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Determinants of Long-term Protection After Hepatitis B Vaccination in Infancy: A Meta-analysis

Schönberger, Katharina MSc, MPH*; Riedel, Christina MSc*; Rückinger, Simon PhD*; Mansmann, Ulrich MSc; Jilg, Wolfgang MD; Kries, Rüdiger v. MD, MPH*

Pediatric Infectious Disease Journal: April 2013 - Volume 32 - Issue 4 - p 307–313
doi: 10.1097/INF.0b013e31827bd1b0
Original Studies

Background: The duration of protection after hepatitis B vaccination in early infancy is unclear and may be related to vaccination schedule, dosage, vaccine type and population characteristics. Factors potentially influencing waning immunity were assessed.

Methods: A systematic review was performed. The main outcomes were prevalence of anti-hepatits B antibodies ≥ 10 mIU/mL after primary or booster vaccination. Factors potentially influencing protection were assessed in an adjusted random-effects meta-analysis model by age for both outcomes. Results of both meta-analyses were combined in a prognostic model.

Results: Forty-six studies reporting on the anti-hepatits B antibodies ≥ 10 mIU/mL 5 to 20 years after primary immunization and 29 on booster response were identified. The adjusted meta-analyses identified maternal carrier status (odds ratio [OR]: 2.37 [1.11; 5.08]), lower vaccine dosage than presently recommended (OR: 0.14 [0.06; 0.30]) and gap time between last and preceding dose of the primary vaccine series (OR: 0.44 [0.22; 0.86]) as determinants for persistence of anti-hepatits B antibodies ≥ 10. A lower vaccine dosage was also associated with failure to respond to booster (OR: 0.20 [0.10; 0.38]). The prognostic model predicted long-term protection of 90% [77%; 100%] at the age of 17 years for offspring of noncarrier mothers vaccinated with a presently recommended dose and vaccination schedule.

Conclusions: Based on meta-analyses, predictors of waning immunity after hepatitis B vaccination in infancy could be identified. A prognostic model for long-term protection after hepatitis B vaccination in infancy was developed.

From the *Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology; Department of Medical Informatics, Biostatistics and Epidemiology, Ludwig Maximilians University of Munich, Munich; and Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany.

Accepted for publication October 30, 2012.

The project was funded by Robert Koch-Institute grant 1362/1–925. The grant donating agency had no influence on the design or conduct of this study. Prof. Wolfgang Jilg has received honoraria for lectures from GlaxoSmithKline and SanofiPasteur-MSD and served as principal investigator in a clinical trial on hepatitis B vaccination sponsored by GlaxoSmithKline. The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Katharina Schönberger, MSc, MPH, Institute of Social Pediatrics and Adolescent Medicine, Division of Epidemiology, Ludwig Maximilians University of Munich, Heiglhofstr. 63, 81377 München, Germany. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.