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Cocchio S, Baldo V, Volpin A, Fonzo M, Floreani A, Furlan P, Mason P, Trevisan A, Scapellato ML. Persistence of Anti-Hbs after up to 30 Years in Health Care Workers Vaccinated against Hepatitis B Virus. Vaccines (Basel) 2021; 9:vaccines9040323. [PMID: 33915763 PMCID: PMC8067181 DOI: 10.3390/vaccines9040323] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/20/2022] Open
Abstract
The burden of hepatitis B virus (HBV) infection is a serious public health problem all over the world. Vaccination remains the most effective prevention measure, and safe and effective HBV vaccines have been available since 1982. Health care workers (HCWs) vaccinated against HBV and prospectively followed up for at least 14 years were classified by their antibody titers after primary vaccination as: poor responders (10–99 mIU/mL); moderate responders (100–999 mIU/mL); and good responders (≥1000 mIU/mL). The incidence of antibody loss was calculated for 1000 person-years and the anti-HBs persistence was calculated. The analysis concerned 539 HCWs: 494 good responders (91.7%); 37 moderate responders (6.9%); and eight poor responders (1.5%). The incidence of anti-HBs loss was 52.1 per 1000 person-years for the poor responders, 11.3 per 1000 person-years for the moderate responders, and 1.4 per 1000 person-years for the good responders. The mean persistence of anti-HBs differed significantly between the three groups, being: 19.2 years (95% CI: 15.6–22.8), 25.4 years (95% CI: 23.0–27.9), and 31.0 years (95% CI: 30.5–31.5) for the poor, moderate and good responders, respectively. In conclusion, our findings demonstrate a good persistence of protective anti-HBs titers in HCWs exposed to occupational risk for up to 30 years after a primary vaccination cycle (even without a booster dose) if their titer was initially higher than 100 mIU/mL.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Vincenzo Baldo
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
- Correspondence:
| | - Anna Volpin
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Marco Fonzo
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Annarosa Floreani
- Scientific Institute for Research, Hospitalization and Healthcare Negrar, 37024 Negrar, Italy;
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35124 Padova, Italy
| | - Patrizia Furlan
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Paola Mason
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Andrea Trevisan
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Maria Luisa Scapellato
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
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Noordeen F, Karunaratne HMS, Nawaratne V, Pitchai FNN, Daulagala SWPL, Abeykoon AMSB. Protective immunity against hepatitis B virus infection in a group of vaccinated Sri Lankan military service men following a complete course of vaccination. Virusdisease 2019; 30:462-464. [PMID: 31803814 DOI: 10.1007/s13337-019-00546-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022] Open
Abstract
Vaccination is the appropriate measure to protect military personnel against the hepatitis B virus (HBV) infection. Testing the military personnel for anti-HBs levels after vaccination is vital in re-vaccinating those that have not developed protective immunity. The aim of the current study was to determine the immunity in a group of vaccinated Sri Lankan military personnel (n = 150; age = 26-44 years) following a complete course of hepatitis B virus surface antigen (HBsAg) vaccination by assessing the antibodies against HBsAg (anti-HBs) levels. Three months after the last dose of the vaccination, blood samples were collected from the study population and tested for anti-HBs levels using a commercially available ELISA. Of the 150 military service men tested, 139 (92.67%) had anti-HBs levels higher than 10 mIU/mL, WHO approved levels for protective immunity against HBV infection. Of the 139 that had sufficient anti-HBs levels, 24% (36/150) had anti-HBs levels between 10 and 100 mIU/mL and 68.67% (103/150) had anti-HBs levels > 100 mIU/mL. Overall, 7.33% (11/150) participants had anti-HBs levels < 10 mIU/mL. Sero-conversion to > 10 mIU/mL anti-HBs was more than 90% in those that were less than 40 years of age and it was less than 90% in those that were more than 40 years of age.
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Affiliation(s)
- Faseeha Noordeen
- 1Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400 Sri Lanka
| | | | - Varuna Nawaratne
- Faculty of Medicine, Sir John Kotelawela Defence University, Ratmalana, 10390 Sri Lanka
| | - F N Nagoor Pitchai
- 1Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400 Sri Lanka
| | - S W P Lakmini Daulagala
- 1Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400 Sri Lanka
| | - A M S Bandara Abeykoon
- 1Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400 Sri Lanka
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Koc ÖM, Damoiseaux J, van Loo IHM, Masquillier HIL, Oude Lashof AML. Case report of delayed seroprotection rather than non-response after primary three-dose hepatitis B vaccination. Vaccine 2019; 38:112-114. [PMID: 31648909 DOI: 10.1016/j.vaccine.2019.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 10/03/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
We describe a delayed hepatitis B seroprotection 12 weeks after the primary vaccination schedule in a 57-year-old male with smoldering multiple myeloma. Based on undetectable anti-HBs antibodies 6 weeks after the third vaccination, the index person was previously considered to be a hepatitis B vaccine non-responder. Because hepatitis B vaccination started in the 1980s, many hepatitis B vaccine non-responders have received a revaccination regimen. If more cases of genuine delayed hepatitis B seroprotection surface in patients with hematologic malignancies, delayed seroprotection should be considered before the commencement of hepatitis B revaccination.
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Affiliation(s)
- Özgür M Koc
- Department of Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Department of Gastro-Enterology and Hepatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - Inge H M van Loo
- Department of Medical Microbiology, School of CAPHRI, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - Heloise I L Masquillier
- Department of Hematology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | - Astrid M L Oude Lashof
- Department of Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
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Bergmann M, Schwertler S, Reese S, Speck S, Truyen U, Hartmann K. Antibody response to feline panleukopenia virus vaccination in healthy adult cats. J Feline Med Surg 2018; 20:1087-1093. [PMID: 29256319 PMCID: PMC11104211 DOI: 10.1177/1098612x17747740] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
OBJECTIVES According to prior studies, between 25.0% and 92.8% of adult cats have antibodies against feline panleukopenia virus (FPV) and thus are likely protected against FPV infection. It is, however, unknown how healthy adult cats with different antibody titres react to FPV vaccination in the field. Therefore, the aim of the study was to measure antibody titres in healthy adult cats within a period of 28 days after vaccination against FPV and to evaluate factors that are associated with a lack of adequate response to vaccination. METHODS One hundred and twelve healthy adult cats were vaccinated with a vaccine against FPV, feline herpesvirus and feline calicivirus. Antibodies against FPV were determined before vaccination (day 0), on day 7 and day 28 after vaccination by haemagglutination inhibition (HI). A HI titre ⩾1:40 was defined as protective. An adequate response to vaccination was defined as a four-fold titre increase. Uni- and multivariate statistical analysis was used to determine factors associated with an adequate response. RESULTS Pre-vaccination antibody titres of ⩾1:40 were present in 64.3% (72/112; 95% confidence interval [CI] 55.1-72.6). Only 47.3% (53/112; 95% CI 37.8-57.0) of cats had an adequate response to vaccination. Factors associated with an adequate response to vaccination were lack of previous vaccination (odds ratio [OR] 15.58; 95% CI 1.4-179.1; P = 0.035), lack of antibodies (⩾1:40) prior to vaccination (OR 23.10; 95% CI 5.4-98.8; P <0.001) and breed (domestic shorthair cats; OR 7.40; 95% CI 1.4-38.4; P = 0.017). CONCLUSIONS AND RELEVANCE As none of the cats with high pre-vaccination antibody titres (⩾1:160) had an at least four-fold increase in FPV antibody titres, measurement of antibodies rather than regular revaccinations should be performed. Thus, evaluation of FPV antibody titre in cats with previous vaccinations against FPV are recommended prior to revaccination.
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Affiliation(s)
- Michèle Bergmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Germany
| | - Stephanie Schwertler
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Germany
| | - Sven Reese
- Department of Veterinary Science for Anatomy, Histology and Embryology, LMU Munich, Germany
| | - Stephanie Speck
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, Leipzig, Germany
| | - Uwe Truyen
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, Leipzig, Germany
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Germany
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Yoshioka N, Deguchi M, Hagiya H, Kagita M, Tsukamoto H, Takao M, Yoshida H, Yamamoto N, Akeda Y, Nabetani Y, Maeda I, Hidaka Y, Tomono K. Durability of immunity by hepatitis B vaccine in Japanese health care workers depends on primary response titers and durations. PLoS One 2017; 12:e0187661. [PMID: 29121107 PMCID: PMC5679562 DOI: 10.1371/journal.pone.0187661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/24/2017] [Indexed: 12/17/2022] Open
Abstract
Background Health care workers (HCWs) are frequently exposed to hepatitis B virus (HBV) infection. The efficacy and safety of immunization with the hepatitis B (HB) vaccine are well recognized, but the durability of immunity and need for booster doses in those with secondary vaccine response failure remains controversial. Methods This was a retrospective cohort study performed at Osaka University Hospital, Japan. We examined antibodies against HB surface antigen (anti-HBs) titers annually after immunization for previously non-immunized HCWs. Primary responders were categorized by their sero-positive durations as short responders (those whose anti-HBs titers declined to negative range within 3 years), and long responders (those who retained positive anti-HBs levels for 3 years and more). We re-immunized short responders with either single or 3-dose boosters, the long responders with a single booster when their titers dropped below protective levels, and examined their sero-protection rates over time thereafter. Results From 2001 to 2012, data of 264 HCWs with a median age of 25.3 were collected. The rate of anti-HBs positivity after primary vaccination were 93.0% after three doses (n = 229), 54.5% after two doses (n = 11), and 4.2% after a single dose (n = 24). Of 213 primary responders, the anti-HBs levels of 95 participants (44.6%) fell below the protective levels, including 46 short responders and 49 long responders. HCWs with higher initial anti-HBs titers after primary vaccination had significantly longer durations of sero-positivity. For short responders, 3-dose booster vaccination induced a longer duration of anti-HBs positivity compared to a single-dose booster, whereas for long responders, a single-dose booster alone could induce prolonged anti-HBs positivity. Conclusion Our preliminary data suggested that it may be useful to differentiate HB vaccine responders based on their primary response durations to maintain protective levels of anti-HBs efficiently. A randomized, prospective, large-scale study is warranted to support our findings.
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Affiliation(s)
- Nori Yoshioka
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
- * E-mail:
| | - Matsuo Deguchi
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
| | - Masanori Kagita
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Hiroko Tsukamoto
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Miyuki Takao
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
| | - Norihisa Yamamoto
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
| | - Yukihiro Akeda
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
| | - Yoshiko Nabetani
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
- Nursing Department, Osaka University Hospital, Suita, Osaka, Japan
| | - Ikuhiro Maeda
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Yoh Hidaka
- Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Osaka, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan
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Das M, Vanar V, Martin DK, Walayat S, Patel J, Badshah MB, Kalva NR, Pisoh WN, Dhillon S. Seroconverting nonresponder of high-dose intramuscular HBV vaccine with intradermal HBV vaccine: A case report. Medicine (Baltimore) 2017; 96:e8575. [PMID: 29145268 PMCID: PMC5704813 DOI: 10.1097/md.0000000000008575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Liver disease is a leading cause of death among human immunodeficiency virus (HIV)-infected patients in the United States. Patients with HIV and hepatitis B virus (HBV) coinfection have accelerated liver disease, higher rates of cirrhosis, and liver cancer, and markedly increased liver-related mortality. The CDC and US Advisory Committee on Immunization Practices recommend hepatitis B vaccination for all HIV-infected individuals. Unfortunately, HIV-infected patients have a worse response rate after standard HBV vaccination. Intradermal (ID) vaccination continues to emerge as an important modality in such difficult to vaccinate individuals and should be considered whenever permissible. Herein, we report a case of a 46-year-old male with HIV who failed to mount an immune response to standard intramuscular vaccine, standard booster dose, and repeat high-dose booster vaccine but subsequently mounted an immune response to the ID vaccine which was sustained at 3 months postvaccination. CONCLUSION ID vaccination continues to emerge as an important modality in difficult to vaccinate individuals and should be considered in all applicable cases.
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Affiliation(s)
| | | | | | - Saqib Walayat
- Division of Internal Medicine, University of Illinois College of Medicine at Peoria, IL, USA
| | - Jaymon Patel
- Division of Internal Medicine, University of Illinois College of Medicine at Peoria, IL, USA
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La Fauci V, Riso R, Facciolà A, Ceccio C, Lo Giudice D, Calimeri S, Squeri R. Response to anti-HBV vaccine and 10-year follow-up of antibody levels in healthcare workers. Public Health 2016; 139:198-202. [PMID: 27600791 DOI: 10.1016/j.puhe.2016.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/14/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite improvements in public health and antiviral treatments, vaccination is still the most effective means of prevention of hepatitis B virus (HBV) infection. However, little is known about the duration of protection given by the anti-HBV vaccine. Healthcare workers represent a category at risk not only of contracting infection but also of being a source of contagion to patients. OBJECTIVES To assess individual responses to the anti-HBV vaccine and duration of protection 10 years after its administration in a cohort of healthcare workers employed by the University Hospital 'G. Martino' in Messina, Italy. METHODS One hundred and seventy medical staff who had been vaccinated following an incident carrying risk of HBV infection were included in this study. The group was followed over a 10-year period, and HBV antibody levels were assessed using an automated microparticle enzyme immunoassay. RESULTS Protective antibody levels (≥10 mIU/ml) were found in 65% of subjects who had completed the full vaccine schedule (three doses) and in 35% of subjects who had only received one or two doses of anti-HBV vaccine. Moreover, 10 years after vaccination, HBV antibody levels were inversely related to age at vaccination (P < 0.001). No differences were found between males and females. CONCLUSIONS This study, in line with the literature, shows the importance of completing the full vaccine schedule (three doses). Moreover, in order to have an effective and durable antibody response and avoid the risk of contracting HBV after an injury at work, it is important to recommend anti-HBV vaccination at a young age, ideally during childhood in accordance with the national vaccination policy.
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Affiliation(s)
- V La Fauci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - R Riso
- Postgraduate Medical School in Hygiene and Preventive Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - A Facciolà
- Postgraduate Medical School in Hygiene and Preventive Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - C Ceccio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - D Lo Giudice
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - S Calimeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - R Squeri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Lamberti M, De Rosa A, Garzillo EM, Corvino AR, Sannolo N, De Pascalis S, Di Fiore E, Westermann C, Arnese A, Gabriella DG, Nienhaus A, Sobrinho APR, Coppola N. Vaccination against hepatitis b virus: are Italian medical students sufficiently protected after the public vaccination programme? J Occup Med Toxicol 2015; 10:41. [PMID: 26539242 PMCID: PMC4632277 DOI: 10.1186/s12995-015-0083-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 10/26/2015] [Indexed: 01/02/2023] Open
Abstract
Background The development of a vaccine against hepatitis B virus (HBV) has been a major achievement in terms of prevention of HBV infection. For the present study, we analysed the long-term immunogenicity and effectiveness of HBV vaccination among healthcare students with different working seniorities. Methods A cross-sectional study of undergraduate and postgraduate students attending the Medical School of the Second University of Naples was conducted between September 2012 and December 2014. HBV serum markers were determined and multivariate logistic regression analysis was used to identify factors associated with the level of long-term immunogenicity. Results Of the 2,932 subjects evaluated, only 33 (1.1 %) declared no history of vaccination. All vaccinated subjects were HBsAg/anti-HBc negative, 459 of which had an anti-HBs titre <10 IU/L. The latter were younger, more likely to be attending a healthcare profession school (i.e., dental hygienists, nursing, paediatric nursing, radiography and midwifery) than a medical school (at either undergraduate or postgraduate level) and more likely to have been vaccinated in infancy. Conclusion The results of this study suggest that assessment of HBV serum markers in workers potentially exposed to hospital infections is useful to identify small numbers of unvaccinated subjects or vaccinated subjects with low antibody titre, all of whom should be referred to a booster series of vaccinations.
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Affiliation(s)
- Monica Lamberti
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, Naples, 80133 Italy
| | - Alfredo De Rosa
- Department of Orthodontics, Second University of Naples, Naples, Italy
| | - Elpidio Maria Garzillo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, Naples, 80133 Italy
| | - Anna Rita Corvino
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, Naples, 80133 Italy
| | - Nicola Sannolo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, Naples, 80133 Italy
| | - Stefania De Pascalis
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Eliana Di Fiore
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, Naples, 80133 Italy
| | - Claudia Westermann
- Institute for Health Services, Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Antonio Arnese
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, Naples, 80133 Italy
| | - Di Giuseppe Gabriella
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, Naples, 80133 Italy
| | - Albert Nienhaus
- Institute for Health Services, Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institution for Statutory Accident Insurance and Prevention in Healthcare and Welfare Services, Hamburg, Germany
| | | | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
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Thomas RJ, Fletcher GJ, Kirupakaran H, Chacko MP, Thenmozhi S, Eapen CE, Chandy G, Abraham P. Prevalence of non-responsiveness to an indigenous recombinant hepatitis B vaccine: a study among South Indian health care workers in a tertiary hospital. Indian J Med Microbiol 2015; 33 Suppl:32-6. [PMID: 25657153 DOI: 10.4103/0255-0857.150877] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Health care workers (HCW) are at higher risk of contracting HBV infection. Non-response to HBV vaccine is one of the major impediments to prevent healthcare associated HBV infection (HAHI). We estimated the prevalence of non-responsiveness to initial 3-dose regimen of an indigenous recombinant HBV vaccine (GeneVac-B) among South Indian HCWs and typed the HLA in non-responders. STUDY DESIGN AND METHOD Of the 778 subjects screened over 1 year, 454 completed all three doses of the hepatitis B vaccination. Anti-HBs titers were estimated by microparticle enzyme immunoassay AxSYM AUSAB, (Abbott, Germany). HLA typing was done using SSP-PCR assay AllSet+™ Gold SSP (Invitrogen, USA). RESULTS The overall seroconversion rate (anti-HBs>10 mIU/mL) was 98.89% wherein 90.8% had titers>1000mIU/mL, 7.6% had titers 100-1000mIU/mL, 0.43% had titers<100 mIU/mL and 1.1% were non-responsive (<10 mIU/mL) to the initial 3-dose regimen. Antibody titers<1000 mIU/mL were significantly associated with the highest quartile of body mass index (BMI) (P<0.001). We found no significant difference in seroprotection rate between gender (P=0.088). There was no difference in seroprotection rates among various ethnic groups (P=0.62). Subjects who were non-responsive in our study had at least one HLA allele earlier known to be associated with non-responsiveness to the vaccine. CONCLUSION Our findings suggest that non-response to HBV vaccine is not a major impediment to prevent HAHI. Robust seroprotection rates can be achieved using this indigenous HBV vaccine. However, gender and BMI might influence the level of anti-HBs titers. We recommend the use of this cost effective HBV vaccine as well as postvaccination anti-HBs testing to prevent HAHI among HCWs.
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Affiliation(s)
| | | | | | | | | | | | | | - P Abraham
- Department of Clinical Virology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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10
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The efficacy of accelerated, multiple, double-dose hepatitis B vaccine against hepatitis B virus infection in cancer patients receiving chemotherapy. Indian J Gastroenterol 2015; 34:372-9. [PMID: 26531066 DOI: 10.1007/s12664-015-0595-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/13/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection in cancer patients receiving chemotherapy carries high morbidity and mortality. Conventional hepatitis B vaccination with three doses at 0, 1, and 6 months apart is ineffective in prevention of HBV infection. OBJECTIVES To compare the efficacy of accelerated, multiple, double-dose HB vaccine with conventional HB vaccine in cancer patients receiving chemotherapy (CT). METHODS Patients of cancer who were planned for CT were screened for HBV markers (HBsAg, total anti-HB core, anti-HBs antibody and HBV DNA). Patients with negative HBV serum markers received HB vaccine in two groups. Group A received three double doses (40 μg) of recombinant HB vaccine at 0, 1, and 3 weeks before CT and additional three double doses post CT. Group B received HB vaccine (20 μg) at 0, 1, and 6 months. Efficacy of vaccine in the two groups was compared by anti-HBs titers achieved at 3, 6, and 9 months and by HBsAg positivity following CT at 1 year follow up. RESULTS Protective anti-HBs titers (>10 mIU/mL) at 3, 6, and 9 months in group A and B was 41.1 %, 66.2 %, and 76% and 26 %, 37.7 %, and 49% respectively (p = 0.001). Seven of 454 (1.5%) patients in group A became HBsAg positive after vaccination compared to 19/472 (4.0%) in group B (p = 0.022). CONCLUSION Accelerated, multiple, double-dose HB vaccine increases seroprotection and is more effective than conventional HB vaccine in preventing HBV infection.
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Filippelli M, Lionetti E, Pulvirenti A, Gennaro A, Lanzafame A, Marseglia GL, Salpietro C, Rosa ML, Leonardi S. New approaches in hepatitis B vaccination for celiac disease. Immunotherapy 2015; 6:945-52. [PMID: 25313572 DOI: 10.2217/imt.14.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Celiac disease (CD) is a gluten-induced immune-mediated disorder that has been associated with a defective response to the hepatitis B virus (HBV) vaccination. This unresponsiveness could lead to a world health problem, because non-responder patients could represent a reservoir of HBV-susceptible people that will persist as healthy carriers, leading to the diffusion of the disease. This article presents a literature review of both intramuscular (IM) and intradermal (ID) routes for boosters in celiac patients. We used PubMed database and generated the odds ratio (OR) of the response on the basis of electronic searches of clinical trials. Although our results confirm the positive response of celiac patients to IM vaccination, the ID route seems to be better than the conventional one, since it could provide a saving in cost and a greater immunogenicity.
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Affiliation(s)
- Martina Filippelli
- Department of Medical & Pediatric Science, University of Catania, Catania, Italy
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12
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Gara N, Abdalla A, Rivera E, Zhao X, Werner JM, Liang TJ, Hoofnagle JH, Rehermann B, Ghany MG. Durability of antibody response against hepatitis B virus in healthcare workers vaccinated as adults. Clin Infect Dis 2014; 60:505-13. [PMID: 25389254 DOI: 10.1093/cid/ciu867] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Follow-up studies of recipients of hepatitis B vaccine from endemic areas have reported loss of antibody to hepatitis B surface antigen (anti-HBs) in a high proportion of persons vaccinated at birth. In contrast, the long-term durability of antibody in persons vaccinated as adults in nonendemic areas is not well defined. We aimed to assess the durability of anti-HBs among healthcare workers (HCWs) vaccinated as adults and response to a booster among those without protective levels of antibody. METHODS Adult HCWs aged 18-60 at the time of initial vaccination were recruited. All were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), and anti-HBs level. HCWs with anti-HBs <12 mIU/mL were offered a booster and levels were measured 1, 7, and 21 days afterward. RESULTS Anti-HBs levels were <12 mIU/mL in 9 of 50 (18%), 13 of 50 (26%), and 14 of 59 (24%) HCWs 10-15, 16-20, and >20 years postvaccination, respectively, (P = ns). Four HCWs were anti-HBc positive; none had HBsAg. By logistic regression, older age at vaccination was the only predictor of inadequate anti-HBs level (P = .0005). Thirty-four of 36 subjects with inadequate anti-HBs levels received a booster and 32 (94%) developed levels >12 mIU/mL within 3 weeks. CONCLUSIONS Anti-HBs levels decrease after 10-31 years and fall below a level considered protective in approximately 25% of cases. The rapid and robust response to a booster vaccine suggests a long-lasting amnestic response. Hepatitis B vaccination provides long-term protection against hepatitis B and booster vaccination does not appear to be necessary in HCWs. Clinical Trials Registration. NCT01182311.
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Affiliation(s)
| | | | | | | | | | | | - Jay H Hoofnagle
- Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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13
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Filippelli M, Lionetti E, Gennaro A, Lanzafame A, Arrigo T, Salpietro C, La Rosa M, Leonardi S. Hepatitis B vaccine by intradermal route in non responder patients: An update. World J Gastroenterol 2014; 20:10383-10394. [PMID: 25132754 PMCID: PMC4130845 DOI: 10.3748/wjg.v20.i30.10383] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/12/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus (HBV) infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90% of general population. Individuals who develop an anti-HBs titer less than 10 mIU/mL after primary vaccination cycle are defined “no responders”. Many factors could cause a non response to the HBV vaccination, such as administration of the vaccine in buttocks, impaired vaccine storage conditions, drug abuse, smoking, infections and obesity. Moreover there are some diseases, like chronic kidney disease, human immunodeficiency virus infection, chronic liver disease, celiac disease, thalassaemia, type I diabetes mellitus, down’s syndrome and other forms of mental retardation that are characterized by a poorer response to HBV vaccination than healthy subjects. To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection. Recent studies seem to indicate that the administration of HBV recombinant vaccine by the intradermal route is very effective and could represent a more useful strategy than intramuscular route. This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients. A comprehensive review of the literature using PubMed database, with appropriate terms, was undertaken for articles in English published since 1983. The literature search was undertaken in September 2013.
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Çiftdoğan DY, Onay H, Tosun S, Özdemir TR, Özkınay F, Vardar F. IFNG and IFNGR1 gene polymorphisms in children with nonresponse to the hepatitis B vaccine. Future Virol 2014. [DOI: 10.2217/fvl.13.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ABSTRACT: Aim: We investigated the +874 T/A polymorphism in the first intron of the IFNG gene and intronic (CA)n polymorphic microsatellite marker of the IFNGR 1 gene in child nonresponders to hepatitis B vaccination. Materials & methods: A total of 100 children who had anti-HBs antibody levels <10 mIU/ml after vaccination against hepatitis B were included as a nonresponder group and 100 children who had anti-HBs antibody levels >10 mIU/ml after vaccination against hepatitis B were included as a responder group. Results: The frequency of the TT genotype of the IFNG (+874 T/A) gene polymorphism was higher in nonresponders (p = 0.003). The frequencies of alleles 170 and 182 for (CA)n alleles for the intronic (CA)n microsatellite of IFNGR1 were significantly higher in nonresponders (for each, p < 0.05). Conclusion: The TT genotype of the IFNG (+874 T/A) gene, and alleles 170 and 182 for (CA)n alleles for the intronic (CA)n microsatellite of the IFNGR1 gene, may be associated with nonresponse to hepatitis B vaccination.
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Affiliation(s)
- Dilek Yılmaz Çiftdoğan
- Ege University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Bornova, İzmir, Turkey
| | - Hüseyin Onay
- Ege University, Department of Medical Genetics, İzmir, Turkey
| | | | | | - Ferda Özkınay
- Ege University, Department of Medical Genetics, İzmir, Turkey
| | - Fadıl Vardar
- Ege University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Bornova, İzmir, Turkey
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15
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High non-responsiveness of males and the elderly to standard hepatitis B vaccination among a large cohort of healthy employees. J Clin Virol 2013; 58:262-4. [PMID: 23895931 DOI: 10.1016/j.jcv.2013.07.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 01/16/2013] [Accepted: 07/03/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hepatitis B virus infection is a major health problem. Although non-response is known to increase with age, hepatitis B vaccinations are considered to have only minor non-response rates (anti-HBs<10IU/L) in healthy subjects. OBJECTIVES The aim of this study was to quantify immunosenescence in a large retrospective cohort of 11,439 healthy adults who received HBV immunisation according to the standard vaccination regime. STUDY DESIGN We evaluated the response to the standard three-dose vaccination regimen, consisting of 20-μg doses of the HbsAg recombinant DNA hepatitis B vaccine, among 11,439 healthy employees using a retrospective cohort design. Logistic regression was applied to predict the non-response rate, and multivariate regression analysis was applied to predict antibody response. Predictors of responsiveness included sex, age and time between the last vaccination and antibody titre measurement. RESULTS From the age of 29 on in men and 43 on in women, more than 5% of subjects did not respond. Compared with women, men had a higher risk of non-response and exhibited a steeper decline in antibody titres produced with increasing age. CONCLUSIONS This retrospective cohort study demonstrates that immunosenescence starts at young age, especially among men, underlining the importance of vaccination at a young age to achieve long-lasting immunity. Moreover, HBV vaccination should always include testing for antibodies to facilitate the performance of necessary interventions to prevent long-term fatal complications.
