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Antibody levels and protection after hepatitis B vaccination: results of a 15-year follow-up.

Ann Intern Med. 2005 Mar 1;142(5):333-41.
Antibody levels and protection after hepatitis B vaccination: results of a 15-year follow-up.
‘McMahon BJ, Bruden DL, Petersen KM, Bulkow LR, Parkinson AJ, Nainan O, Khristova
M, Zanis C, Peters H, Margolis HS.
Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, and the Alaska Native’

BACKGROUND: The duration of protection afforded by hepatitis B vaccination is unknown. OBJECTIVE: To determine antibody persistence and protection from hepatitis B virus (HBV) infection. DESIGN: Prospective cohort study. SETTING: 15 villages in southwest Alaska. PARTICIPANTS: 1578 Alaska Natives vaccinated at age 6 months or older. INTERVENTION: During 1981-1982, participants received 3 doses of plasma-derived hepatitis B vaccine. This cohort was followed annually over the first 11 years, and 841 (53%) persons were tested at 15 years. MEASUREMENTS: Antibody to hepatitis B surface antigen (anti-HBs), markers of HBV infection, and testing to identify HBV variants. RESULTS: Levels of anti-HBs in the cohort decreased from a geometric mean concentration of 822 mIU/mL after vaccination to 27 mIU/mL at 15 years. Initial anti-HBs level, older age at vaccination, and male sex were associated with persistence of higher anti-HBs levels at 15 years when analyzed by a longitudinal linear mixed model. After adjustment for initial anti-HBs level and sex, those vaccinated at age 6 months to 4 years had the lowest anti-HBs level at 15 years. Asymptomatic breakthrough infections were detected in 16 participants and occurred more frequently in persons who did not respond to vaccination than those who responded (P = 0.01). Among infected persons with viremia, 2 were infected with wild-type HBV and 4 had HBV surface glycoprotein variants, generally accompanied by wild-type HBV. LIMITATIONS: The loss of participants to follow-up at 15 years was 47%. However, characteristics of persons tested were similar to those of persons lost to follow-up. CONCLUSIONS: Hepatitis B vaccination strongly protected against infection for at least 15 years in all age groups. Antibody levels decreased the most among persons immunized at 4 years of age or younger.
MeSH Terms : Adolescent – Adult – Alaska/epidemiology – Antibodies, Viral/blood* – Child – Child, Preschool – DNA, Viral/blood – Female – Follow-Up Studies – Hepatitis B/epidemiology – Hepatitis B/prevention & control* – Hepatitis B Surface Antigens/immun

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