Persistence of Protection Against Hepatitis B Virus Infection Among Adolescents Vaccinated With Recombinant Hepatitis B Vaccine Beginning at Birth: A 15-Year Follow-Up Study

Background: Long-term follow-up studies of populations that received recombinant hepatitis B (HB) vaccination beginning at birth are limited. Methods: Micronesian adolescents who had received 3 doses of recombinant HB vaccine (Recombivax 5 μg at birth, 2.5 μg at 2 months, 2.5 μg at 6 months) and tested negative for antibody to HB core antigen (anti-HBc) 2 years after primary vaccination (baseline testing) were followed up 15 years after primary vaccination. After testing for anti-HBc, HB surface antigen (HBsAg), and antibody to HBsAg (anti-HBs), participants received a booster dose of HB vaccine. An anamnestic response was defined as an increase in anti-HBs concentrations to a level ≥10 mIU/mL 14 days postbooster. Results: Of the 105 participants, 42 (40.0%) had anti-HBs concentrations ≥10 mIU/mL on baseline testing. At 15 years, 8 (7.6%) were anti-HBc positive; none were HBsAg positive. Of the remaining 97, 7 (7.3%) had anti-HBs concentrations ≥10 mIU/mL. Of the 96 who received a booster dose, 46 (47.9%) had an anamnestic response; final antibody concentrations were 10-99 mIU/mL for 17 (17.7%) and >100 mIU/mL for 29 (30.2%). Participants with anti-HBs concentrations ≥10 mIU/mL on baseline testing were more likely to have an anamnestic response at 15 years [26/39 (66.7%) versus 20/57 (35.1%); P = 0.003]. Conclusions: Fifteen years after primary vaccination starting at birth, 8% of participants had evidence of past HB virus infection, but none had chronic infection. Absence of an anamnestic response to an additional vaccine dose, seen in half of participants, might indicate waning immunity.