Ethnicity, substance use, and response to booster hepatitis B vaccination in anti-HBs-seronegative adolescents who had received primary infantile vaccination

Background/Aims In this revaccination study, we explored the determinants of response to booster hepatitis B (HB) vaccination in anti-HBs-seronegative adolescents who had received primary HB vaccination 15–18 years before. Results After controlling for prebooster anti-HBs levels, cigarette smoking, betel–quid chewing, alcohol drinking, and indigenous ethnicity were significantly associated with elevated risks of non-response to booster HB vaccination. The adjusted odds ratios (aORs) were 3.21 (CI: 1.33–7.84), 8.78 (CI: 2.03–37.94), 2.64 (CI: 1.15–6.02), and 2.46 (CI: 1.28–4.72), respectively. Among adolescents with undetectable prebooster anti-HBs titers, only indigenous ethnicity significantly associated with elevated risk, with an adjusted OR of 2.57 (CI: 1.20–5.54), of non-response to booster HB vaccination. On the contrary, the influences of cigarette smoking, betel–quid chewing, and alcohol drinking were restricted to adolescents with prebooster anti-HBs titers of 0.1–9.9 mIU/mL. The corresponding multivariate-adjusted ORs were 5.70, 17.41, and 3.72, respectively. Adolescents who smoked cigarettes and chewed betel–quid were at highest risk of non-response (aOR, 25.3; CI: 2.97–215.7). Conclusions A booster dose of HB vaccine may be insufficient to induce immunological response in healthy adolescents who had undetectable prebooster anti-HBs titers or who were of Malay-Polynesian ethnicity. Responses to booster vaccination are probably modified by recent cigarette smoking and/or betel–quid chewing.