{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:54:14Z","timestamp":1781639654907,"version":"3.54.5"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":37,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100013885","name":"Kementerian Kesihatan Malaysia","doi-asserted-by":"publisher","award":["NMRR-190867-47973"],"award-info":[{"award-number":["NMRR-190867-47973"]}],"id":[{"id":"10.13039\/501100013885","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hepatitis B vaccination is a cornerstone of global disease prevention, yet susceptibility among vaccinated individuals remains a concern. This study aimed to determine the prevalence and factors associated with hepatitis B susceptibility in vaccinated adults in Malaysia. A cross-sectional analysis was conducted using data from the National Health and Morbidity Survey (NHMS) 2020, involving 4,083 respondents aged 15 years and older. Serological testing for hepatitis B virus (HBV) markers, HBsAg, anti-HBs, and anti-HBc assays was performed. Susceptibility was defined based on serological profiles, and complex sampling logistic regression was employed to identify associated risk factors. Among the participants, 64.9% (2,649\/4,083) were susceptible to HBV infection, with a prevalence of 22.9% among vaccinated individuals. Susceptibility was notably higher in young adults aged 15\u201329 (19.0%), and Malay ethnic group (20.5%). Additionally, individuals with tertiary education (18.9%) and single marital status (20.1%) exhibited elevated susceptibility. Multivariate analysis revealed significant associations with ethnicity, where Chinese (aOR 7.10, 95% CI: 2.67, 18.91) and other ethnic groups (aOR 5.67, 95% CI: 2.03, 15.92) had higher odds of susceptibility compared to Malays. Education level was another strong predictor, with tertiary (aOR 9.82, 95% CI: 3.61, 26.73), secondary (aOR 8.88, 95% CI: 3.42, 23.11), and primary education (aOR 6.96, 95% CI: 2.77, 17.51) showing substantially increased odds relative to no formal education. This study highlights a substantial prevalence of hepatitis B susceptibility among vaccinated adults in Malaysia. Ethnicity and education level emerged as significant factors. These findings underscore the need for targeted interventions, such as booster vaccinations or enhanced screening, particularly for high-risk groups like the Chinese and other minority ethnicities, as well as those with higher education levels. Further research is warranted to explore these associations\u2019 underlying reasons and optimize vaccination strategies in Malaysia.<\/jats:p>","DOI":"10.1038\/s41598-026-42115-9","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T18:46:50Z","timestamp":1772563610000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and factors associated with characteristics of hepatitis B susceptibility among vaccinated adults in Malaysia: a cross-sectional study"],"prefix":"10.1038","volume":"16","author":[{"given":"Filza Noor","family":"Asari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eida Nurhadzira","family":"Muhammad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurfatehar","family":"Ramly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Hatta Abdul","family":"Mutalip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Faiz Mohd","family":"Hisham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuo Lin","family":"Chong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"42115_CR1","unstructured":"WHO. Hepatitis B. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-b (2024)."},{"key":"42115_CR2","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1016\/S0140-6736(15)61412-X","volume":"386","author":"A Schweitzer","year":"2015","unstructured":"Schweitzer, A., Horn, J., Mikolajczyk, R. T., Krause, G. & Ott, J. J. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet 386, 1546\u20131555 (2015).","journal-title":"Lancet"},{"key":"42115_CR3","doi-asserted-by":"publisher","unstructured":"Wong, G. L. H. & Lemoine, M. The 2024 updated WHO guidelines for the prevention and management of chronic hepatitis B: Main changes and potential implications for the next major liver society clinical practice guidelines. J. Hepatol. 82, 918\u2013925. https:\/\/doi.org\/10.1016\/j.jhep.2024.12.004 (2025).","DOI":"10.1016\/j.jhep.2024.12.004"},{"key":"42115_CR4","doi-asserted-by":"crossref","unstructured":"Hepatitis in Malaysia: past, present, and future. Euroasian J. Hepatogastroenterol. 6, 52\u201355 (2016).","DOI":"10.5005\/jp-journals-10018-1167"},{"key":"42115_CR5","unstructured":"The Malaysian National Immunisation Programme (NIP). Ministry Health 40,87 (2023). https:\/\/immunise4life.my\/the-malaysian-national-immunisation-programme-nip\/."},{"key":"42115_CR6","unstructured":"Norlia Othman, S. et al. Hepatitis B Seroepidemiology and Booster Vaccination in Pre-Clinical Medical Students in a Malaysian University (2025)."},{"key":"42115_CR7","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1111\/jvh.12735","volume":"24","author":"HS Kim","year":"2017","unstructured":"Kim, H. S. et al. Racial\/ethnic disparities in the prevalence and awareness of Hepatitis B virus infection and immunity in the United States. J. Viral Hepat. 