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Older people have less response to recombinant hepatitis B vaccine


Clinical bottom line

Older people have a lower response to hepatitis B vaccine, even when the definition of older is as young as 30 years.


DN Fisman et al. The effect of age on immunologic response to recombinant hepatitis B vaccine: a meta-analysis. Clinical Infectious Diseases 2002 35: 1368-1375.


The search of MEDLINE and the Cochrane Library looked for human studies involving individuals aged 19 years or older and published in English. Randomised trials and observational studies were eligible if they use standard recombinant hepatitis B vaccines. Recipients could be healthy individuals and individuals with comorbid illnesses, but studies with only individuals (students, military recruits) less than 30 years of age were not included. Studies additionally had to have examined age as a variable for immulogical response.

The description of "older" was that used in each study. If stratified by age, 40 years was used as a default definition.


There were 24 studies with 11,000 subjects. The results for all studies and higher quality studies are shown in Table 1.

Table 1: Relative risk of nonresponse


Relative risk (95% CI)

All studies

1.8 (1.5 to 2.1)

Higher quality studies

1.6 (1.2 to 2.2)


This review does all sorts of things to do with heterogeneity and publication bias, much of which is unnecessary. What they do not give are the actual rates of nonresponse in younger or older people. This is a shame, because a relative risk without this information is quite useless. What we have are the results of the search, so that if necessary we could pull the papers and find that information.