The hepatitis B vaccine protects re-exposed health care workers, but does not provide sterilizing immunity

Gastroenterology. 2013 Nov;145(5):1026-34. doi: 10.1053/j.gastro.2013.07.044. Epub 2013 Jul 31.


Background & aims: Infection with hepatitis B virus (HBV) can be prevented by vaccination with HB surface (HBs) antigen, which induces HBs-specific antibodies and T cells. However, the duration of vaccine-induced protective immunity is poorly defined for health care workers who were vaccinated as adults.

Methods: We investigated the immune mechanisms (antibody and T-cell responses) of long-term protection by the HBV vaccine in 90 health care workers with or without occupational exposure to HBV, 10-28 years after vaccination.

Results: Fifty-nine of 90 health care workers (65%) had levels of antibodies to HBs antigen above the cut-off (>12 mIU/mL) and 30 of 90 (33%) had HBs-specific T cells that produced interferon-gamma. Titers of antibodies to HBs antigen correlated with numbers of HBs-specific interferon-gamma-producing T cells, but not with time after vaccination. Although occupational exposure to HBV after vaccination did not induce antibodies to the HBV core protein (HBcore), the standard biomarker for HBV infection, CD4(+) and CD8(+) T cells against HBcore and polymerase antigens were detected. Similar numbers of HBcore- and polymerase-specific CD4(+) and CD8(+) T cells were detected in health care workers with occupational exposure to HBV and in patients who acquired immunity via HBV infection. Most of the HBcore- and polymerase-specific T cells were CD45RO(+)CCR7(-)CD127(-) effector memory cells in exposed health care workers and in patients with acquired immunity. In contrast, most of the vaccine-induced HBs-specific T cells were CD45RO(-)CCR7(-)CD127(-) terminally differentiated cells.

Conclusions: HBs antigen vaccine-induced immunity protects against future infection but does not provide sterilizing immunity, as evidenced by HBcore- and polymerase-specific CD8(+) T cells in vaccinated health care workers with occupational exposure to HBV. The presence of HBcore- and HBV polymerase-specific T-cell responses is a more sensitive indicator of HBV exposure than detection of HBcore-specific antibodies.

Keywords: DMSO; FCS; HBV; HBV core protein; HBV polymerase; HBVpol; HBcore; HBsAg; HDV; IFN; Immune Response; Immunization; PBMC; PBS; PE; PHA-M; T Cell; Virus; anti-HBs; antibody to hepatitis B surface antigen; dimethyl sulfoxide; fetal calf serum; hepatitis B surface antigen; hepatitis B virus; hepatitis D virus; interferon; peripheral blood mononuclear cells; phosphate-buffered saline; phycoerythrin; phytohemagglutinin.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Viral / blood
  • Antibodies, Viral / immunology
  • CD8-Positive T-Lymphocytes / immunology
  • CD8-Positive T-Lymphocytes / pathology
  • Female
  • Health Personnel*
  • Hepatitis B / immunology
  • Hepatitis B / prevention & control*
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B Surface Antigens / immunology
  • Hepatitis B Vaccines / immunology
  • Hepatitis B Vaccines / therapeutic use*
  • Hepatitis B virus / immunology
  • Humans
  • Immunity / immunology*
  • Infectious Disease Transmission, Professional-to-Patient / prevention & control*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Occupational Exposure*
  • Time Factors


  • Antibodies, Viral
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines