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Hepatitis B vaccine does not always provide life-long protection.  Nearly all children who received three doses of hepatitis B vaccine achieved immunity, but about 20% fell below the protective antibody threshold by year 15 and in some cases even undetectable. Gilca V et al, 52nd Inter Science Conference on Antimicrobial Agents and Chemotherapy, San Francisco, 2012
In patients with hepatitis B, viral load predicts the risk of development of liver cancer. When the viral load is low (< 2000 IU / mL), high levels of hepatitis B surface antigen (> 1000 IU / mL) increase the risk of liver cancer. Tseng TC et al, Gastroenterology. 2012 May; 142 (5):1140
Hepatitis B occult infection is characterized by detectable levels of HBV DNA in individuals who test negative for hepatitis B surface antigen.

In HIV patients, hepatitis B vaccination protocols involving high-dose and four-shot regimen, instead of standard three-dose schedule produced superior serological response. Journal of the American Medical Association April 2011; 305(14): 1432

Chronic hepatitis B afflicts approximately 350 million people, globally. An estimated 20% of those with chronic hepatitis B infection will develop cirrhosis or cancer of liver. Centers for Disease Control and Prevention (CDC),  Atlanta USA

In patients with chronic hepatitis B infection, the clinical course of the disease is influenced by the presence or absence of Hepatitis B e antigen (HBeAg). Individuals without HBeAg in the blood have lower viral load and low infectivity. But they progress faster to have liver damage. Clearance of both HBV virus and infected cells are faster in HBeAg‐negative infection. Faster turnover of infected cells may be responsible for the more aggressive liver disease in HBeAg‐negative infection. The Journal of Infectious Diseases 2010; 202: 1309

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