for Research and Reference in Viral Hepatitis), National Center for Infectious Diseases, Centers for Disease Control and Prevention, (Averhoff, Mahoney, Coleman, Schatz, Margolis) Atlanta, Georgia, USA 30333
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  • Author Footnotes
    1 F. Averhoff is currently with National Immunization Program, Centers for Disease Control and Prevention.
    2 G. Schatz is currently Consulting Epidemiologist, St. Simons Island, Georgia.

      Abstract

      Objectives: To assess risk factors for decreased immunogenicity among adults vaccinated with hepatitis B vaccine and to determine the importance of differences in immunogenicity between vaccines among health care workers (HCWs).
      Design: Randomized clinical trial and decision analysis.
      Participants: HCWs.
      Main Outcome Measures: Development of seroprotective levels of antibody to hepatitis B surface antigen (anti-HBs) and the number of expected chronic hepatitis B virus (HBV) infections associated with lack of protection.
      Results: Overall, 88% of HCWs developed seroprotection. Risk factors associated with failure to develop seroprotection included increasing age, obesity, smoking, and male gender (P < .05). Presence of a chronic disease was associated with lack of seroprotection only among persons ≥40 years of age (P < .05). The two vaccines studied differed in their overall seroprotection rates (90% vs. 86%; P < .05), however, this difference was restricted to persons ≥40 years of age (87% vs. 81%; P < .01). Among HCWs ≥40 years of age, the decision analysis found 44 (0.34/100,000 person-years) excess chronic HBV infections over the working life of the cohort associated with use of the less immunogenic vaccine compared to the other.
      Conclusions: Hepatitis B vaccines are highly immunogenic, but have decreased immunogenicity associated with increasing age, obesity, smoking, and male gender; and among older adults, the presence of a chronic disease. One of the two available vaccines is more immunogenic among older adults; however, this finding has little clinical or public health importance. Hepatitis B vaccines should be administered to persons at occupational risk for HBV infection early in their career, preferably while they are still in their training.

      Keywords

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