Background: In universal vaccination programs, when there is no postvaccina
tion serologic assessment of response, there must be confidence that the va
ccines used provide a high degree of seroprotection.
Objective: This parallel analysis of 2 recombinant hepatitis B vaccines (En
gerix B (R) and Recombivax (R) /HB-Vax II (R)) was conducted to review the
seroprotective efficacy of each vaccine in defined populations.
Methods: Clinical studies of the 2 vaccines published as manuscripts or con
ference abstracts in the public domain between January 1986 and April 1999
were identified retrospectively by unrestricted screening of journals throu
gh BIOSIS (R), MEDLINE (R), and EMBASE (R) and the Internet. Unpublished or
internal company data were excluded to maintain impartiality. The studies
were reviewed and analyzed. The studies were not assessed for quality other
than a judgment of their eligibility for inclusion in the analysis. The pr
imary outcome measure was the proportion of subjects in defined populations
who showed an early seroprotective response to currently licensed vaccinat
ion schedules. Summary statistical analyses of seroprotective response rate
s and 95% CIs were calculated for each vaccine for each population. Seropro
tective response was defined by an anti-hepatitis B surface antigen titer g
reater than or equal to 10 IU/L measured between I and 3 months after the f
inal vaccination. Because the study was designed specifically to review pub
lished immunogenicity data, safety data were not assessed. The study was no
t designed to demonstrate superiority of one vaccine over the other.
Results: A total of 181 clinical studies representing 32,904 vaccinated sub
jects were reviewed and analyzed, of whom 24,277 had been vaccinated with E
ngerix B and 8627 vaccinated with Recombivax/ MB-Var II. Seroprotection was
achieved in 20,060 subjects (95.8%) with Engerix B and in 7774 subjects (9
4.3%) with Recombivax/HB-Vax II in the normal population vaccinated accordi
ng to currently licensed 3-dose schedules. In a subgroup analysis, response
rates in health care workers were 6492 subjects (94.5%) for Engerix B and
3245 subjects (92.2%) for Recombivax/HB-Vax II. Children and adolescents(1-
19 years) showed the highest response rates to vaccination (4612 [98.6%], E
ngerix B: 2292 [98.9%], Recombivax/HB-Vax II). A total of 2875 infants (<1
year) (95.8%) achieved seroprotection with Engerix B. 701 (88.5%) achieved
seroprotection with Recombivax/ MB-Var II.
Conclusions: Hepatitis B vaccination programs using either Engerix B or Rec
ombivax/HB-Vax II can achieve high seroprotective response rates, particula
rly in childhood and adolescence. Ideally, younger populations should be a
primary target in current universal vaccination programs.