VACUN-166; No.

of Pages 6
ARTICLE IN PRESS
v a c u n a s . 2 0 2 0;x x x(x x):xxx–xxx

Vacunas

www.elsevier.es/vac

Original article

Evaluation of hepatitis B vaccination status

and immune response among health care workers
in a tertiary care hospital in western India

K. Mehta Tanmay ∗ , D. Shah Parul

Department of Microbiology, Smt. N.H.L. Municipal Medical College, Ahmedabad, India

a r t i c l e i n f o a b s t r a c t

Article history: Introduction: Hepatitis B virus infection is still an important health problem worldwide. The
Received 11 July 2020 risk of contracting HBV by health-care workers (HCWs) is higher than that of the general
Accepted 6 September 2020 adult population. Seroprotection is defined as anti-HBs level 10 mIU/ml or more following a
Available online xxx successful three-dose vaccination course.
Objective: To find out the hepatitis B vaccination status and test immune response using
Keywords: anti-HBs titer among HCWs.
Hepatitis B vaccination coverage Methods: We carried out a retrospective observational study of 218 serum samples from vac-
Hepatitis B vaccine cinated HCWs tested for anti-HBs ELISA from January 2016 to December 2017. We collected
Antiviral immune response demographic, health, and HBV vaccination details from test requisition forms.
Seroprotection Results: We found that 195 (89.44%) HCWs had received a complete course of HBV vaccina-
Anti-HBs tion. 74.87% HCWs showed a protective level (10 mIU/ml or more) of antibodies. We noted a
statistically significant association between the protective antibody level and the complete
course of vaccination (P < 0.001). HCWs had protective levels of antibodies even after 25 years
post-vaccination. We found a statistically significant decrease in mean antibody titer with
duration (in years) of post-primary vaccination (P < 0.001). We noted higher seroprotection
in females, age group of 21–30 years, and weight range of 51–70 kg.
Conclusion: Hepatitis B vaccination coverage is still inadequate even among HCWs. Even with
recommended three dose full vaccination, some HCWs have not achieved protective anti-
HBs titer, so we have to make testing of anti-HBs compulsory irrespective of the vaccination
status. We noted a decrease in mean antibody titer with duration (in years) of post-primary
vaccination.
© 2020 Elsevier España, S.L.U. All rights reserved.

∗
Corresponding author.
E-mail address: tanmay.smit@gmail.com (K. Mehta Tanmay).
https://doi.org/10.1016/j.vacun.2020.09.004
1576-9887/© 2020 Elsevier España, S.L.U. All rights reserved.

Please cite this article in press as: Mehta Tanmay K, Shah Parul D. Evaluation of hepatitis B vaccination status and immune response among
health care workers in a tertiary care hospital in western India. Vacunas. 2020. https://doi.org/10.1016/j.vacun.2020.09.004
VACUN-166; No. of Pages 6
ARTICLE IN PRESS
2 v a c u n a s . 2 0 2 0;x x x(x x):xxx–xxx

Evaluación del estatus de la vacunación frente a la hepatitis B y de la

respuesta inmune entre los trabajadores sanitarios de un hospital de
atención terciaria del Oeste de India

