http://bmj.com/cgi/content/abstract/325/7364/569
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 Collections under
which this article appears: Other
Infectious Diseases Other
Public Health Medicine
in Developing Countries Drugs:
immunological products and vaccines Liver,
including hepatitis and cirrhosis Other
Pediatrics |
Hilton Whittle
a Medical Research Council Laboratories, PO Box 273, Banjul, Gambia, b London School of Hygiene and Tropical Medicine, London WC1E 7HT
Correspondence to: H Whittle hwhittle@mrc.gm
Objective: To determine the duration of protection from
hepatitis B vaccine given in infancy and early childhood.
Design: Cross sectional serological study of hepatitis B virus
infection in children of various ages 14 years after the start of a
trial of vaccination regimens.
Setting: Two villages in the Gambia.
Participants: Children and adolescents given hepatitis B
vaccine in infancy or early childhood: 232 were aged 1-5 years,
225 aged 5-9 years, 220 aged 10-14 years, and 175 aged 15-19 years.
Main outcome measures: Vaccine efficacy against infection and against
chronic infection in the different age groups.
Results: Vaccine efficacy against chronic carriage of
hepatitis B virus was 94% (95% confidence interval 89% to 97%), which
did not vary significantly between the age groups. Efficacy against
infection was 80% (76% to 84%). This was significantly lower in the
oldest age group (65%, 56 to 73). Of the uninfected participants in
this age group, 36% had no detectable hepatitis B virus surface
antibody. Time since vaccination and a low peak antibody response
were the most powerful risk factors for breakthrough infection
(P<0.001 in each case). Low peak antibody response was also a risk
factor for chronic carriage (odds ratio 95, 19 to 466).
Conclusions: Children vaccinated in infancy are at increased
risk of hepatitis B virus infection in the late teens. The risk of
chronic carriage after sexual exposure needs further assessment to
determine if booster vaccines are necessary.
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What is already known on this topic The evidence for maintenance of immunity in teenagers after vaccination in infancy is slender The risk of hepatitis B virus infection is increased by sexual exposure What this study adds Even though breakthrough infections are common at this age, protection against chronic infections with hepatitis B virus may be maintained |
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