B型肝炎疫苗保护再次暴露医护人员，但不提供消毒免疫

StephenW

The Hepatitis B Vaccine Protects Re-Exposed Health Care Workers, But Does Not Provide Sterilizing Immunity

    Jens M. Werner
    ,
    Adil Abdalla
    ,
    Naveen Gara
    ,
    Marc G. Ghany
    ,
    Barbara Rehermannemail address

• Immunology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
• Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
  

Received 3 January 2013; accepted 23 July 2013. published online 02 August 2013.

   

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.
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.
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.

StephenW

背景与目的

接种HB表面（ HBs）中和抗原，诱导HBs抗体特异性抗体和T细胞与B型肝炎病毒（HBV）感染是可以预防的。然而，疫苗诱导的保护性免疫的持续时间定义不清谁接种了疫苗的成年人为医护人员。
方法

我们调查了90个医护工作者有或无职业暴露乙肝病毒，疫苗接种后10-28年的长期保护乙肝疫苗的免疫机制（抗体和T细胞的反应） 。
结果

五十九个（ 65％），有90个医护工作者HBs抗原抗体水平高于截止（> 12 MIU /毫升） 30 90（ 33％）有乙型肝炎表面抗原特异性T细胞产生γ-干扰素。 HBs抗体特异性干扰素- γ产生的T细胞的数目与HBs抗原的抗体滴度，但不能与疫苗接种后的时间。虽然职业接触乙型肝炎病毒疫苗接种后不诱导HBV核心蛋白（ HBcore ） ， HBV感染的是标准的生物标志物的抗体， CD4 +和CD8 + T细胞对HBcore和聚合酶抗原进行检测。类似的数字HBcore -聚合酶特异性CD4 +和CD8 +在卫生保健工作者职业暴露HBV患者通过HBV感染获得性免疫T细胞进行检测。大多数HBcore和聚合酶特异性T细胞CD45RO + CCR7 - CD127效应的记忆细胞在暴露医护人员和患者获得性免疫。相反，大多数CD45RO - CCR7 - CD127疫苗诱导的乙型肝炎表面抗原特异性T细胞的终末分化细胞。
结论

HBs抗原疫苗诱导的免疫，防止未来的感染，但不提供消毒免疫，证明了HBcore和聚合酶特异性CD8 + T细胞在接种疫苗的医护工作者的职业接触乙型肝炎病毒。的存在下HBcore和HBV聚合酶特异性T细胞应答是HBV的曝光比检测的HBcore特异性抗体更敏感的指标。