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Zhang L, Gui X, Fan J, Wang B, Ji H, Yisilafu R, Li F, Zhou Y, Tong Y, Kong X, Ye P, Zong L. Breast feeding and immunoprophylaxis efficacy of mother-to-child transmission of hepatitis B virus. J Matern Fetal Neonatal Med 2013; 27:182-6. [DOI: 10.3109/14767058.2013.806901] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Halperin SA, Ward BJ, Dionne MS, Langley JM, McNeil SA, Smith B, MacKinnon-Cameron D, Heyward WL, Martin JT. Immunogenicity of an investigational hepatitis B vaccine (hepatitis B surface antigen co-administered with an immunostimulatory phosphorothioate oligodeoxyribonucleotide) in nonresponders to licensed hepatitis B vaccine. Hum Vaccin Immunother 2013; 9:1438-44. [DOI: 10.4161/hv.24256] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Vitaliti G, Praticò AD, Cimino C, Di Dio G, Lionetti E, La Rosa M, Leonardi S. Hepatitis B vaccine in celiac disease: Yesterday, today and tomorrow. World J Gastroenterol 2013; 19:838-45. [PMID: 23430309 PMCID: PMC3574880 DOI: 10.3748/wjg.v19.i6.838] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 10/12/2012] [Accepted: 10/16/2012] [Indexed: 02/06/2023] Open
Abstract
Some studies showed that in celiac patients the immunological response to vaccination is similar to that one found in general population except for vaccine against hepatitis B virus (HBV). The non-responsiveness to HBV vaccine has also been described in healthy people, nevertheless the number of non-responders has been demonstrated to be higher in celiac disease (CD) patients than in healthy controls. Several hypothesis explaining this higher rate of unresponsiveness to HBV vaccine in CD patients have been described, such as the genetic hypothesis, according with CD patients carrying the disease-specific haplotype HLA-B8, DR3, and DQ2, show a lower response to HBV vaccine both in clinical expressed CD patients and in healthy people carrying the same haplotype. On the other hand, it has been demonstrated that the gluten intake during the vaccination seems to influence the response to the same vaccine. Moreover, it has been demonstrated a possible genetic predisposition to hepatitis B vaccine non-responsiveness likely due to the presence of specific human leukocyte antigen haplotypes and specific single nucleotide polymorphism in genes of cytokine/cytokine receptors and toll like receptors, but the pathogenic mechanism responsible for this low responsiveness still remains unclear. The aim of this review is to focus on the possible pathogenic causes of unresponsiveness to HBV vaccine in CD patients and to propose an alternative vaccination schedule in order to improve the responsiveness to HBV vaccine in this at-risk patients.
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19
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Hoebe CJ, Vermeiren AP, Dukers-Muijrers NH. Revaccination with Fendrix® or HBVaxPro® results in better response rates than does revaccination with three doses of Engerix-B® in previous non-responders. Vaccine 2012; 30:6734-7. [DOI: 10.1016/j.vaccine.2012.08.074] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/22/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
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20
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Grosso G, Mistretta A, Marventano S, Ferranti R, Mauro L, Cunsolo R, Proietti L, Malaguarnera M. Long-term persistence of seroprotection by hepatitis B vaccination in healthcare workers of southern Italy. HEPATITIS MONTHLY 2012; 12:e6025. [PMID: 23087756 PMCID: PMC3475028 DOI: 10.5812/hepatmon.6025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 05/17/2012] [Accepted: 07/28/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of hepatitis B virus (HBV) vaccination campaigns on HBV epidemiology needs to be evaluated, in order to assess the long-term immunity offered by vaccines against HBV. OBJECTIVES To evaluate the current status of anti-HBV vaccine coverage among healthcare workers (HCWs) in Southern Italy, and to determine the long-term persistence of antibodies to hepatitis B surface antigens (anti-HBs) in such a cohort of subjects. PATIENTS AND METHODS A longitudinal, retrospective seroepidemiological survey was conducted among 451 HCWs, who were working at or visiting, the Occupational Health Department of a city hospital, in Catania, Italy, between January 1976 and December 2010. RESULTS At the 30-year follow-up (mean follow-up 10.15 ± 5.96 years, range 0.74-30), 261 HCWs had detectable anti-HBs titers indicating a persistence of seroprotection of 89.4% (out of 292 anti-HBs positive results, three months after vaccination). An inadequate vaccination schedule was the strongest predictor of antibody loss during follow-up (OR = 8.37 95% CI: 5.41-12.95, P < 0.001). A Kaplan-Maier survival curve revealed that the persistence of anti-HBs 30 years after vaccination, was 92.2% for high responders, while it was only 27.3% for low responders (P = 0.001). CONCLUSIONS A good level of seroprotection persisted in 57.9% of the subjects after 30 years. Factors related to this immunization status confirmed the importance of vaccinating HCWs early in their careers and ensuring an adequate vaccination schedule. However, with particular reference to the low rate of hepatitis B vaccine coverage among HCWs in Southern Italy, the implementation of a new educational intervention as part of an active vaccination program is needed.
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Affiliation(s)
- Giuseppe Grosso
- G.F. Ingrassia Department, Section of Hygiene and Public Health, University of Catania, Catania, Italy
| | - Antonio Mistretta
- G.F. Ingrassia Department, Section of Hygiene and Public Health, University of Catania, Catania, Italy
- Corresponding author: Antonio Mistretta, G.F. Ingrassia Department, Section of Hygiene and Public Health, University of Catania, Via Santa Sofia 87, 95123, Catania, Italy. Tel.: +39-953782182, Fax: +39-953782177, E-mail:
| | - Stefano Marventano
- G.F. Ingrassia Department, Section of Hygiene and Public Health, University of Catania, Catania, Italy
| | - Roberta Ferranti
- G.F. Ingrassia Department, Section of Hygiene and Public Health, University of Catania, Catania, Italy
| | - Luisa Mauro
- G.F. Ingrassia Department, Section of Hygiene and Public Health, University of Catania, Catania, Italy
| | - Rosario Cunsolo
- Rosario Cunsolo, Vittorio Emanuele Hospital of Catania Health Direction, Catania, Italy
| | - Lidia Proietti
- Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy
| | - Mariano Malaguarnera
- The Great Senescence Research Center, University of Catania, Ospedale Cannizzao, Catania, Italy
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21
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Ozdemir R, Canpolat FE, Yurttutan S, Oncel MY, Erdeve O, Dilmen U. Effect of needle length for response to hepatitis B vaccine in macrosomic neonates: a prospective randomized study. Vaccine 2012; 30:3155-8. [PMID: 22446632 DOI: 10.1016/j.vaccine.2012.02.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/17/2012] [Accepted: 02/25/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objective of this study was to determine whether use of a longer (1 in.) rather than a standard (5/8 in.) needle used for macrosomic neonates (birthweight over 4000 g) may affect antibody titers after immunization against hepatitis B virus (HBV). METHODS Fifty nine healthy infants were vaccinated at birth, 1, and 6 months of age with hepatitis B vaccine, with follow up to 7 months of age. Infants were randomized into two groups according to needle length of first vaccine at birth. First group vaccinated with standart needle length and other group received vaccine by longer needle length. RESULTS Macrosomic infants who were immunized with a longer needle achieved significantly higher antibody titers to hepatitis B surface antigen than standart needle length (median, 3890.2 vs 1311.7 mIU/mL, respectively; p=0.001). CONCLUSIONS Macrosomic neonates benefit from longer needle length with higher levels of antibody titers after HBV vaccination.
