Hepatitis B vaccine in the EPI schedule

Loss of protective anti-HBs titers and seroconversion to hepatitis B vaccination in children during chemotherapy for acute lymphoblastic leukemia

BACKGROUND

This study aimed to evaluate loss of protective anti-hepatitis B (HBs) titers and seroconversion to hepatitis B vaccine (HBV) during chemotherapy in children with acute lymphoblastic leukemia (ALL).

METHODS

Anti-HBs titers were done at diagnosis. Patients were divided into two groups. Group I (protective titers >10 mIU/ml) received single double dose of HBV as booster. Titers were repeated at three time points: end of phase 1b, beginning of re-induction, and start of maintenance chemotherapy. Group II (nonprotective titers <10 mIU/L) received hepatitis B immunoglobulin (HBIG), prior to start of chemotherapy, followed by three double doses of HBV as booster. Titers were repeated at two time points: prior to first dose, and 4 weeks after third dose of vaccine.

RESULTS

Total 125 patients were included: 88 in group I; 37 in group II. Among group I patients, 98.7%, 90%, and 84% retained protective titers at the three points, respectively. Subgroup analysis showed that those with initial titers greater than 100 mIU/L retained protective titers better than those with titers between 11 and 100 mIU/L (p = .0001). Among group II patients, 62% and 64% attained protective titers at the two points, respectively.

CONCLUSIONS

HBV boosters helped maintain protective titers during intensive ALL chemotherapy in immunized children having titers more than 10 mIU/L, and more so if titer was more than 100 mIU/L. Therefore, we propose that cut off for protective anti-HBs titers be changed to greater than or equal to 100 mIU/L. Titers between 11 and 100 mIU/L may require combined active and passive immunization. Around one-third of group II patients who fail to attain protective titers may need frequent doses of HBIG.

GAVI and hepatitis B immunisation in India

In cooperation with Indian health authorities, the GAVI Alliance (GAVI) is introducing Hepatitis B (HepB) vaccination into the immunisation programmes of 11 'better-performing' Indian states. This article describes the concerns and interests of major stakeholders in the programme, including GAVI partners and the Indian government, and summarises Indian debates that have emerged in response to the project, especially on the issue of selective vs. universal immunisation. The article suggests that programme planning should be based on a good knowledge of disease prevalence and the relative importance of perinatal HepB transmission, which would require a comprehensive cross-country study of the epidemiology of HepB among different populations, the relative importance of different transmission routes and the degree of geographical variation in India. Based on this research, further studies could address the feasibility and cost-effectiveness of routine birth-dose administration and selective birth-dose immunisation of infants born to mothers who are chronic HepB virus carriers. The GAVI 'formula' could be strengthened by supporting the basic epidemiological research that is essential to effective programme planning in recipient countries, which are by definition among the world's poorest countries.

Hepatitis B vaccination strategies tailored to different endemicity levels: some considerations

Hepatitis B is a serious public health problem. Worldwide three different levels of hepatitis B endemicity (high, intermediate and low) can be distinguished. Areas with different levels of endemicity require tailored vaccination strategies to fit the needs for individuals at risk and/or countries, depending on the infection risk per age group, vaccination rate, duration of protection after vaccination, cost effectiveness of vaccination strategies and ease of implementation in the national immunization schedules.This opinion paper evaluates these factors and proposes a combination of infant risk group and universal adolescent vaccination for low endemic countries thus targeting the different groups at risk. A universal infant vaccination schedule starting with a newborn vaccination within 24h after birth is more appropriate in intermediate- and high-endemic regions.

Randomized clinical trial comparing hepatitis B vaccine administered by 0, 6 and 14 week versus 6, 10 and 14 week schedule in healthy infants

OBJECTIVE

This randomized, single-blinded trial was carried out to compare the sero-efficacy of hepatitis B vaccine administered to healthy infants by either of two schedules-birth, 6, 14 weeks or 6, 10 and 14 weeks.

METHODS

The 74 infants born to HbsAg-negative mothers were randomized to receive recombinant hepatitis B vaccine at 0, 6 and 14 weeks (Group A) or 6, 10 and 14 weeks (Group B). Serum anti-HBs antibody titer was measured before the first dose and 6 months after the third dose by laboratory personnel blinded to the intervention. All participants received other vaccines as per the national immunization schedule.

RESULTS

At 6 months after the third dose sero-conversion was 100% in both groups. A total of 97.3% of subjects in Group A were sero protected (>10 mIUml(-1)) with geometric mean titer (GMT) of 113.78 mIUml(-1) and 94.6% in Group B (GMT 107.04 mIUml(-1)) [p = 0.8].

CONCLUSION

Hepatitis B vaccination by 0, 6 and 14 weeks and 6, 10 and 14 weeks schedules are comparable in terms of sero-efficacy.