Persistence of antibody to hepatitis B and protection from disease among Alaska natives immunized at birth

Background: Alaska Native (AN) children were at high risk of acquiring hepatitis B virus (HBV) infection before vaccination began in 1983. We evaluated the long-term protection from hepatitis B (HB) vaccination among AN children immunized when infants. Methods: During 1984-1995, we recruited a convenience sample of AN children who had received a three dose series of FIB vaccine starting at birth and had serum antibody to hepatitis B (anti-HBs) concentrations of >= 10 mlU/mL at 7-26 months of age. We evaluated anti-HBs concentrations and the presence of anti-HBc in participants' sera every other year up to age 16 years. Anti-HB core antigen (anti -HBc)-positive specimens were tested for hepatitis B surface antigen and for HBV DNA. Results: We followed 334 children for 3151 person-years (median, 10 years per child) with 1610 specimens collected. Anti-HBs concentrations dropped rapidly among all participants. Among children 2, 5 and 10 years of age, 37 of 79 (47%), 33 of 176 (19%) and 8 of 95 (8%), respectively, had anti-HBs concentrations of >= 10 mIU/mL. Receipt of recombinant vaccine was significantly associated with a more rapid antibody decline ( P < 0.001). Six (1.8%) children acquired anti-HBc, 3 of whom had definite breakthrough infections (at least 2 consecutive anti-HBc-positive specimens or at least 1 anti-HBc-positive specimen and HBV DNA detection by PCR). None of these children had detectable hepatitis B surface antigen, and none had symptoms of hepatitis. Conclusions: Anti-HBs concentrations declined over time among AN infants successfully immunized with FIB vaccine starting at birth. Transient anti-HBc appeared in a small percentage of children; however, none developed clinical signs of hepatitis or chronic HBV infection.