Duration of Hepatitis B Immunity in Low Risk Children Receiving Hepatitis B Vaccinations from Birth - 1 OF 4

[Guest guest]

From The Pediatric Infectious Disease Journal®

Duration of Hepatitis B Immunity in Low Risk Children Receiving Hepatitis B

Vaccinations from Birth

Posted 07/20/2004

M. sen, MD; R. Bulkow, MS; J. McMahon, MD; Carolyn

Zanis, BS; Marilyn Getty, RN; Helen s, RN; Alan J. Parkinson, PhD

Abstract and Introduction

Abstract

Background: The duration of protection after hepatitis B vaccination of

infants is unknown.

Methods: We determined antibody to hepatitis B surface antigen (anti-HBs) at

4-13 years of age in 363 low risk children who had been vaccinated starting

at birth with hepatitis B vaccine. Those with nonprotective titers (<10

mIU/mL) received a booster dose. We similarly followed 16 children of

hepatitis B surface antigen (HBsAg)-positive mothers.

Results: Of low risk infants receiving a plasma-derived vaccine, 41% (42 of

102) of those whose primary response was unknown and 24% (4 of 17) who had

initially responded retained protective titers (>/=10 mIU/mL) of anti-HBs at

9 and 13 years, respectively. Of those who did not have protective antibody

titers, 61% (33 of 54) and 67% (8 of 12), respectively, responded to a

booster dose. In children of HBsAg-positive mothers, 31% retained protective

anti-HBs at 12 years, and 90% (9 of 10) with nonprotective titers responded

to a booster. In low risk children initially receiving a recombinant

vaccine, 12.5% (26 of 208) and none (0 of 36) retained protective anti-HBs

titers at 5 and 7 years of age, respectively. Of those who did not have

protective titers, 90% (120 of 134) and 91% (32 of 35), respectively,

responded to a booster.

Conclusions: Anti-HBs disappeared by 5 years of age in most children who

were vaccinated with hepatitis B vaccine from birth. Although most children

showed immunologic memory, one-third failed to demonstrate an anamnestic

response to a booster dose. Additional long term studies of low risk infants

are needed to determine duration of protection and the necessity for or

timing of booster doses.

Introduction

Hepatitis B virus (HBV) is a major global health concern with >350 million

people chronically infected.[1] The strategy for the control of HBV

infection, as outlined by the World Health Organization and endorsed by the

Advisory Committee on Immunization Practices (ACIP), is the introduction of

hepatitis B immunization at birth.[2,3] This strategy is designed to reduce

the risk of early childhood acquisition of HBV and reduce the number of

chronic carriers in endemic populations. In lower risk populations, such as

the United States, where transmission of HBV primarily occurs in older

individuals, newborn immunization is also used to prevent the small number

of cases transmitted in early childhood. Also when the hepatitis B

vaccination is initiated at birth, there is an increased likelihood that the

child will complete the series.[4,5]

The duration of hepatitis B vaccine protection has not been firmly

established. Long term protection of 10-12 years appears to occur for those

infants at high risk whose mothers were positive for hepatitis B surface

antigen (HBsAg) and hepatitis B e antigen.[6-12] However, the duration of

protection in low risk infants whose mothers are negative for HBsAg and who

receive hepatitis B vaccine from birth is unknown. In these populations, the

risk of HBV increases during adolescence and early adulthood primarily

because of the risk of sexual transmission.[3] Whether booster doses might

eventually be necessary to extend protection through adulthood has not been

established.

We examined the long term persistence of antibody to hepatitis B surface

antigen (anti-HBs) in children ages 4-13 years whose mothers were

HBsAg-negative and who originally received a course of hepatitis B vaccine

starting at birth. We also assessed the status of immunologic memory for HBV

by evaluating the response to a booster dose of a hepatitis B vaccine in

those children whose serum anti-HBs had fallen below 10 mIU/mL, the accepted

protective concentration.[6]

[Guest guest]

From The Pediatric Infectious Disease Journal®

Duration of Hepatitis B Immunity in Low Risk Children Receiving Hepatitis B

Vaccinations from Birth

Posted 07/20/2004

M. sen, MD; R. Bulkow, MS; J. McMahon, MD; Carolyn

Zanis, BS; Marilyn Getty, RN; Helen s, RN; Alan J. Parkinson, PhD

Abstract and Introduction

Abstract

Background: The duration of protection after hepatitis B vaccination of

infants is unknown.

Methods: We determined antibody to hepatitis B surface antigen (anti-HBs) at

4-13 years of age in 363 low risk children who had been vaccinated starting

at birth with hepatitis B vaccine. Those with nonprotective titers (<10

mIU/mL) received a booster dose. We similarly followed 16 children of

hepatitis B surface antigen (HBsAg)-positive mothers.

