TY  - BOOK
AU  - Gara, Naveen
TI  - The hepatitis B vaccine protects re-exposed health care workers, but does not provide sterilizing immunity
SN  - 0016-5085
KW  - *Health Personnel
KW  - *Hepatitis B Vaccines/tu [Therapeutic Use]
KW  - *Hepatitis B/pc [Prevention & Control]
KW  - *Immunity/im [Immunology]
KW  - *Infectious Disease Transmission, Professional-to-Patient/pc [Prevention & Control]
KW  - *Occupational Exposure
KW  - Adult
KW  - Aged
KW  - Antibodies, Viral/bl [Blood]
KW  - Antibodies, Viral/im [Immunology]
KW  - CD8-Positive T-Lymphocytes/im [Immunology]
KW  - CD8-Positive T-Lymphocytes/pa [Pathology]
KW  - Female
KW  - Hepatitis B Surface Antigens/bl [Blood]
KW  - Hepatitis B Surface Antigens/im [Immunology]
KW  - Hepatitis B Vaccines/im [Immunology]
KW  - Hepatitis B virus/im [Immunology]
KW  - Hepatitis B/im [Immunology]
KW  - Humans
KW  - Longitudinal Studies
KW  - Male
KW  - Middle Aged
KW  - Time Factors
KW  - MedStar Washington Hospital Center
KW  - Medicine/Gastroenterology
KW  - Comparative Study
KW  - Journal Article
KW  - Research Support, N.I.H., Intramural
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1996 - present
N2  - BACKGROUND & AIMS: Infection with hepatitis B virus (HBV) can be prevented by vaccination with HB surface (HBs) antigen, which induces HBs-specific antibodies and T cells. However, the duration of vaccine-induced protective immunity is poorly defined for health care workers who were vaccinated as adults; CONCLUSIONS: HBs antigen vaccine-induced immunity protects against future infection but does not provide sterilizing immunity, as evidenced by HBcore- and polymerase-specific CD8(+) T cells in vaccinated health care workers with occupational exposure to HBV. The presence of HBcore- and HBV polymerase-specific T-cell responses is a more sensitive indicator of HBV exposure than detection of HBcore-specific antibodies. Copyright  2013 AGA Institute. Published by Elsevier Inc. All rights reserved; METHODS: We investigated the immune mechanisms (antibody and T-cell responses) of long-term protection by the HBV vaccine in 90 health care workers with or without occupational exposure to HBV, 10-28 years after vaccination; RESULTS: Fifty-nine of 90 health care workers (65%) had levels of antibodies to HBs antigen above the cut-off (>12 mIU/mL) and 30 of 90 (33%) had HBs-specific T cells that produced interferon-gamma. Titers of antibodies to HBs antigen correlated with numbers of HBs-specific interferon-gamma-producing T cells, but not with time after vaccination. Although occupational exposure to HBV after vaccination did not induce antibodies to the HBV core protein (HBcore), the standard biomarker for HBV infection, CD4(+) and CD8(+) T cells against HBcore and polymerase antigens were detected. Similar numbers of HBcore- and polymerase-specific CD4(+) and CD8(+) T cells were detected in health care workers with occupational exposure to HBV and in patients who acquired immunity via HBV infection. Most of the HBcore- and polymerase-specific T cells were CD45RO(+)CCR7(-)CD127(-) effector memory cells in exposed health care workers and in patients with acquired immunity. In contrast, most of the vaccine-induced HBs-specific T cells were CD45RO(-)CCR7(-)CD127(-) terminally differentiated cells
UR  - http://dx.doi.org/10.1053/j.gastro.2013.07.044
ER  -