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Affiliation(s)
- Ramazan Ozdemir
- Neonatal Intensive Care Unit, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
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22
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Ouyang K, Chen L, Sun H, Du J, Shi M. Screening and appraisal for immunological adjuvant-active fractions fromPlatycodon grandiflorumtotal saponins. Immunopharmacol Immunotoxicol 2011; 34:126-34. [DOI: 10.3109/08923973.2011.586704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Zingone F, Morisco F, Zanetti A, Romanò L, Portella G, Capone P, Andreozzi P, Tortora R, Ciacci C. Long-term antibody persistence and immune memory to hepatitis B virus in adult celiac patients vaccinated as adolescents. Vaccine 2010; 29:1005-8. [PMID: 21129395 DOI: 10.1016/j.vaccine.2010.11.060] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 11/09/2010] [Accepted: 11/16/2010] [Indexed: 12/21/2022]
Abstract
Aim of this study was to investigate the anti-HBs antibody persistence and immune memory to hepatitis B virus in adult celiacs vaccinated as adolescents and the effect of a booster administration in non-protected individuals. Eleven years after primary vaccination, the proportion of vaccinees with titres ≥ 10 mIU/ml and antibody geometric mean concentrations (GMCs) were lower among celiac patients than among controls (68.6% vs 91.7%, p<0.01; GMCs 29.38 mIU/ml vs 250.6 mIU/ml, p<0.001). Participants with anti-HBs below 10 mIU/ml received a booster dose and were retested 2 weeks later to assess the anamnestic response. Post-booster anti-HBs levels were still <10 mIU/ml in 71.4% celiacs and 25% controls (p<0.01). Our findings indicate that the prevalence of seroprotective levels of anti-HBs detected eleven years after primary immunization as well as the frequency of response to a booster dose of vaccine are lower in celiac patients compared to healthy controls.
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Affiliation(s)
- F Zingone
- Department of Clinical and Experimental Medicine, Federico II University of Naples, Italy
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Abstract
Chronic hepatitis B virus (HBV) is estimated to be present in 350 million people worldwide. One of its major complications is reactivation of dormant HBV, which is associated with significant morbidity and mortality. Although reactivation can occur spontaneously, the most common risk factor is initiation of immunosuppression. As the use of immunosuppressive therapy increases, the incidence of HBV reactivation is expected to rise. Screening with serologic markers for hepatitis B is recommended before initiating immunosuppressive therapy. In patients with no evidence of HBV infection, immunization is recommended. In chronic carriers, prophylactic antiviral treatment has been shown to decrease overall morbidity and mortality. Patients with inactive HBV should be monitored closely during immunosuppressive treatment with alanine transaminase and serum HBV-DNA levels and treated promptly if they develop HBV reactivation. Although HBV reactivation is a serious complication, it can be prevented with screening and prophylactic treatment.
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Roukens AH, Vossen AC, Boland GJ, Verduyn W, van Dissel JT, Visser LG. Intradermal hepatitis B vaccination in non-responders after topical application of imiquimod (Aldara). Vaccine 2010; 28:4288-93. [PMID: 20433806 DOI: 10.1016/j.vaccine.2010.04.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 04/07/2010] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Five to ten percent of immunocompetent persons fail to develop a protective immune response to hepatitis B vaccination, and are defined non-responders (NR). We investigated the immune response to intradermal hepatitis B vaccination after pre-treatment of the skin with the TLR7 agonist imiquimod. METHODS Twenty-one non-responders (anti-HBs <10 IU/l after at least 6 intramuscular hepatitis B vaccinations) were randomly assigned to the control group (N=11) or the experimental group (N=10). Participants in both groups received 3 intradermal (ID) vaccinations with 5 microg HBsAg (0.125 mL) at 0, 1 and 6 months. In the experimental group, the dermal site of injection was pre-treated with 250 mg imiquimod ointment. Anti-HBs antibodies were determined at 0, 1, 2, 6 and 7 months. RESULTS In both study groups, 70% of the participants developed a protective immune response (anti-HBs >or=10 IU/l), after the 3rd intradermal vaccination. CONCLUSION The application of imiquimod on the skin prior to intradermal vaccination did not enhance the humoral response to hepatitis B vaccine. However, irrespective of imiquimod application, 70% of the NR who had not responded to 6 previous intramuscular vaccinations, developed a protective immune response with high affinity antibodies after 3 ID hepatitis B vaccinations with 5 microg HBsAg.
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Affiliation(s)
- Anna H Roukens
- Department of Infectious Diseases, Leiden University Medical Center, The Netherlands.