Results: Of low risk infants receiving a plasma-derived vaccine, 41% (42 of

102) of those whose primary response was unknown and 24% (4 of 17) who had

initially responded retained protective titers (>/=10 mIU/mL) of anti-HBs at

9 and 13 years, respectively. Of those who did not have protective antibody

titers, 61% (33 of 54) and 67% (8 of 12), respectively, responded to a

booster dose. In children of HBsAg-positive mothers, 31% retained protective

anti-HBs at 12 years, and 90% (9 of 10) with nonprotective titers responded

to a booster. In low risk children initially receiving a recombinant

vaccine, 12.5% (26 of 208) and none (0 of 36) retained protective anti-HBs

titers at 5 and 7 years of age, respectively. Of those who did not have

protective titers, 90% (120 of 134) and 91% (32 of 35), respectively,

responded to a booster.

Conclusions: Anti-HBs disappeared by 5 years of age in most children who

were vaccinated with hepatitis B vaccine from birth. Although most children

showed immunologic memory, one-third failed to demonstrate an anamnestic

response to a booster dose. Additional long term studies of low risk infants

are needed to determine duration of protection and the necessity for or

timing of booster doses.

Introduction

Hepatitis B virus (HBV) is a major global health concern with >350 million

people chronically infected.[1] The strategy for the control of HBV

infection, as outlined by the World Health Organization and endorsed by the

Advisory Committee on Immunization Practices (ACIP), is the introduction of

hepatitis B immunization at birth.[2,3] This strategy is designed to reduce

the risk of early childhood acquisition of HBV and reduce the number of

chronic carriers in endemic populations. In lower risk populations, such as

the United States, where transmission of HBV primarily occurs in older

individuals, newborn immunization is also used to prevent the small number

of cases transmitted in early childhood. Also when the hepatitis B

vaccination is initiated at birth, there is an increased likelihood that the

child will complete the series.[4,5]

The duration of hepatitis B vaccine protection has not been firmly

established. Long term protection of 10-12 years appears to occur for those

infants at high risk whose mothers were positive for hepatitis B surface

antigen (HBsAg) and hepatitis B e antigen.[6-12] However, the duration of

protection in low risk infants whose mothers are negative for HBsAg and who

receive hepatitis B vaccine from birth is unknown. In these populations, the

risk of HBV increases during adolescence and early adulthood primarily

because of the risk of sexual transmission.[3] Whether booster doses might

eventually be necessary to extend protection through adulthood has not been

established.

We examined the long term persistence of antibody to hepatitis B surface

antigen (anti-HBs) in children ages 4-13 years whose mothers were

HBsAg-negative and who originally received a course of hepatitis B vaccine

starting at birth. We also assessed the status of immunologic memory for HBV

by evaluating the response to a booster dose of a hepatitis B vaccine in

those children whose serum anti-HBs had fallen below 10 mIU/mL, the accepted

protective concentration.[6]

[Guest guest]

From The Pediatric Infectious Disease Journal®

Duration of Hepatitis B Immunity in Low Risk Children Receiving Hepatitis B

Vaccinations from Birth

Posted 07/20/2004

M. sen, MD; R. Bulkow, MS; J. McMahon, MD; Carolyn

Zanis, BS; Marilyn Getty, RN; Helen s, RN; Alan J. Parkinson, PhD

Abstract and Introduction

Abstract

Background: The duration of protection after hepatitis B vaccination of

infants is unknown.

Methods: We determined antibody to hepatitis B surface antigen (anti-HBs) at

4-13 years of age in 363 low risk children who had been vaccinated starting

at birth with hepatitis B vaccine. Those with nonprotective titers (<10

mIU/mL) received a booster dose. We similarly followed 16 children of

hepatitis B surface antigen (HBsAg)-positive mothers.

Results: Of low risk infants receiving a plasma-derived vaccine, 41% (42 of

102) of those whose primary response was unknown and 24% (4 of 17) who had

initially responded retained protective titers (>/=10 mIU/mL) of anti-HBs at

9 and 13 years, respectively. Of those who did not have protective antibody

titers, 61% (33 of 54) and 67% (8 of 12), respectively, responded to a

booster dose. In children of HBsAg-positive mothers, 31% retained protective

anti-HBs at 12 years, and 90% (9 of 10) with nonprotective titers responded

to a booster. In low risk children initially receiving a recombinant

vaccine, 12.5% (26 of 208) and none (0 of 36) retained protective anti-HBs

titers at 5 and 7 years of age, respectively. Of those who did not have

protective titers, 90% (120 of 134) and 91% (32 of 35), respectively,

responded to a booster.

Conclusions: Anti-HBs disappeared by 5 years of age in most children who

were vaccinated with hepatitis B vaccine from birth. Although most children

showed immunologic memory, one-third failed to demonstrate an anamnestic

response to a booster dose. Additional long term studies of low risk infants

are needed to determine duration of protection and the necessity for or

timing of booster doses.