r e s u m e n

Palabras clave: Introducción: La infección por virus de la hepatitis B (VHB) sigue siendo un problema de salud
Cobertura de la vacuna frente a importante a nivel mundial. El riesgo de que los trabajadores sanitarios (TS) contraigan
la hepatitis B el VHB es más elevado que el riesgo de la población general adulta. La seroprotección se
Vacuna frente a la hepatitis B define como el nivel de anticuerpos anti-HB de 10 mIU/ml o más, tras una serie de 3 dosis
Respuesta inmune antiviral de vacunación exitosa.
Seroprotección Objetivo: Estudiar el estatus de la vacunación frente a la hepatitis B, y probar la respuesta
Anti-HB inmune utilizando el título anti-HB entre los TS.
Métodos: Realizamos un estudio observacional retrospectivo de 218 muestras séricas de TS
vacunados utilizando ELISA anti-HB, desde enero de 2016 a diciembre de 2017. Recopilamos
los datos demográficos, de salud y de vacunación frente al VHB a partir de formularios de
solicitud.
Resultados: Encontramos que 195 TS (89,44%) habían recibido una serie completa de vacunas
frente al VHB. El 74,87% de los TS reflejaron un nivel protector de anticuerpos (10 mIU/ml
o más). Encontramos una asociación estadísticamente significativa entre el nivel de antic-
uerpos protectores y la serie completa de la vacunación (P < 0,001). Los TS tenían niveles
protectores de anticuerpos transcurridos incluso 25 años de la vacunación. Encontramos
una reducción estadísticamente significativa del título de anticuerpos medio en función del
tiempo transcurrido (en años) desde la primera vacunación (P < 0,001). Encontramos una
mayor seroprotección en mujeres, del grupo de edad de 21 a 30 años, y rango de peso de 51
a 70 kg.
Conclusión: La cobertura de la vacunación frente a la hepatitis B sigue siendo inadecuada,
incluso entre los TS. Aun con la vacunación completa de 3 dosis, algunos TS no han logrado
el título anti-HB protector, por lo que debemos realizar pruebas obligatorias anti-HB, inde-
pendientemente del estatus de vacunación. Advertimos una reducción del título medio de
anticuerpos en función del tiempo transcurrido (en años) desde la primera vacunación.
© 2020 Elsevier España, S.L.U. Todos los derechos reservados.

assay within one to three months of the last dose of primary

Introduction vaccination.3–5 Anti-HBs titer more than 10 mIU/ml should
be considered protective and the individual immune to hep-
Hepatitis B virus (HBV) infection is still an important health
atitis B. If the anti-HBs titer is less than 10 mIU/ml, further
problem with about 2 billion people worldwide infected with
three doses of HBV vaccine should be given and anti-HBs titer
HBV. In India, hepatitis B surface antigen prevalence among
reassessed 1–2 months thereafter. Vaccinated HCWs whose
the general population ranges from 2% to 8% which places
anti-HBs titer is less than 10 mIU/ml after revaccination, i.e.,
India in an intermediate endemicity zone, and India with
after receiving 6 doses in total, should be tested for HBsAg
50 million cases is the second-largest global pool of chronic
and anti-HBc to determine the infection status. If not found
HBV infection. The risk of contracting HBV by health-care
to be infected, they should be considered susceptible to HBV
workers (HCWs) is four times greater than that of the general
infection.6
adult population.1
There are only a few studies are available from India regard-
Fortunately, there are effective vaccines against the virus,
ing the hepatitis B vaccination status and immune response
which are about 95% effective.2 The protective efficacy of
among HCWs. We carried out this study to find out hepatitis B
hepatitis B vaccination relates to the development of anti-
vaccination status and test immune response using anti-HBs
bodies to hepatitis B surface antigen (anti-HBs). In India,
titer among HCWs in a tertiary care hospital to identify those
pre-vaccination serologic testing is indicated using the hep-
who are at risk and to advise them regarding revaccination
atitis B surface antigen [HBsAg]. All HCWs with or without
and further testing.
prior serologic testing should receive at least three doses of
the hepatitis B vaccine. A 4-week gap between the first two
doses is recommended along with an 8- and 16-week gap
between second and third and first and third doses, respec- Methods
tively. As per Occupational Safety and Health Administration
We conducted a retrospective observational study at a tertiary
(OSHA) recommendation, HBV vaccination is followed by con-
care hospital in western India from January 2016 to December
firmation of vaccine response in all HCW by ‘initial’ anti-HBs
2017 after the permission of the Institutional Review Board.

