Prophylactic vaccination against hepatitis B: achievements, challenges and perspectives

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• 作者：Wolfram H. Gerlich
• 关键词：Hepatitis B virus ; HBsAg ; Vaccine ; PreS ; Mother ; to ; child transmission ; Escape mutant
• 刊名：Medical Microbiology and Immunology
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：204
• 期：1
• 页码：39-55
• 全文大小：826 KB
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• 作者单位：Wolfram H. Gerlich (1) <br><br>1. Institute for Medical Virology, National Reference Center for Hepatitis B and D, Justus-Liebig-University Giessen, Schubert Str. 81, 35392, Giessen, Germany <br>
• 刊物类别：Biomedical and Life Sciences
• 刊物主题：Biomedicine<br>Medical Microbiology<br>Immunology<br>
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1831

文摘

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 70-0?% decrease in chronic HBV carrier rates. However, 10-0?% 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.