Adolescent booster with hepatitis B virus vaccines decreases HBV infection in high-risk adults

•Some vaccination-protected children developed chronic HBV infection in adulthood.•Vaccination-protected children have increased risk when born to HBsAg(+) mothers.•More anti-HBc(+) vaccinated children develop HBsAg(+) when born to HBsAg(+) mothers.•Vaccinated children born to HBsAg(+) mothers benefit from adolescent booster.•Adolescent booster might be appropriate for anti-HBs(−) high-risk individuals.

BackgroundNeutralizing antibodies (anti-HBs) after immunization with hepatitis B virus (HBV) vaccines against HBV surface antigen (HBsAg) wane after 10-15 years. We analyzed the effect of an adolescent booster given to vaccination-protected children born to mothers with different HBsAg-carrying status against HBV infection in their mature adulthood.MethodsA total of 9793 individuals, who were HBsAg-negative at childhood (baseline) and donated blood samples, both during childhood and adulthood, from the vaccination group in “Qidong Hepatitis B Intervention Study”, were enrolled. Among them 7414 received a one-dose, 10 μg-recombinant HBV vaccine booster at 10-14 years of age. At endpoint (23-28 years of age), we determined the HBV serological markers and quantified their serum HBV-DNA in each of the chronic HBV-infected adults.ResultsFifty-seven adults were identified as chronic HBV infection, indicated by HBsAg(+)&anti-HBc(+) for more than 6 months. The individuals who were born to HBsAg-positive mothers (high-risk adults) had significantly increased risk of developing chronic HBV infections in adulthood compared with those who were born to HBsAg-negative mothers; the adjusted odds ratio (OR) was 12.56, 95%CI:7.14-22.08. The seronegative status of anti-HBs at 10-11 years of age significantly increased the risk of HBV infections among the high-risk adults. When HBsAg(−)&anti-HBc(+) children who were born to HBsAg-positive mothers 70% of them remained as the status and 10% of them developed HBsAg(+)&anti-HBc(+). While when they were born to HBsAg-negative mothers 1.05% HBsAg(−)&anti-HBc(+) children developed HBsAg(+)&anti-HBc(+) and 24.74% of them remained as the status in 12-18 years. One dose of adolescent booster showed significant protection on high-risk adults from chronic HBV infection; P for trend was 0.015.ConclusionsMaternal HBsAg-positive status was an independent risk factor for vaccination-protected children to develop HBV breakthrough infection in adulthood. Adolescent boosters might be appropriate for high-risk individuals who were born to HBsAg-positive mothers when their serum anti-HBs < 10 mIU/ml.