Please cite this article in press as: Mehta Tanmay K, Shah Parul D. Evaluation of hepatitis B vaccination status and immune response among
health care workers in a tertiary care hospital in western India. Vacunas. 2020. https://doi.org/10.1016/j.vacun.2020.09.004
VACUN-166; No. of Pages 6
ARTICLE IN PRESS
v a c u n a s . 2 0 2 0;x x x(x x):xxx–xxx
We included HBs Ag negative health care workers who had
received one or more of the three doses of hepatitis B vaccine
intramuscularly with a dose of 20 ␮g of HBsAg (Hepatitis B sur-
face Antigen) vaccine in the study. We analyzed the data of 218
serum samples from such health care workers (63 consultant
doctors, 84 resident doctors, 27 lab technicians, 16 nurses, and
28 servants) tested for anti-HBs ELISA.
Commercially available anti-HBs ELISA tested the serum
samples for the quantitative assay of IgG anti-HBs, as per the
manufacturer’s instruction. We noted their anti-HBs titer level
in the data collection form. We grouped the levels of anti-HBs
titer: less than 10 mIU/ml, 10–100 mIU/ml, 100–1000 mIU/ml,
and 1000–10 000 mIU/ml. We considered anti-HBs levels of
10 mIU/ml or more seroprotective. We considered HCWs with
the anti-HBs titer of less than 10 mIU/ml, 10–100 mIU/ml,
over 100 mIU/ml, and 1000 mIU/ml were as hypo respon-
ders, responders, high responders, and very high responders
respectively.
We collected demographic, health, and HBV vaccination
details and other data of health care workers from test req-
uisition forms. We presented data as an absolute number and
percentage. We used SPSS 21 Package program (Chicago, IL,
USA) for statistical analysis. We used unpaired t-test to com-
pare the means of two independent groups to determine if
there is a significant difference between them. A P value of
less than 0.05 is considered statistically significant.
Results
Among 218 healthcare workers, 195 healthcare workers
(89.44%) had received a complete course (three doses) of HBV
vaccination. The rest of the 14 (6.42%) and 9 (4.12%) HCWs
had received one and two doses of vaccine, respectively. None
of the HCWs had received hepatitis B vaccine four times or
more. None of them had got themselves tested for anti-HBs
titer value.
The difference in the seroprotection rates among those
who received three doses of vaccination (74.87%) and those
who received less than three doses (7.33%) was statistically
significant (P < 0.001). We found that 146 (74.87%) healthcare
workers developed protective anti-HBs titer (10 mIU/ml or
more) with three doses of vaccine. We observed high anti-HBs
titer levels (100 mIU/ml or more) in 132 (60.55%) healthcare
workers who have received three doses of vaccine. However,
we noted that 49 (22.47%) healthcare workers were non-
responders (anti-HBs level less than 10 mIU/ml) even after
receiving all the three doses of vaccination (Table 1).
In the present study, there was a statistically significant
decrease in mean antibody titer with duration (in years) of
post-primary vaccination (P < 0.001). We noted protective anti-
body titer in 77 (39.48%) and 38 (19.48%) health care workers
even up to 5 years and 6–10 years after the last dose of vaccine.
We found out that the protective antibody titer lasted even up
to 30 years after the last dose of complete vaccination in 5
(2.56%) health care workers (Table 2).
In our study 81 (41.53%) female and 65 (33.33%) male health
care workers were having protective antibody titer value after
complete vaccination. We observed higher mean antibody
