Durability of antibody response against hepatitis B virus in healthcare workers vaccinated as adults

Clin Infect Dis. 2015 Feb 15;60(4):505-13. doi: 10.1093/cid/ciu867. Epub 2014 Nov 10.


Background: Follow-up studies of recipients of hepatitis B vaccine from endemic areas have reported loss of antibody to hepatitis B surface antigen (anti-HBs) in a high proportion of persons vaccinated at birth. In contrast, the long-term durability of antibody in persons vaccinated as adults in nonendemic areas is not well defined. We aimed to assess the durability of anti-HBs among healthcare workers (HCWs) vaccinated as adults and response to a booster among those without protective levels of antibody.

Methods: Adult HCWs aged 18-60 at the time of initial vaccination were recruited. All were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and anti-HBs level. HCWs with anti-HBs <12 mIU/mL were offered a booster and levels were measured 1, 7, and 21 days afterward.

Results: Anti-HBs levels were <12 mIU/mL in 9 of 50 (18%), 13 of 50 (26%), and 14 of 59 (24%) HCWs 10-15, 16-20, and >20 years postvaccination, respectively, (P = ns). Four HCWs were anti-HBc positive; none had HBsAg. By logistic regression, older age at vaccination was the only predictor of inadequate anti-HBs level (P = .0005). Thirty-four of 36 subjects with inadequate anti-HBs levels received a booster and 32 (94%) developed levels >12 mIU/mL within 3 weeks.

Conclusions: Anti-HBs levels decrease after 10-31 years and fall below a level considered protective in approximately 25% of cases. The rapid and robust response to a booster vaccine suggests a long-lasting amnestic response. Hepatitis B vaccination provides long-term protection against hepatitis B and booster vaccination does not appear to be necessary in HCWs. Clinical Trials Registration. NCT01182311.

Keywords: booster vaccination; chronic hepatitis B; healthcare workers; hepatitis B vaccine.

Publication types

  • Observational Study
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Follow-Up Studies
  • Health Personnel*
  • Hepatitis A Vaccines / immunology*
  • Hepatitis B / prevention & control
  • Hepatitis B Antibodies / blood*
  • Hepatitis B Antibodies / immunology
  • Hepatitis B Core Antigens / blood
  • Hepatitis B Core Antigens / immunology*
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B Surface Antigens / immunology*
  • Hepatitis B Vaccines / immunology*
  • Humans
  • Immunization, Secondary
  • Immunologic Memory
  • Logistic Models
  • Male
  • Maryland
  • Middle Aged
  • Regression Analysis
  • Serologic Tests
  • Time Factors
  • Vaccination
  • Vaccines, Combined / immunology
  • Young Adult


  • Hepatitis A Vaccines
  • Hepatitis B Antibodies
  • Hepatitis B Core Antigens
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines
  • Vaccines, Combined
  • twinrix

Associated data

  • ClinicalTrials.gov/NCT01182311