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Medical Microbiology and Immunology
Published in: Medical Microbiology and Immunology 1/2015

01-02-2015 | Review

Prophylactic vaccination against hepatitis B: achievements, challenges and perspectives

Author: Wolfram H. Gerlich

Published in: Medical Microbiology and Immunology | Issue 1/2015

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Abstract

Large-scale vaccination against hepatitis B virus (HBV) infection started in 1984 with first-generation vaccines made from plasma of chronic carriers containing HBV surface antigen (HBsAg). Thereafter, it was replaced in most countries by second-generation vaccines manufactured in yeast cells transformed with gene S encoding HBsAg. Both generations of vaccines have been applied for universal neonate and early childhood vaccination worldwide and have led to a 70–90 % decrease in chronic HBV carrier rates. However, 10–30 % of newborns from HBsAg/HBeAg-positive mothers cannot be protected by passive/active vaccination alone and become chronic HBV carriers themselves. Asymptomatic occult HBV infections are frequent even in those who have protective levels of anti-HBs. Suboptimal protection may be due to heterologous HBsAg subtypes that are present in 99 % of HBV carriers worldwide. Second-generation vaccines contain partially misfolded HBsAg and lack preS1 antigen that carries the major HBV attachment site and neutralizing epitopes. Third-generation vaccines produced in mammalian cells contain correctly folded HBsAg and neutralizing epitopes of the preS antigens, induce more rapid protection, overcome nonresponse to second-generation vaccines and, most importantly, may provide better protection for newborns of HBV-positive mothers. PreS/S vaccines expressed in mammalian cells are more expensive to manufacture, but introduction of more potent HBV vaccines should be considered in regions with a high rate of vertical transmission pending assessment of health economics and healthcare priorities. With optimal vaccines and vaccination coverage, eradication of HBV would be possible.
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Metadata
Title
Prophylactic vaccination against hepatitis B: achievements, challenges and perspectives
Author
Wolfram H. Gerlich
Publication date
01-02-2015
Publisher
Springer Berlin Heidelberg
Published in
Medical Microbiology and Immunology / Issue 1/2015
Print ISSN: 0300-8584
Electronic ISSN: 1432-1831
DOI
https://doi.org/10.1007/s00430-014-0373-y

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