titer values in female health care workers compared to male
Please cite this article in press as: Mehta Tanmay K, Shah Parul D. Evaluation of hepatitis B vaccination status and immune response among
health care workers in a tertiary care hospital in western India. Vacunas. 2020. https://doi.org/10.1016/j.vacun.2020.09.004
3
health care workers. However, we found no statistically sig-
nificant difference in mean antibody titer between male and
female HCWs (P = 0.8764). The age range of the study subjects
was 21–65 years. The age group of 21–30 years has shown
protective antibody titer values in 120 (61.53%) of completely
vaccinated health care workers (Table 3).
On observing the relationship between the weight of com-
pletely vaccinated health care workers and anti-HBS titer
value, we noticed that protective titer in 86 (44.10%) health
care workers with a weight range of 51–70 kg. Lower weight
range of 30–50 kg and higher weight range of 71 kg or more
had shown protective titer only in 23 (11.79%) and 37 (18.97%)
respectively (Table 4).
Discussion
In our study, only 89.44% had received three doses of hepati-
tis B vaccine (complete vaccination), while 6.42% and 4.12%
had received one and two doses vaccine respectively (incom-
plete vaccination). This is low compared to a study done in
New Delhi, where 96% of doctors got vaccinated.1 It shows
that hepatitis B vaccination coverage is still inadequate, even
among high-risk groups such as HCWs. The primary reason
behind this could be a failure in implementing vaccination
policies established by hospital management, and a lack of
awareness among healthcare workers. We advised the HCWs
with incomplete vaccination to take complete the course of
hepatitis B immunization and anti-HBs assay within one to
three months of primary vaccination.
However, 16 (8.2%) HCWs with incomplete vaccination sta-
tus attained protective antibody levels, probably because of
the acquisition of natural infection in the past which conferred
natural immunity to these individuals.
In the present study, 74.87% HCWs showed a protective
level (10 mIU/ml or more) of antibodies after three doses of
vaccine. The seroprotection rate of the hepatitis B vaccine
globally ranges from 85 to 90%.7 Other studies in the past
observed higher such as Tripathy et al. (100%), Jain et al.
(98.45%), and Kruman et al. (99%).8–10 We advised HCWs with
ant-HBs levels less than 10 mIU/ml, revaccination with a
complete course (0, 1, 6 months) and to return after 1 month
for a repeat test.
Among seroprotected individuals 17.43% were high respon-
ders (anti-HBs titer 100–1000 mIU/ml), 67.12% very high
responders (anti-HBs titer 1000 mIU/ml or more) and 9.58%
hypo-responders (anti-HBs titer 10–mIU/ml–100 mIU/ml) and
22.47% were non-responders (anti-HBs titer less than
10 mIU/ml). In a study by Tripathy et al., 80% had a high
response, 20% were hypo-responders and nobody was non-
responder.8 In another Indian study conducted by Das showed
that among seroprotected individuals there were 32.4% hypo-
responders (and 52.9% were responders).11 We know that
hepatitis B vaccination induces a protective level of antibod-
ies after a complete course of vaccination, but there are a few
genuine non-responders.8
The assessment of anti-HBs titer in vaccinated HCWs
showed a statistically significant association between anti-
body titration and complete vaccination series. This is
comparable to a study by Sugunan et al. in India.12 We observe
VACUN-166; No. of Pages 6
ARTICLE IN PRESS
4 v a c u n a s . 2 0 2 0;x x x(x x):xxx–xxx