Introduction

Hepatitis B virus (HBV) is a major global health concern with >350 million

people chronically infected.[1] The strategy for the control of HBV

infection, as outlined by the World Health Organization and endorsed by the

Advisory Committee on Immunization Practices (ACIP), is the introduction of

hepatitis B immunization at birth.[2,3] This strategy is designed to reduce

the risk of early childhood acquisition of HBV and reduce the number of

chronic carriers in endemic populations. In lower risk populations, such as

the United States, where transmission of HBV primarily occurs in older

individuals, newborn immunization is also used to prevent the small number

of cases transmitted in early childhood. Also when the hepatitis B

vaccination is initiated at birth, there is an increased likelihood that the

child will complete the series.[4,5]

The duration of hepatitis B vaccine protection has not been firmly

established. Long term protection of 10-12 years appears to occur for those

infants at high risk whose mothers were positive for hepatitis B surface

antigen (HBsAg) and hepatitis B e antigen.[6-12] However, the duration of

protection in low risk infants whose mothers are negative for HBsAg and who

receive hepatitis B vaccine from birth is unknown. In these populations, the

risk of HBV increases during adolescence and early adulthood primarily

because of the risk of sexual transmission.[3] Whether booster doses might

eventually be necessary to extend protection through adulthood has not been

established.

We examined the long term persistence of antibody to hepatitis B surface

antigen (anti-HBs) in children ages 4-13 years whose mothers were

HBsAg-negative and who originally received a course of hepatitis B vaccine

starting at birth. We also assessed the status of immunologic memory for HBV

by evaluating the response to a booster dose of a hepatitis B vaccine in

those children whose serum anti-HBs had fallen below 10 mIU/mL, the accepted

protective concentration.[6]

[Guest guest]

From The Pediatric Infectious Disease Journal®

Duration of Hepatitis B Immunity in Low Risk Children Receiving Hepatitis B

Vaccinations from Birth

Posted 07/20/2004

M. sen, MD; R. Bulkow, MS; J. McMahon, MD; Carolyn

Zanis, BS; Marilyn Getty, RN; Helen s, RN; Alan J. Parkinson, PhD

Abstract and Introduction

Abstract

Background: The duration of protection after hepatitis B vaccination of

infants is unknown.

Methods: We determined antibody to hepatitis B surface antigen (anti-HBs) at

4-13 years of age in 363 low risk children who had been vaccinated starting

at birth with hepatitis B vaccine. Those with nonprotective titers (<10

mIU/mL) received a booster dose. We similarly followed 16 children of

hepatitis B surface antigen (HBsAg)-positive mothers.

Results: Of low risk infants receiving a plasma-derived vaccine, 41% (42 of

102) of those whose primary response was unknown and 24% (4 of 17) who had

initially responded retained protective titers (>/=10 mIU/mL) of anti-HBs at

9 and 13 years, respectively. Of those who did not have protective antibody

titers, 61% (33 of 54) and 67% (8 of 12), respectively, responded to a

booster dose. In children of HBsAg-positive mothers, 31% retained protective

anti-HBs at 12 years, and 90% (9 of 10) with nonprotective titers responded

to a booster. In low risk children initially receiving a recombinant

vaccine, 12.5% (26 of 208) and none (0 of 36) retained protective anti-HBs

titers at 5 and 7 years of age, respectively. Of those who did not have

protective titers, 90% (120 of 134) and 91% (32 of 35), respectively,

responded to a booster.

Conclusions: Anti-HBs disappeared by 5 years of age in most children who

were vaccinated with hepatitis B vaccine from birth. Although most children

showed immunologic memory, one-third failed to demonstrate an anamnestic

response to a booster dose. Additional long term studies of low risk infants

are needed to determine duration of protection and the necessity for or

timing of booster doses.

Introduction

Hepatitis B virus (HBV) is a major global health concern with >350 million

people chronically infected.[1] The strategy for the control of HBV

infection, as outlined by the World Health Organization and endorsed by the

Advisory Committee on Immunization Practices (ACIP), is the introduction of

hepatitis B immunization at birth.[2,3] This strategy is designed to reduce

the risk of early childhood acquisition of HBV and reduce the number of

chronic carriers in endemic populations. In lower risk populations, such as

the United States, where transmission of HBV primarily occurs in older

individuals, newborn immunization is also used to prevent the small number

of cases transmitted in early childhood. Also when the hepatitis B

vaccination is initiated at birth, there is an increased likelihood that the

child will complete the series.[4,5]

The duration of hepatitis B vaccine protection has not been firmly

established. Long term protection of 10-12 years appears to occur for those

infants at high risk whose mothers were positive for hepatitis B surface

antigen (HBsAg) and hepatitis B e antigen.[6-12] However, the duration of

protection in low risk infants whose mothers are negative for HBsAg and who

receive hepatitis B vaccine from birth is unknown. In these populations, the

risk of HBV increases during adolescence and early adulthood primarily

because of the risk of sexual transmission.[3] Whether booster doses might

eventually be necessary to extend protection through adulthood has not been

established.

We examined the long term persistence of antibody to hepatitis B surface

antigen (anti-HBs) in children ages 4-13 years whose mothers were

HBsAg-negative and who originally received a course of hepatitis B vaccine

starting at birth. We also assessed the status of immunologic memory for HBV

by evaluating the response to a booster dose of a hepatitis B vaccine in

those children whose serum anti-HBs had fallen below 10 mIU/mL, the accepted

protective concentration.[6]