How much immunity does the hepatitis B vaccine confer?

The push to eliminate hepatitis B in the United States has been focused on preventing the disease through vaccination. However, there has been limited information on vaccine-linked immunity following the implementation of universal hepatitis B vaccination in the United States. An investigation in JAMA Network Open offers some much-needed insight.¹

The researchers used data from National Health and Nutrition Examination Survey. Blood specimens from participants were processed, stored, and shipped to the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, at the Centers for Disease Control and Prevention. Researchers used enzyme-linked immunoassays to examine hepatitis B surface antibody titers and hepatitis B core antibody titers from 1999 to 2006. The titers were tested using the VITROS Reagent Packs and VITROS Immunodiagnostic Products Calibrators from 2007. Hepatitis B immunity was defined through a positive-hepatitis B surface antibody test result (hepatitis B surface antibody titer >10 IU/L from 1999 to 2006 and ≥12 IU/L from 2007 to 2016).

There were a total of 21,873 children and adolescents included in the study. The data showed that hepatitis B vaccination coverage went up significantly from 1999 to 2016 from 62.6% [95% CI, 58.6%-66.4%] to 86.3% [95% CI, 82.9%-89.2%]; P < .001). Consequently, immunity tied to the vaccine also increased from 1999 to 2016 in children aged 2 to 5 years (from 60.7% [95% CI, 48.8%-71.4%] to 65.2% [95% CI, 57.4%-72.3%]; P = .001). However, it decreased in the other age groups: children aged 6 to 10 years (from 64.6% [95% CI, 57.7%-70.9%] to 46.5% [95% CI, 39.1%-54.0%]; P < .001), adolescents aged 11 to 13 years (from 68.8% [95% CI, 58.1%-77.8%] to 26.2% [95% CI, 18.6%-35.5%]; P < .001), and adolescents aged 14 to 18 years (from 68.5% [95% CI, 62.9%-73.6%] to 15.6% [95% CI, 12.2%-19.8%]; P < .001). Additionally, the researchers found that by birth year the serologic evidence of vaccine-linked immunity significantly decreased in the 1994-2003 National Health and Nutrition Examination Survey, but this was not true among participants who had been born between 1988 and 1993. Children born outside of the United States did not seem to have the same decreasing trend in immunity.

The investigators concluded that there was decreasing hepatitis immunity found in US-born children and teenagers, even though there was an increasing rate of hepatitis B vaccine coverage. They believe that it’s possible there is a need for surveillance as well as a booster vaccine dose.

Reference

1. Le M, Yeo Y, So S, Gane E, Cheung R, Nguyen M. Prevalence of Hepatitis B Vaccination Coverage and Serologic Evidence of Immunity Among US-Born Children and Adolescents From 1999 to 2016. JAMA Netw Open. 2020;3(11):e2022388. doi:10.1001/jamanetworkopen.2020.22388