Table 1 – Anti-HBs titer as per dose(s) of hepatitis B vaccine received.

Anti-HBs titer (mIU/ml) Incomplete vaccination Complete vaccination Total
n (%)

After 1 dose After 2 doses After 3 doses

n (%) n (%) n (%)

Mean ± SD 573.23 ± 765.91 168.22 ± 244.02 460.14 ± 702.22

Less than 10 5 (2.29%) 2 (0.91%) 49 (22.47%) 56 (25.68%)
10–100 2 (0.91%) 4 (1.83%) 14 (6.42%) 20 (9.17%)
100–1000 2 (0.91%) 3 (1.37%) 34 (15.59%) 39 (17.88%)
1000–10 000 5 (2.29%) 0 (0%) 98 (44.95%) 103 (47.24%)

Total 14 (6.42%) 9 (4.12%) 195 (89.44%) 218 (100%)

Table 2 – Anti-HBs titer as per duration after last dose of vaccine in completely vaccinated healthcare workers.
Anti-HBs titer Duration after receiving last dose of hepatitis B vaccine Total
(mIU/ml) n (%)

0–5 years 6–10 years 11–15 years 16–20 years 21–25 years 26–30 years
n (%) n (%) n (%) n (%) n (%) n (%)

Mean ± SD 757.56 ± 725.85 475.53 ± 688.67 921.61 ± 725.69 430.06 ± 512.58 1130.17 ± 208.47 1034.29 ± 0 706.52 ± 702.22
Non- 29 (14.87%) 10 (5.12%) 6 (3.07%) 2 (1.02%) 2 (1.02%) 0 (0%) 49 (25.12%)
responders
(less than 10)
10–100 6 (3.07%) 5 (2.56%) 1 (0.51%) 2 (1.02%) 0 (0%) 0 (0%) 14 (7.17%)
100–1000 16 (8.2%) 7 (3.58%) 7 (3.58%) 3 (1.53%) 0 (0%) 1 (0.51%) 34 (17.43%)
1000–10 000 55 (28.2%) 26 (13.33%) 7 (3.58%) 6 (3.07%) 0 (0%) 4 (2.05%) 98 (50.25%)
Total 77 (39.48%) 38 (19.48%) 15 (7.69%) 11 (5.64%) 0 (0%) 5 (2.56%) 146 (74.87%)
responders
(10 or more)

Total 106 (54.35%) 48 (24.61%) 21 (10.76%) 13 (6.66%) 2 (1.02%) 5 (2.56%) 195 (100%)

Table 3 – Relationship of gender and age with anti-HBs titer in completely vaccinated healthcare workers.
Anti-HBs titer Gender Age group
(mIU/ml)

Male Female 21–30 years 31–40 years 41–50 years 51 years or more
n (%) n (%) n (%) n (%) n (%) n (%)

Mean ± SD 698.94 ± 700.59 714.72 ± 709.70 703.16 565.62 802.99 776.23

± 723.32 ± 653.73 ± 624.24 ± 753.61
Non-responders 25 (12.82%) 24 (12.30%) 35 (17.94%) 8 (4.10%) 5 (2.56%) 1 (0.51%)
(less than 10)
10–100 5 (2.56%) 9 (4.61%) 5 (2.56%) 3 (1.53%) 5 (2.56%) 1 (0.51%)
100–1000 17 (8.71%) 17 (8.71%) 18 (9.23%) 8 (4.10%) 6 (3.07%) 2 (1.02%)
1000–10 000 43 (22.05%) 55 (28.20%) 62 (31.79%) 20 (10.25%) 14 2 (1.02%)
Total responders 65 (33.33%) 81 (41.53%) 85 (43.58%) 31 (15.89%) 25 (12.82%) 5 (2.56%)
(10 or more)

Total 90 (46.15%) 105 (53.85%) 120 (61.53%) 39 (20%) 30 (15.38%) 6 (3.07%)

Table 4 – Relationship of weight and anti-HBs titer in completely vaccinated healthcare workers.
Anti-HBs titer (mIU/ml) 30–50 kg 51–70 kg 71 kg or more
n (%) n (%) n (%)

Mean ± SD 963.10 ± 723.79 678.49 ± 705.24 585.34 ± 651.74

Anti-HBs negative
Non-responders (less than 10) 6 (3.07%) 32 (16.41%) 11 (5.64%)

Anti-HBs positive
10–100 2 (1.02%) 7 (3.58%) 5 (2.56%)
100–1000 4 (2.05%) 19 (9.74%) 11 (5.64%)
1000–10 000 17 (8.71%) 60 (30.76%) 21 (10.76%)
Total responders (10 or more) 23 (11.79%) 86 (44.10%) 37 (18.97%)

Total 29 (14.87%) 118 (60.51%) 48 (24.61%)

