Evidence for a change in the epidemiology of hepatitis B virus infection after nearly two decades of universal hepatitis B vaccination in South Africa

J Med Virol. 2014 Jun;86(6):918-24. doi: 10.1002/jmv.23910. Epub 2014 Feb 23.


The hepatitis B vaccine has been part of the South African Expanded Program on Immunization since April 1995 but its long-term impact remains unknown. This study tested 1,206 sera collected from patients aged 1-25 years from various health facilities across the country for HBV serological markers and HBV DNA. Based on the year the vaccine was introduced, samples were stratified by age into pre- and post-vaccine introduction populations, which were then compared for evidence of immunity and chronic carriage using the Chi-square test. Where HIV status was known, subset analyses were performed. Immunity to HBV infection increased from 13.0% in the pre- to 57.0% in the post-vaccine introduction population (P < 0.001). This decreased with increasing age within the post-vaccine introduction population (76.1% for 1-5 years, 50.0% for 6-10 years, and 46.3% for 11-16 years). In addition, HBV chronic carriage was significantly (P = 0.003) reduced in the post- (1.4%) compared to the pre-vaccine introduction population (4.2%). The difference in prevalence of active HBV infection in the serologically exposed pre- and post-vaccine introduction populations was not statistically significant. Subset analyses showed that evidence of immunity was significantly (P < 0.001) higher in the HIV negative compared to the HIV positive subset in both populations. Universal hepatitis B vaccination has been a remarkable success, with a significant increase in immunity to HBV infection. The observation that HBV chronic carriage increases as immunity wanes over time calls into question whether the time has come to consider a pre-adolescence vaccine booster dose policy.

Keywords: booster dose; chronic carriage; hepatitis B vaccine; immunity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Carrier State / epidemiology*
  • Carrier State / prevention & control*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • HIV Infections / complications
  • Hepatitis B / epidemiology*
  • Hepatitis B / prevention & control*
  • Hepatitis B Vaccines / administration & dosage*
  • Humans
  • Infant
  • Male
  • Prevalence
  • South Africa / epidemiology
  • Vaccination / statistics & numerical data*
  • Young Adult


  • Hepatitis B Vaccines