The Effect of Age on Immunologic Response ...

liver411

Clinical Infectious Diseases 2002;35:000
© 2002 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2002/3511-00XX$15.00


The Effect of Age on Immunologic Response to Recombinant Hepatitis B
Vaccine: A Meta-analysis

David N. Fisman,1,2 Deepak Agrawal,3 and Karin Leder4
1City of Hamilton Social and Public Health Services Department and
2Department of Clinical Epidemiology and Biostatistics, McMaster University,
Hamilton, Ontario, Canada;
3Massachusetts General Hospital, Charlestown; and
4Department of Epidemiology and Preventive Medicine, Monash University,
Victoria, Australia


Received 7 May 2002; accepted 8 August 2002; electronically published 12
November 2002.

Hepatitis B vaccine is a key tool for the prevention of hepatitis B
infection. Age-associated changes in immune function may contribute to
decreased vaccine efficacy in older individuals, although research related
to this topic has yielded contradictory findings. We performed a
meta-analysis of 24 published trials and studies that evaluated the
association of age with response to hepatitis B vaccine, using a
random-effects model. Pooling of study results suggested a significantly
increased risk of nonresponse to hepatitis B vaccine among older individuals (relative risk [RR], 1.76; 95% confidence interval [CI], 1.482.10). An elevated risk of nonresponse persisted even after exclusion of poor-quality studies (RR, 1.63; 95% CI, 1.232.15) and adjustment for publication bias (RR, 1.52; 95% CI, 1.261.83), and it was present even when "older"
individuals were defined as being as young as 30 years. These findings have important implications for individuals at risk for hepatitis B infection,
including health care workers and travelers.



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