Please cite this article in press as: Mehta Tanmay K, Shah Parul D. Evaluation of hepatitis B vaccination status and immune response among
health care workers in a tertiary care hospital in western India. Vacunas. 2020. https://doi.org/10.1016/j.vacun.2020.09.004
VACUN-166; No. of Pages 6
ARTICLE IN PRESS
v a c u n a s . 2 0 2 0;x x x(x x):xxx–xxx
anti-HBs titer levels of 100 mIU/ml or more in approximately
60% of the healthcare workers who have received three doses
of vaccine. So as per the recommendation of the CDC, HCWs
should receive at least 3 doses of hepatitis B vaccine to ensure
an adequate immune response.6
We noted that 22.47% of healthcare workers did not develop
protective HBs antibody titer (less than 10 mIU/ml) even after
3 doses of vaccines. This suggests that we have to implement
testing of anti-HBs for all health care workers as a manda-
tory investigation irrespective of their vaccination status. We
also found that 7.33% of healthcare workers who developed
protective HBs antibody levels even with incomplete vaccina-
tion (after one or two doses). We should not consider HCW
immune who tested before receiving 3 documented doses of
the hepatitis B vaccine achieved protective antibody titer (anti-
HBs 10 mIU/ml or more) because anti-HBs 10 mIU/ml or more
is a known correlate of protection only when testing follows a
documented 3-dose vaccination series.6
We found that participants had protective levels of antibod-
ies, even after 25 years of post-vaccination. Studies by Tripathy
et al. and Jafar Zadeh et al. also noted protective antibody lev-
els even after 10 years of post-primary vaccination.8,13 Some
long-term studies suggest that the hepatitis B vaccine protects
an individual for over 15 years.14,15 Protection against acute
symptomatic and chronic HBV infection persists for 30 years
or more among immunocompetent persons who originally
responded to the hepatitis B vaccine.6,16–19 In the present study
there was a statistically significant decrease in mean anti-
body titer with duration (in years) of post-primary vaccination.
Studies by Tripathy et al., Sugnan et al., and Murhekar et al.
also concluded that antibody decay occurs with time.8,12,20
In a long time follow-up study, some observed that approx-
imately 20% geometric mean titer decay occurs per year.21
The responders can be considered as protected even if the
anti-HBs level falls to less than 10 mIU/ml with no booster
requirement or any periodic antibody concentration testing.
However, it is advisable to administer a booster dose when
the anti-HBs antibody titer falls below 10 mIU/ml particu-
larly for all people at risk. We recommend researchers for
long-term follow-up studies to monitor groups of immunized
individuals and to determine if clinically significant episodes
of hepatitis B occur or whether the carrier state develops.
The outcome will help in future decisions on booster poli-
cies.
We noted seroprotection rate and mean antibody titer
was higher in females than males. This was consistent
with earlier studies that reported higher anti-HBs levels in
females.22–23 However, we found no statistically significant
difference in mean antibody titer between male and female
HCW (P = 0.8764). Studies by Tripathy et al. in India and Ahad
et al. in Bangladesh also noted similar findings.8,24 However,
McMohan noted that males had a higher antibody level than
females.14
We found that the age group of 21–30 years showed a
maximum seroconversion rate of 42.56% compared to other
age groups. However, there was no significant difference in
mean antibody titer in different age groups in the present
study (P > 0.05). John Looney also found that the seroprotec-
