Seroconversion of hepatitis B surface antigen among those with previously successful immune response in Southern China

ABSTRACT

Recommendations promoted worldwide have suggested a period of protection lasting more than 20 years against hepatitis B (HB) following primary immunization. Starting in 1987, universal HB vaccinations were carried out in Long An County, Guangxi Province, one of the earliest counties in which plasma-derived HB vaccine was delivered to newborns across China. Data collection targeted toward understanding the long term (26–33 years since primary immunization) immune effects of the plasma-derived HB vaccine was conducted in 2015; a second data collection was carried out in 2019 to assess seroconversion in the same cohort. This study qualitatively compared positive vs negative results and quantitatively assessed HB biomarkers – HB surface antigen (HBsAg), antibody to HBsAg (anti-HBs), HB e-antigen (HBeAg), antibody to HBeAg (anti-HBe), and antibody to HB core antigen (anti-HBc) – in serum 26–33 years after the full initial course of HB vaccination, then analyzed anti-HBs seroconversion using the two-phase sampling method in the same cohort and calculated the anti-HBs seroconversion rate from 2015 to 2019. The protective sero-conversion rate (anti-HBs ≥10mIU/mL) was 37.6% (192/511); the HBsAg-positive rate was 5.3% (27/511); the anti-HBs mean geometric titer (GMT) was 11.1 mIU/mL. Among the 143 participants involved in both 2015 and 2019 data collections, the seroconversion rate was 3.5% (5/143); two individuals had protective anti-HBs levels in 2015. These findings indicate that anti-HBs status can be seroconverted to a protective concentration level 4 years earlier in a high HBV epidemic region. The role of genomic mutations and the disappearance of immune memory and seroconversion should be investigated.

KEYWORDS:

• Hepatitis B vaccine
• seroconversion
• HBsAg
• immunization cohort
• Long An County

Acknowledgments

We thank Dr. Eric J. Nehl for his revision on this manuscript. We also thank Mr. Riwei Zhai and Dr. Yuanhai Lu for their coordination, and arrangement of the field blood-sampling; we also thank the health-care workers in villages and township of Long An County for their assistance during the process of field investigation.

Author contributions

Conceptualization, Z.F. and Z.Z.; funding source and conceptualization: G.L.; methodology, Z.Z., Z.F. and Q.C.; data collection, Z.Z, F.L., L.Z., X.W., Q.C., H.L. and L.H.; data curation and formal analysis, Z.Z.; writing, Z.Z. All authors have read and agreed to the published version of the manuscript.

Disclosure of potential conflicts of interest

No potential conflicts of interest were disclosed.

Additional information

Funding

The National Natural Science Foundation of China (Funding NO.:81560546).