24, 1052\u20131066 (2017).","journal-title":"J. Viral Hepat."},{"key":"42115_CR8","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/infdis\/jiv748","volume":"214","author":"MG Bruce","year":"2016","unstructured":"Bruce, M. G. et al. Antibody levels and protection after hepatitis B vaccine: results of a 30-year follow-up study and response to a booster dose. J. Infect. Dis. 214, 16\u201322 (2016).","journal-title":"J. Infect. Dis."},{"key":"42115_CR9","doi-asserted-by":"publisher","unstructured":"Lao, T. T. Immune persistence after hepatitis B vaccination in infancy \u2013 fact or fancy? Hum. Vacc. Immunotherapeut. 12, 1172\u20131176. https:\/\/doi.org\/10.1080\/21645515.2015.1130195 (2016).","DOI":"10.1080\/21645515.2015.1130195"},{"key":"42115_CR10","doi-asserted-by":"publisher","first-page":"104663","DOI":"10.1016\/j.meegid.2020.104663","volume":"87","author":"J Xu","year":"2021","unstructured":"Xu, J., Zhan, Q., Fan, Y., Yu, Y. & Zeng, Z. Human genetic susceptibility to hepatitis B virus infection. Infect. Genet. Evol. 87, 104663 (2021).","journal-title":"Infect. Genet. Evol."},{"key":"42115_CR11","doi-asserted-by":"publisher","unstructured":"Al-Busafi, S. A. & Alwassief, A. Global perspectives on the hepatitis B vaccination: challenges, achievements, and the road to elimination by 2030. Vaccines 2024, 12. https:\/\/doi.org\/10.3390\/vaccines12030288 (2024).","DOI":"10.3390\/vaccines12030288"},{"key":"42115_CR12","unstructured":"Kusnin, F. Public Health Physician Disease Control Division Ministry of Health (2025)."},{"key":"42115_CR13","unstructured":"Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030GLOBAL HEALTH STRATEGIES WHO. 69\u201378 (WHO, 2025)."},{"key":"42115_CR14","unstructured":"Eric, E. & Mast, M. A Comprehensive immunization strategy to eliminate transmission of hepatitis b virus infection in the united states: recommendations of the advisory committee on immunization practices. Part I: immunization of infants, children, and adolescents. cdc_31556_DS1. Mortality and Mortality Weekly Report (2006). https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/rr5516a1.htm."},{"key":"42115_CR15","unstructured":"Centers for Disease Control and Prevention (CDC). National health and nutrition examination survey (NHNES): sample design, 2011\u20132014 (CDC, 2014). https:\/\/www.cdc.gov\/nchs\/data\/series\/sr_02\/sr02_162.pdf."},{"key":"42115_CR16","unstructured":"Medical Development Division. Guidelines For The Safe Transport Of Clinical Specimens and Infectious Substances In Malaysia 2023. MOH\/P\/PAK\/528.23(GU)-e (2023)."},{"key":"42115_CR17","doi-asserted-by":"publisher","first-page":"2353","DOI":"10.1002\/hep.31991","volume":"74","author":"H Roberts","year":"2021","unstructured":"Roberts, H. et al. Prevalence of HBV infection, vaccine-induced immunity, and susceptibility among at-risk populations: US households, 2013\u20132018. Hepatology 74, 2353\u20132365 (2021).","journal-title":"Hepatology"},{"key":"42115_CR18","doi-asserted-by":"crossref","unstructured":"Chen, C., Wang, L. & Yu, M. Epidemiology of hepatitis B virus infection in the Asia\u2013Pacific region. J Gastroenterol. 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Gastroenterol. 12, 4788\u20134793 (2006).","journal-title":"World J. Gastroenterol."},{"key":"42115_CR22","doi-asserted-by":"crossref","unstructured":"Wei, Y., Tian, Q. & Donghui, Z. Association between IFN-\u03b3 genetic polymorphisms and susceptibility to hepatitis B virus infection: a meta-analysis. Ann. Hum. Biol. 43, 527\u2013536 (2016).","DOI":"10.3109\/03014460.2015.1106583"},{"key":"42115_CR23","doi-asserted-by":"publisher","first-page":"127","DOI":"10.4103\/jehp.jehp_65_18","volume":"7","author":"T Bayati","year":"2018","unstructured":"Bayati, T., Dehghan, A., Bonyadi, F. & Bazrafkan, L. Investigating the effect of education on health literacy and its relation to health-promoting behaviors in health center. J. Educ. Health Promot. 7, 127 (2018).","journal-title":"J. Educ. 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Med."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-42115-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-42115-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-42115-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:14:53Z","timestamp":1781637293000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-42115-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["42115"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-42115-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]},"assertion":[{"value":"11 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The survey was registered with the National Medical Research Registry as NMRR-190867-47973. The protocol and the procedures used were approved by the Medical Research and Ethics Committee (MREC), Ministry of Health, which operates in accordance with the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH), the Malaysian Guidelines for Good Clinical Practice, and the ethical principles outlined in the Declaration of Helsinki. All participants provided written informed consent before being recruited into the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}],"article-number":"11919"}}