Hepatitis B vaccine booster dose: low-dose recombinant hepatitis B vaccines as a booster dose

Booster dose vaccination for preventing hepatitis B

BACKGROUND

Antibodies against hepatitis B surface antigen (HBs) wane over time after vaccination for hepatitis B (HB); hence, the duration of protection provided by the vaccine is still unknown but may be evaluated indirectly by measuring the anamnestic immune response to booster doses of vaccine.

OBJECTIVES

To assess the benefits and harms of booster dose hepatitis B vaccination for preventing HB infection.

SEARCH STRATEGY

We searched The Cochrane Hepato-biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 4, 2010) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, conference databases, and reference lists of articles to May 2010. We also contacted authors of articles and manufacturers.

SELECTION CRITERIA

Randomised clinical trials addressing anamnestic immune response to booster of HB vaccine five years or more after primary vaccination in apparently healthy participants, vaccinated in a 3-dose or 4-dose schedules of HB vaccine without receiving additional dose or immunoglobulin.

DATA COLLECTION AND ANALYSIS

Two authors made the decisions if the identified publications on studies met the inclusion criteria or not. Primary outcome measures included the proportion with anamnestic immune response in non-protected participants and signs of hepatitis B virus infection. Secondary outcomes were the proportion with local and systemic adverse event events developed following booster dose injection. Weighted proportion were planned to be reported with 95% confidence intervals.

MAIN RESULTS

There were no eligible randomised clinical trials fulfilling the inclusion criteria of this review.

AUTHORS' CONCLUSIONS

We were unable to identify randomised clinical trials on the topic. We need randomised clinical trials to formulate future booster policies for preventing hepatitis B infection.

Comparative immunogenicity under field conditions of two recombinant hepatitis B vaccines in 8-10-year-old children

The immunogenicity of two hepatitis B vaccines was compared in 8-10-year-old children immunized in a school program. One year apart, 1129 children received Engerix-B 10 microg vaccine (EB), and 1126 received Recombivax-HB 2.5 microg (RB), following the 0, 1, 6 schedule. Blood samples were collected one month after the third dose. Anti-Hbs were measured by commercial radioimmunoassay. In the EB group, 99.1% of the children seroconverted (>/=2 IU/l) compared to 99.7% in the RHB group (p=0.09). The seroprotection rate (>/=10 IU/l) was similar for both groups: 98.9% in the EB group and 99.2% in the RB group (p=0.66). However, GMCs of anti-HBs were higher in children given EB compared to those given RB (7307 vs. 3800 mIU/ml, p<0.0001). This study showed that both vaccines were highly immunogenic, in the course of a regular field immunization program. However, the difference observed in the antibody levels attained according to the vaccine may play a role in the long-term protection of these children.