Persistence of antibodies to the surface antigen of the hepatitis B virus (anti-HBs) in children subjected to the Expanded Programme on Immunization (EPI), including hepatitis-B vaccine, in Thailand

Poovorawan, Yong; Theamboonlers, Apiradee; Hirsch, Petra; Vimolket, Thosporn; Sinlaparatsamee, S.; Chaiear, K.; Siraprapasiri, Taweesap; Khwanjaipanich, Sawan; Owatanapanich, Somchai; Chunsuttiwat, Supamit

doi:10.1080/00034983.2000.11813584

Cited by 18 publications

(9 citation statements)

References 16 publications

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“…In clinical studies conducted in Taiwan and Thailand, a primary course of hepatitis B vaccination has been shown to result in protective levels of antibody (>10 mIU/mL) in the great majority of vaccinees (83–99%) 1,26 . However, the proportion of vaccinees with protective levels of antibody decreases to 75–87% after 5 years and to 50–70% after 10–12 years 1,26 …”

Section: Long‐term Anamnestic Antibody Responsementioning

confidence: 99%

Hepatitis B vaccine boosters: Is there a clinical need in high endemicity populations?

John

Cooksley

2005

J of Gastro and Hepatol

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The Steering Committee for the Prevention and Control of Infectious Diseases in Asia recently conducted a survey of primary-care physicians in Asia, which revealed that many physicians administer boosters in their clinical practice and that there is considerable variation and uncertainty among physicians regarding this practice. This paper serves as a response to physicians' uncertainties by reviewing the literature regarding the administration of hepatitis B vaccine boosters in high endemicity areas and presenting the Steering Committee's guidelines for booster administration. While there are few data to support a need for routine hepatitis B vaccine boosters as a public health measure, they help to provide reassurance of immunity against breakthrough infection in certain risk groups. In clinical practice, primary-care physicians must exercise their judgment regarding the need for booster vaccination on an individual basis. This paper examines the available literature on the administration and value of hepatitis B vaccine boosters, explores the differences between the public health approach and clinical practice, and provides guidelines for those who use boosters in high endemicity Asian populations. Relevant articles were identified through searches of MEDLINE (1975MEDLINE ( -2003 and the Cochrane Library, using 'hepatitis B' and 'booster' as primary search terms. Guidelines for those who decide to administer hepatitis B vaccine boosters include: boosting approximately 10-15 years after primary vaccination; boosting rather than not when monitoring of antibody levels is not feasible; boosting immunocompromised patients when the antibody to hepatitis B surface antigen titer falls below 10 mIU/mL; and boosting healthcare workers based on the endemicity of the particular country.

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Section: Long‐term Anamnestic Antibody Responsementioning

confidence: 99%

Hepatitis B vaccine boosters: Is there a clinical need in high endemicity populations?

John

Cooksley

2005

J of Gastro and Hepatol

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“…Several studies have shown that in the first decade of life, acute infections are uncommon, and chronic infections are rare in populations in which infants are vaccinated. [16][17][18] Even in groups at high risk of HBV infection, low rates of infection have been achieved up to 18 years after vaccination. 11,13,19 These data, which suggest that vaccination of infants can offer excellent protection into adolescence, are summarized in Table 1.…”

Section: Universal Vaccination Of Infantsmentioning

confidence: 99%

Hepatitis B immunization strategies: timing is everything

Mackie¹,

Buxton²,

Tadwalkar³

et al. 2009

Canadian Medical Association Journal

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Chronic HBV infection, with the attendant risk of cirrhosis and hepatocellular carcinoma, occurs in 1%-5% of adults and up to 90% of infants who are infected with HBV.3-5 Providing vaccinations during adolescence without offering vaccinations during infancy misses this critical period when the acquisition of a HBV infection can be the most harmful. Epidemiologic studies show that the age distribution of HBV varies by jurisdiction and suggest that roughly one-third of chronic infections are acquired during infancy and early childhood.6-9 An ideal vaccine schedule should protect against infection both in infancy, when the risk of becoming a chronic HBV carrier is highest, and in adolescence, when high-risk sexual and drugusing behaviours occur more frequently.Epidemiologic data are critical for informing decisions about vaccination. Estimating the age-specific incidence of acute infections is valuable for planning prevention measures. However, acute infections in infants and toddlers may be missed because HBV infection is often asymptomatic in young children. In many jurisdictions, the age-specific incidence of HBV infection is unknown.The controversy surrounding booster injections stems in part from the rapid drop in antibodies after completion of the primary series of injections. Serum levels of antibodies against hepatitis B surface antigen have been used to measure the initial response to vaccination (antibody levels ≥ 10 IU/L are considered protective). This marker measures response to the vaccine within the first few weeks but is not an appropriate indicator of long-term immunity. Serologic studies have shown that the titre of antibodies against hepatitis B surface antigen drops within the first few years after vaccination and that one-third to one-half of children vaccinated as infants will have titres below 10 IU/L by 10-15 years of age. [10][11][12] This has been misinterpreted to mean that population-level protection shows a similar dramatic drop.Long-term observational data show that vaccinated individuals -even those who have an undetectable titre of hepatitis B surface antigen -can mount an anamnestic response to contact with HBV.11,13 A recent booster trial performed 18 years after vaccination of infants in Gambia provides further evidence of persistent immunity.14 Although almost 70% of participants had no detectable antibodies at baseline, of the 181 participants who were tested 2 weeks after receiving a booster dose, 92.3% (95% CI 87.4-95.7) showed an early anamnestic response.14 The geometric mean concentration of antibodies against hepatitis B surface antigen in this group rose to 524 IU/L (95% CI 441-621), which suggests that most people who have been vaccinated can mount a protective immune response even 18 years after receiving a primary series of vaccinations in infancy. Universal vaccination of infantsAs of 2007, 171 of the 193 member countries of the World Health Organization (WHO) had implemented the recommendations of the Expanded Programme on Immunization to offer universal hepatitis B ...

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“…Several studies conducted in countries with different prevaccination HBV epidemiologic characteristics have shown persistent protection for 10-15 years after infant vaccination despite waning antibodies, suggesting that there is no need for a booster before adolescence [6][7][8][9][10][11][12][13]. One study documented protection after 18 years of follow-up but included only 88 of 138 original subjects [14].…”

mentioning

confidence: 99%

Long‐Term Protection against Carriage of Hepatitis B Virus after Infant Vaccination

et al. 2006

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Persistence of antibodies to the surface antigen of the hepatitis B virus (anti-HBs) in children subjected to the Expanded Programme on Immunization (EPI), including hepatitis-B vaccine, in Thailand

Cited by 18 publications

References 16 publications

Hepatitis B vaccine boosters: Is there a clinical need in high endemicity populations?

Hepatitis B vaccine boosters: Is there a clinical need in high endemicity populations?

Hepatitis B immunization strategies: timing is everything

Long‐Term Protection against Carriage of Hepatitis B Virus after Infant Vaccination

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