# Factors Associated with the Anamnestic Immune Response Following Hepatitis B Booster Vaccination in the Elderly

## TL;DR

This study examines how well elderly people's immune systems respond to a hepatitis B booster vaccine nine years after initial vaccination and finds that pre-booster antibody levels strongly influence the response.

## Contribution

The study identifies pre-booster anti-HBs titers as a key predictor of anamnestic immune response in elderly individuals.

## Key findings

- Higher pre-booster anti-HBs titers correlate with stronger immune responses after vaccination.
- Both one and three booster doses induced robust immune responses in elderly participants.
- Individuals with pre-booster titers ≥ 4.58 mIU/mL were more likely to achieve high post-booster titers (>1000 mIU/mL).

## Abstract

Objective: To investigate factors influencing the anamnestic immune response 9 years after hepatitis B vaccination in elderly people (aged > 60 years). Methods: We quantitatively tested 630 elderly people who participated in the free hepatitis B vaccination program for adults in Zhangjiagang City during 2015 for hepatitis B surface antibody (anti-HBs) titers. Three booster doses of hepatitis B vaccine were given to subjects with anti-HBs titers below 10 mIU/mL, while a single booster dose was administered to those with titers between 10 and 100 mIU/mL, in accordance with their antibody titer measurements. The post-booster anti-HBs titers were evaluated at 2–3 months. A logistic regression model was used to identify factors influencing the anamnestic immune response, and a receiver operating characteristic curve analysis was conducted. Results: Among the 90 participants who received three doses and the 101 participants who received one dose, baseline characteristics did not differ significantly between the two cohorts. Both groups exhibited robust anamnestic immune responses. Significant differences were observed before and after booster vaccination within each group (Z = −8.24, p < 0.001; Z = −8.73, p < 0.001). Multivariate logistic regression indicated that individuals with higher pre-booster anti-HBs titers were less likely to show weak anamnestic responses compared to those with lower pre-booster titers (OR = 0.30, 95% CI: 0.16–0.58). Furthermore, a high anamnestic immune response (>1000 mIU/mL) was significantly more frequent among subjects with pre-booster titers ≥ 4.58 mIU/mL. Conclusions: Booster immunization administered nine years after hepatitis B vaccination induces robust anamnestic immunity, with its magnitude significantly correlated with pre-booster anti-HBs titers. Particular attention should be given to individuals with extremely low pre-booster anti-HBs levels.