Insights into induction of the immune response by the hepatitis B vaccine

Abstract

After more than four decades of hepatitis B virus (HBV) vaccine implementation, its safety and efficacy in preventing HBV infection have been proven and several milestones have been achieved. Most countries have included HBV immunization schedules in their health policies and progress has been made regarding universalization of the first HBV vaccine dose at birth. All of these actions have significantly contributed to reducing both the incidence of HBV infection and its related complications. However, there are still many drawbacks to overcome. The main concerns are the deficient coverage rate of the dose at birth and the large adult population that has not been reached timely by universal immunization. Additionally, the current most widely used second-generation vaccines do not induce protective immunity in 5% to 10% of the population, particularly in people over 40-years-old, obese (body mass index > 25 kg/m 2 ), heavy smokers, and patients undergoing dialysis or infection with human immunodeficiency virus. Recently developed and approved novel vaccine formulations using more potent adjuvants or multiple antigens have shown better performance, particularly in difficult settings. These advances re-launch the expectations of achieving the World Health Organization’s objective of completing hepatitis control by 2030.

Immune Response to GeneVac-B® (rDNA I.P. Hepatitis B Vaccine) in Vaccinated Persons with a Standard Schedule in Bobo-Dioulasso, Burkina Faso

“…This result aligns with the protection level expected for second-generation vaccines. Indeed, it is estimated that for these vaccines, around 5 to 10% of the vaccinated population do not induce protective immunity [27]. Similar response rates have been reported in previous studies evaluating the efficacy of GeneVac in healthy infants, adolescents, and adults in India [21][22][23][24][25][26].…”

Immune response to hepatitis B vaccine among children under 5 years in Africa: a meta-analysis

“…Although there is no comparative study among children, our finding is consistent with results observed among adults in Africa [ 92 ]. The lack of protective immune response among people living with HIV has been linked with reduced CD4 cell count and B-cell dysfunction [ 35 , 38 ] and factors such as viral load, sex, and age also influence immune response to HBV vaccine among people living with HIV [ 92 , 93 ]. Our finding further supports routine PVST for children living with HIV after completion of the primary series.…”

“…Several factors including perinatal host, nutritional, environmental, and immunization-related factors such as suboptimal dosing, site of administration, and reduced potency due to poor vaccine storage and handling conditions, could have accounted for the nonresponse among the under 5 children in the studies [ 31 , 94 ]. While the cellular mechanisms involved in nonresponse to HBV vaccination remain unclear, impaired lymphocyte activation has been implicated [ 38 , 95 ]. Interventions to address nonresponse among children will depend on largely the prevailing health status.…”

“…For those at high risk of HBV infection, post-vaccination serologic testing (PVST) within one to two months after the final dose of vaccine is recommended to identify non-responders and evaluate the need for revaccination [ 18 ]. Strategies to improve immune response among non-responders include increased vaccination dose, additional vaccination cycles, an alternative route of administration, or the use of adjuvants [ 35 – 38 ].…”

Vaccination and the risk of systemic lupus erythematosus: a meta-analysis of observational studies

“…It has been reported that hepatitis B is contribute to onset or exacerbation of autoimmune disorders via molecular mimicry [ 40 , 41 ]. Whereas, it has been proven the safety and efficacy in preventing HBV infection [ 42 , 43 ], and ruled out any confirmed evidence that HBV vaccine causes autoimmune disorders [ 44 ]. HBV vaccine contains yeast, aluminium, thimerosal, hepatitis B surface antigen epitopes, and adjuvants, which may result in hepatitis B vaccine being associated with autoimmune diseases among susceptible adult vaccine recipients [ 44 ].…”