tion rate is higher in young individuals.25 A study by Tripathy
et al. also showed that the young age group below 25 years
Please cite this article in press as: Mehta Tanmay K, Shah Parul D. Evaluation of hepatitis B vaccination status and immune response among
health care workers in a tertiary care hospital in western India. Vacunas. 2020. https://doi.org/10.1016/j.vacun.2020.09.004
5
shows statistically significant mean antibody titer value.8 Liu
F noted that individuals above 40 years could not respond.26
The protective antibody titer was maximum in the weight
range of 51–70 kg. 50 kg or less and 71 kg or more both groups
have shown protective antibody titer values in less frequency.
In a study by Liu F, they noted that obese could not respond.26
In the obese individuals the vaccine may get deposited in
fat tissue rather than muscle and this causes diminished
immunity response. Some believed that hormonal effects in
overweight persons can decrease antibody titers.27 Unfortu-
nately, ours was a retrospective study, so we could not get the
height of participants and as a result, we could not use a more
sensitive parameter of obesity like body mass index here.
Conclusion
Hepatitis B vaccination coverage is still inadequate even
among HCWs and needs better implementation of vaccina-
tion policies and awareness campaigns. We recommend three
doses (complete) hepatitis B vaccine to achieve protective
anti-HBs levels. Even with full vaccination, some HCWs have
not achieved protective anti-HBs titer even with a complete
vaccination course, so we have to make testing of anti-HBs
compulsory irrespective of the vaccination status. We noted
a decrease in mean antibody titer with duration (in years) of
post-primary vaccination. Future long-term follow-up studies
can monitor immunized individuals to determine hepatitis
B or carrier state development to help decisions on booster
policies. We could not establish any significant association of
gender, age, and body weight with anti-HBs status.
Conflict of interests
The authors declare no conflict of interests.
references
1. Datta S. An overview of molecular epidemiology of hepatitis B
virus (HBV) in India. J Virol. 2008;19:156.
2. Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis (seminar).
Lancet. 2003;362:2089–94.
3. Averhoff F, Mahoney FJ, Coleman PJ, Schatz G, Hurwitz E,
Margolis HS. Immunogenicity of Hepatitis B vaccines.
Implications for persons at occupational risk of Hepatitis B
virus infection. Am J Prev Med. 1998;15:1–8.
4. Poland GA. Hepatitis B immunisation in health care workers
dealing with vaccine non-response. Am J Prev Med.
1998;15:73–7.
5. CDC. Updated US public health service guidelines for the
management of occupational exposure to HBV HCV and HIV
and recommendation for post exposure prophylaxis. MMWR.
2001;50(RR11):1–42.
6. Prevention of Hepatitis B virus infection in the United States:
Recommendations of the Advisory Committee on
Immunization Practices. Centres for Disease Control and
Prevention. Morbid Mortal Week Rep. 2018;67.
7. Zeeshan M, Jabeen K, Ali AN, Ali AW, Farooqui SZ, Mehraj V,
et al. Evaluation of immune response to hepatitis B vaccine in
healthcare workers at a tertiary care hospital in Pakistan.
BMC Infect Dis. 2007;7:120.
VACUN-166; No. of Pages 6
ARTICLE IN PRESS
6 v a c u n a s . 2 0 2 0;x x x(x x):xxx–xxx
8. Tripathy S, Sati HC, Puspa, Saha S, Shankar R, Singh VK.
Study of immune response after Hepatitis B vaccination in
medical students and health care workers. Indian J Prev Soc
Med. 2011;42:314–21.
9. Jain AK, Mittal SK, Ramji S, Chakravarti A. Hepatitis B vaccine
in the EPI schedule. Indian J Pediatr. 2005;72:661–4.
