Prevention of hepatitis B infections: Vaccination and its limitations

Infection with hepatitis B virus has become a vaccine-preventable disease. The recombinant hepatitis B vaccines available today are safe and immunogen ic. In order for these vaccines to eradicate HBV a universal vaccination of neonates and/or children needs to be implemented. Major obstacles on the r oad to global hepatitis B vaccination are poverty and scarcity of human res ources in those parts of the world who are most badly in need of these vacc ines. Despite their proven immunogenicity hepatitis B vaccines are unable to indu ce an adequate immune response in 5-10% of healthy adults. The non-responsi veness of these subjects is a selective phenomenon and not the expression o f a general immune deficiency. Studies that correlated the HLA haplotype of vaccine recipients with their anti-HBs response patterns has led to the id entificiation of markers of good and non/poor response. Universal vaccination of neonates and children has elicited questions about the durability of antibody persistence and the need for booster doses late r in life. The European Consensus Group on Hepatitis B Immunity has propose d a series of recommendations that are summarized in this review.