Early Hepatitis B Vaccination May Be Ineffective in Teenagers
Li-Yu Wang, of Mackay Medical College, Taiwan, and colleagues investigated the long-term success of the hepatitis B virus (HBV) vaccine in a high-risk population. The researchers studied 8,733 Taiwanese high school students born after July 1987. All the students were tested for hepatitis B surface antigen (HBsAg) and for antibodies to HBsAG. The antibodies would indicate prior vaccination or cleared HBV infection. Approximately 87 percent of the group had records showing that they had received three or more doses of HBV vaccine before the age of three years. The research also indicated that 381 participants showed additional receipt of hepatitis B immunoglobin (HBIG).
The researchers found that approximately 15 percent of individuals who received HBIG after birth plus up to four doses of the HBV vaccine tested positive for HBsAg, an early indicator of HBV infection or carriage. Results show that significantly more children (15–29 percent) who received HBIG off schedule and whose mothers were persistently positive for HBsAg were positive for HBsAg themselves. Also, 1.9 percent of the group was HBsAg-positive and 48.3 percent had antibodies to HBsAg. In those who received HBIG, the HBsAg positivity was 15 percent. Receiving fewer than the four recommended doses of the HBV vaccine was associated with an increased risk for being HBsAg-positive. Receiving three and one/two doses was associated with a 1.52- and 2.85-fold increased risk of being HBsAg-positive compared with those who had received four doses.
The authors suggest that an HBV vaccination booster should be considered at age 15 years or older for adolescents who lose protection, particularly for those born to HBsAg-positive mothers or who had a high risk of HBV exposure.
The full report, “Chronic Hepatitis B Infection in Adolescents Who Received Primary Infantile Vaccination,” was published in the journal Hepatology (2013; 57(1):37–45).
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