10. Merck Canada Inc. Recombivax HB. Data on file at Merck
Research Laboratory; 2012. Available from:
https://www.merck.ca/static/pdf/RECOMBIVAX HB-PM E.pdf.
11. Das K, Gupta RK, Kumar V, Kar P. Immunogenicity and
reactogenicity of a recombinant Hepatitis B vaccine in
subjects over 40 years of age and response to a booster
among non responders. World J Gastroenterol. 2003;9:1132–4.
12. Sugunan AP, Bhattacharya H, Bhattacharya D, Mandal A,
Ghosal SR, Rao RC, et al. Impact of hepatitis B immunization
among the Nicobarese tribe – antibody titers & seroprotection
five years after vaccination. Indian J Med Res. 2014;139:427–30.
13. Jafar Zadeh A, Montazerifar SJ. Persistence of anti HBS
antibody and immunological memory in children vaccinated
with Hepatitis B vaccine at birth. J Ayub Med College
Abbottabad. 2006;18:4–9.
14. McMahon BJ, Bruden DL, Petersen KM, Bulkow LR, Parkinson
AJ, Nainan O, et al. Antibody levels and protection after
hepatitis B vaccination: results of a 15-year follow-up. Ann
Intern Med. 2005;142:333–41.
15. Chaudhari CN, Bhagat M, Shah T, Misra R. Antibody to
Hepatitis B surface antigen in vaccinated health care workers.
MJAFI. 2008;64:329–32.
16. Leuridan E, Van Damme P. Hepatitis B and the need for a
booster dose. Clin Infect Dis. 2011;53:68–75,
http://dx.doi.org/10.1093/cid/cir270.
17. Vandamme P, Van Herck K. A review of the long term
protection after hepatitis b vaccine. Travel Med Infect Dis.
2007;5:79–84.
18. Bruce MG, Bruden D, Hurlburt D, Zanis C, Thompson G, Rea L,
et al. Antibody levels and protection after hepatitis B vaccine:
Please cite this article in press as: Mehta Tanmay K, Shah Parul D. Evaluation of hepatitis B vaccination status and immune response among
health care workers in a tertiary care hospital in western India. Vacunas. 2020. https://doi.org/10.1016/j.vacun.2020.09.004
results of a 30-year follow-up study and response to a booster
dose. J Infect Dis. 2016;214:16–22,
http://dx.doi.org/10.1093/infdis/jiv748.
19. Simons BC, Spradling PR, Bruden DJ, Zanis C, Case S,
Choromanski TL, et al. A longitudinal hepatitis B vaccine
cohort demonstrates long-lasting hepatitis B virus (HBV)
cellular immunity despite loss of antibody against HBV
surface antigen. J Infect Dis. 2016;214:273–80,
http://dx.doi.org/10.1093/infdis/jiw142.
20. Murhekar MV, Murhekar KM, Sehgal SC. Hepatitis B
vaccination in a hyper endemic tribal community from India:
assessment after three years. Vaccine. 2004;23:399–403.
21. Wang CW, Wang L-C, Chang M, Ni Y, Chen H, Hsu H, et al.
Long time follow up of hepatitis b surface antibody level in
subjects receiving universal hepatitis b vaccination in infancy
in an area of hyperendemicity. Clin Diag Lab Immunol.
2005;12:1442–7.
22. Yu AS, Cheung RC, Keeffe EB. Hepatitis B vaccines. Infect Dis
Clin N Am. 2006;20:27–30.
23. Hegde S, Praveen BN, Pal S, Shetty SR, Ajila V, Babu S, et al.
Serum antibody analysis following hepatitis b vaccination for
occupational risk assessment among dental students. Nitte
Univ J Health Sci. 2014;4:52–6.
24. Ahad MA, Alim MA, Guho A, Islam QT, Azad KAK. Role of
booster dose on antibody titer after recombinant hepatitis B
vaccine. J Med. 2009;10:67–76.
25. Looney RJ, Hasan MS, Coffin D, Campbell D, Falsey AR, Kolassa
J, et al. Hepatitis B immunization of healthy elderly adults. J
Clin Immunol. 2001;21:30–6.
26. Liu F, Guo Z, Dong C. Influences of obesity on the
immunogenicity of Hepatitis B vaccine. Hum Vaccin
Immunother. 2017;13:1014–7.
27. Abdolsamadi HR, Vaziri BP, Abdollahzadeh SH, Kashani KHM,
Vahedi M. Immune response to hepatitis B vaccine among
dental students. Iranian J Publ Health. 2009;38:113–8.