Recombinant hepatitis B vaccine (Engerix-B): a review of its
immunogenicity and protective efficacy against hepatitis B.
Keating GM, Noble S.
Adis International Limited, Auckland, New Zealand. demail@adis.co.nz
Engerix-B (Hep-B[Eng]) is a noninfectious recombinant DNA vaccine containing
hepatitis B surface antigen (HBsAg). It is produced from genetically engineered
yeast (Saccharomyces cerevisiae). Intramuscular Hep-B(Eng) [0-, 1-, 6-month
schedule] has excellent immunogenicity in healthy neonates and infants,
children, adolescents and adults, with seroprotection rates of 85-100% seen
approximate, equals 1 month after the final dose of vaccine; seroprotection was
defined as an antibody against HBsAg (anti-HBs) titre of > or =10 IU/L. The use
of alternative Hep-B(Eng) immunisation schedules (e.g. a 0-, 1-, 2-, 12-month
schedule in neonates and infants, 0-, 12-, 24-month or two-dose schedules in
children and adolescents, and accelerated schedules in adults) have also been
associated with high rates of seroprotection. Seroprotection rates were
generally similar with Hep-B(Eng) and the recombinant vaccine Recombivax HB
(Hep-B[Rax]) or plasma-derived vaccines (PDVs) approximate, equals 1 month after
the final dose (although anti-HBs geometric mean titres were significantly
higher with Hep-B[Eng] than with Hep-B[Rax]). One month after the final dose,
adults had significantly higher seroprotection rates with the recombinant
triple-antigen vaccine Bio-Hep-B (Hep-B[Bio]) than with Hep-B(Eng), although
seroprotection rates in healthy infants were similar with Hep-B(Eng) and
Hep-B(Bio). Hep-B(Eng) had excellent immunogenicity in several groups considered
at high risk of acquiring hepatitis B (e.g. neonates born to hepatitis B carrier
mothers and healthcare workers). The immunogenicity of Hep-B(Eng) was reduced in
patients with conditions associated with impaired immune function (e.g. patients
undergoing haemodialysis or being treated for malignancy), although it had good
immunogenicity in patients with diabetes mellitus.Hep-B(Eng) had excellent
protective efficacy against HBsAg carriage in healthy infants and children, and
in neonates born to hepatitis B carrier mothers (protective efficacy of 95-99%).
Hep-B(Eng) also demonstrated good protective efficacy in a number of other
high-risk groups. Hep-B(Eng) is generally well tolerated with a tolerability
profile similar to that of Hep-B(Rax), Hep-B(Bio) and PDVs. In conclusion,
Hep-B(Eng) is a well established, highly immunogenic hepatitis B vaccine with
good tolerability and excellent protective efficacy; it offers flexibility
through a variety of immunisation schedules. In addition, it appears that
Hep-B(Eng) confers immunity for at least 10 years. Hep-B(Eng) has an important
role in mass vaccination campaigns against hepatitis B, as well as in groups
considered at high risk of acquiring hepatitis B.
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