Consensus StatementAre booster immunisations needed for lifelong hepatitis B immunity?
Section snippets
HB-vaccine-induced antibodies
The strength of the immune response after administration of hepatitis B surface antigen (HBsAg)–which is the basis of immunisation against hepatitis B–has historically been assessed by measuring antibody to HBs with commercial kits. Although a level above 10 mIU/mL is generally taken to be protective,3, 4, 5 the potential for low anti-HBs levels to mask significant infection (indicated by HBsAg) has led some countries to adopt a higher reference level (eg, 100 mIU/mL in the UK).6 The
Anamnestic antibody response
In the primary, three-dose course of immunisation (0, 1, 6 month schedule), the first two doses usually suffice to initiate anti-HBs production and to prime the immune system for a secondary response to antigen. The third dose stimulates this secondary response; anti-HBs titres are higher than those achieved after the first two doses, and antibody appears in the blood more rapidly. While this third dose is biologically acting as a booster, it should not be confused with the earlier definition.
Persistent immunity with waning antibody
Studies of vaccinated populations at high risk of exposure to HBV support the hypothesis that immunological memory confers long-lived protection against clinically significant breakthrough infections. For example, of 74 Chinese children vaccinated at birth because of the HBsAg positivity of their mothers (perinatal transmission rates of 70–90% have been reported16), only 38 (51%) still had an anti-HBs titre above 10 mIU/mL 9 years later. The high risk of transmission to children of
Non-responders
The administration of an additional dose of vaccine to low responders or non-responders can, in some cases, effect an antibody response and immunological priming.27 Indeed, it is likely that some apparent non-responders are in fact primed after a course of vaccination even in the absence of detectable antibody, since some can mount an anti-HBs response when given a dose of vaccine years later. Chiaramonte et al speculate that these apparent non-responders may have developed cell-mediated
Booster recommendations
The three options for ensuring protection against HBV infection and/or disease are.30
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Reliance on immunological memory rather than booster doses to protect against clinically significant breakthrough infections
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Provision of regular booster vaccinations to all vaccinated people without assessing anti-HBs status
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Testing anti-HBs 1 month after the primary vaccination or booster has been administered, and administering a booster or the next booster before the minimum protective anti-HBs level is
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Consensus committee members listed at end of article, with affiliations in panel 2