This study assessed the level of vaccine-induced hepatitis B surface antibo
dy that is protective against hepatitis B infection and carriage in The Gam
bia. Sera from 700 of a cohort of 1041 children vaccinated against hepatiti
s B in infancy were serially tested for markers of hepatitis B until age 7
years. No absolute level of protection against infection was found, but all
children who attained a peak antibody response to vaccination of greater t
han or equal to 10 IU/L were protected against carriage of hepatitis B surf
ace antigen. Two-thirds of 45 infected children experienced brief infection
(determined by loss of core antibody). This transient infection was likely
related to surface antibody level. The data support the use of the peak an
tibody response as the best indicator of protection against carriage and su
ggest that most infections after vaccination are short-lived.