Background: the duration of protection after hepatitis B vaccination in early infancy is unclear and may be related to vaccination schedule, dosage, vaccine type and population characteristics. Factors potentially influencing waning immunity were assessed. Methods: a systematic review was performed. the main outcomes were prevalence of anti-hepatits B antibodies ≥ 10 miu/ml after primary or booster vaccination. Factors potentially influencing protection were assessed in an adjusted random-effects meta-analysis model by age for both outcomes. results of both meta-analyses were combined in a prognostic model. Results: Forty-six studies reporting on the anti-hepatits B antibodies ≥ 10 miu/ml 5 to 20 years after primary immunization and 29 on booster response were identified. the adjusted meta-analyses identified maternal carrier status (odds ratio [Or]: 2.37 [1.11; 5.08]), lower vaccine dosage than presently recommended (Or: 0.14 [0.06; 0.30]) and gap time between last and preceding dose of the primary vaccine series (Or: 0.44 [0.22; 0.86]) as determinants for persistence of anti-hepatits B antibodies ≥ 10. a lower vaccine dosage was also associated with failure to respond to booster (Or: 0.20 [0.10; 0.38]). the prognostic model predicted long-term protection of 90% [77%; 100%] at the age of 17 years for offspring of noncarrier mothers vaccinated with a presently recommended dose and vaccination schedule. Conclusions: Based on meta-analyses, predictors of waning immunity after hepatitis B vaccination in infancy could be identified. a prognostic model for long-term protection after hepatitis B vaccination in infancy was developed.Key Words: hepatitis B, infant vaccination, booster, long-term protection, determinants of protection (Pediatr Infect Dis J 2013;32: 307-313) A lthough hepatitis B vaccination is highly effective, vaccination failures leading to acute [1][2][3][4][5] and sometimes chronic infection [5][6][7][8] have been observed. although infections occurring within a short time interval after vaccination are likely to reflect primary vaccination failure 1,4 due to nonresponse, those occurring after decades are likely to reflect secondary vaccination failure due to waning immunity. anti-hepatits B antibodies [anti-HBs] ≥ 10 miu/ ml either after primary vaccination or as response to booster if the antibody concentrations have fallen below are widely accepted marker of protection after hepatitis B vaccination. 9-11 immunity against hepatitis B gives protection against infection and protection against disease. 12-14 Protection against infection is based on the presence of anti-HBs ≥ 10 miu/ml. after vaccination against hepatitis B, the proportion of individuals with anti-HBs ≥10 miu/ ml is highly dependent on the time elapsed since primary vaccination. individuals whose anti-HBs concentrations dropped below a level of 10 miu/ml are not protected any more against infection with hepatitis B virus. However, they are not at risk of hepatic disease as long as they have hepatitis B surface antigen (HBsag)-spe...