Sadra Medical Journal

Epidemiological Investigation of Non-Response to the Hepatitis B Vaccine in the South of Iran

Document Type : Original Article

Authors

Navid Omidifar 1
Fatemeh Mohtashamifar 2
Kamran Bagheri Lankarani 3
Mansoureh Shokripour 4
Reza Masoumzadeh 5
Erfan Sadeghi 6
Majid Akbarzadeh 7
Reza Rahimi 2
Yousef Nikmanesh 8

1 Biotechnology Research Center, Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Internal Medicine, School of Medicine, Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

5 Department of Medical, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

6 Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

7 Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

8 Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

https://doi.org/10.30476/smsj.2026.107542.1657
Abstract
Introduction: Vaccination is the primary method for preventing hepatitis B worldwide. In some individuals, the anti-hepatitis B surface antigen (anti-HBs) antibody titer does not reach the protective range following primary vaccination. Consequently, evaluating the immune response and appropriate antibody titer is essential to determine the level of post-vaccination immunity.
Methods: This cross-sectional study included all patients referred to the laboratory of Shahid Motahari Clinic in Shiraz for anti-HBs antibody testing from 2019 to 2024. Data were analyzed using SPSS version 24.
Results: A total of 4,192 individuals were examined, of whom 2,064 were women and 2,128 were men, with a mean age of 21.74±5.15 years. Among those born in 1994 and later who had received the hepatitis B vaccine at birth, 422 individuals had an anti-HBs antibody titer of less than 10 mIU/mL. Complete data were collected for 231 of these individuals (155 women and 76 men). The mean antibody titer was 4.01±2.58 mIU/mL and had no statistically significant relationship with any of the demographic variables in non-parametric tests. In the univariate general linear model, students and employees were associated with lower antibody titers.
Conclusion: The low anti-HBs antibody titers observed in vaccinated individuals might be related to occupational factors, non-compliance with the cold chain during vaccine transportation, and intrinsic factors. These results underscored the critical need to rigorously enforce vaccination protocols, strictly maintain the cold chain during transport, and systematically investigate the underlying causes of non-response, particularly in high-risk occupations. 

Keywords

Hepatitis B
Hepatitis B Vaccines
Vaccination
 Antibodies
Iran
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Sadra Medical Journal
Volume 14, Issue 2
Spring 2026
Pages 280-289

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