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26
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Bobak DA. Hepatitis B vaccine nonresponders: a role for revaccination with the combination hepatitis A/B vaccine? Curr Infect Dis Rep 2009; 11:93-4. [PMID: 19239797 DOI: 10.1007/s11908-009-0013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barreiro P, Martín-Carbonero L, García-Samaniego J. [Hepatitis B in patients with HIV infection]. Enferm Infecc Microbiol Clin 2008; 26 Suppl 7:71-9. [PMID: 19100234 DOI: 10.1016/s0213-005x(08)76522-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chronic hepatitis B virus infection affects approximately 10% of HIV-infected patients. There are an estimated 4 million patients with HIV/HBV coinfection. HIV infection has a deleterious effect on the natural history of chronic hepatitis B and increases the risk of progression to cirrhosis and terminal liver disease. Since the widespread use of highly active antiviral therapy (HAART), liver disease has emerged as one of the main causes of morbidity and mortality in HIV-positive patients. Therefore, all patients with HIV/HBV coinfection should be evaluated for treatment of hepatitis B, independently of the CD4 lymphocyte count. Six drugs are currently authorized for the treatment of chronic hepatitis B: standard interferon-alpha (2a and 2b), pegylated interferon alpha-2a, lamivudine, adefovir, entecavir and telbivudine. Other drugs with activity against HBV, such as tenofovir and emtricitabine, are used for the treatment of HIV infection. In patients not requiring HAART, treatment of hepatitis B should preferably consist of drugs without activity against HIV, such as pegylated interferon or adefovir. In contrast, in patients requiring HAART, a combination of drugs with activity against both viruses should be used, such as lamivudine, emtricitabine and tenofovir, with the aim of achieving maximal viral suppression and avoiding the development of resistance. Patients with HIV/HBV coinfection require periodic clinical and virological monitoring. Patients with cirrhosis should undergo ultrasonography and alphafetoprotein determination every 6 months for the early detection of hepatocellular carcinoma.
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Affiliation(s)
- Pablo Barreiro
- Servicio de Enfermedades Infecciosas, Hospital Carlos III, Madrid, España
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Oliveira LCMD, Silva TED, Alves MH. [Response to hepatitis B vaccine in alcoholics without clinically evident liver cirrhosis]. ARQUIVOS DE GASTROENTEROLOGIA 2008; 44:195-200. [PMID: 18060270 DOI: 10.1590/s0004-28032007000300003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 01/24/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND Alcoholics have higher prevalence of hepatitis B virus (HBV) infection than non-alcoholics and such fact may influence in the development of liver cirrhosis and/or hepatocellular carcinoma. AIM To evaluate the response to hepatitis B vaccine in alcoholics without liver cirrhosis. METHODS Twenty male alcoholics with mean age of 46.6 +/- 10.9 years were vaccinated; they ingested more than 80 g of ethanol/day for more than 10 years. As control group 40 male non-alcoholics with mean age of 37.8 +/- 9.7 years were also vaccinated. No serological evidence of contact with HBV, hepatitis C virus or human immunodeficiency virus was found among the subjects of both groups. The vaccine Euvax B (20 microg) was administered intramuscularly into the deltoid area at 0, 1 and 6 months. Serum anti-HBs were determined after one month of the last dose. Levels <10 mUI/mL were considered as non-response, between 10 and 99 mUI/mL as seroconversion, and > or = 100 mUI/mL as seroprotection. RESULTS No significant difference was found between alcoholics and controls, respectively, in the frequency of non-response (35.0% vs 32.5%), seroconversion (15.0% vs 15.0%) and seroprotection (50.0% vs 52.5%). Among responders, mean levels of anti-HBs in alcoholics (511 +/- 448 mUI/mL) were similar to the controls (696 +/- 410 mUI/mL). No negative interference on the response was associated with the body mass index, tabagism, being drinking or concurrent chronic pancreatitis without pancreatic insufficiency. CONCLUSIONS Male alcoholics without liver cirrhosis had similar frequency and serum levels of anti-HBs to the non-alcoholics in response to HBV vaccination.
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Care of HIV patients with chronic hepatitis B: updated recommendations from the HIV-Hepatitis B Virus International Panel. AIDS 2008; 22:1399-410. [PMID: 18614862 DOI: 10.1097/qad.0b013e3282f8b46f] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nearly 10% of the estimated 36 million people having HIV worldwide suffer from chronic hepatitis B virus (HBV) infection. The advent of new antiviral agents against HBV and the recent availability of improved molecular diagnostic tools have revolutioned the management of HIV/HBV coinfected patients. The present study represents an update of the current knowledge about HBV/HIV coinfection and an intent to provide practical advise about how to give the best care to HIV-infected persons with chronic hepatitis B.
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Amouri A, Chtourou L, Mnif L, Tahri N. [Management of hepatitis B virus reactivation during chemotherapy or immunosuppressive therapy]. Presse Med 2008; 37:1591-8. [PMID: 18555638 DOI: 10.1016/j.lpm.2008.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 03/20/2008] [Accepted: 03/26/2008] [Indexed: 10/21/2022] Open
Abstract
Reactivation of viral hepatitis B is a well-known complication in patients receiving chemotherapy or immunosuppressive therapy; its incidence reaches 50%. This reactivation is associated with a high rate of morbidity and mortality. Prophylactic treatment of viral reactivation with lamivudine resulted in lowering the incidence of this risk and improving prognosis in recent studies. Patients with hematological malignancies and other cancers require a precise assessment of their hepatitis B status and adequate management. There is not yet a consensus about the appropriateness of prophylactic treatment of occult hepatitis B infection or of pretreatment virologic assessment, especially measurement of viral DNA.
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Affiliation(s)
- Ali Amouri
- Service de Gastro-Entérologie, EPS Hédi Chaker, Sfax, Tunisie.
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Mizrahi M, Lalazar G, Ben Ya’acov A, Livovsky DM, Horowitz Y, Zolotarov L, Adler R, Shouval D, Ilan Y. β-Glycoglycosphingolipid-induced augmentation of the anti-HBV immune response is associated with altered CD8 and NKT lymphocyte distribution: A novel adjuvant for HBV vaccination. Vaccine 2008; 26:2589-95. [DOI: 10.1016/j.vaccine.2008.03.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 02/26/2008] [Accepted: 03/12/2008] [Indexed: 01/12/2023]
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Lalazar G, Rund D, Shouval D. Screening, prevention and treatment of viral hepatitis B reactivation in patients with haematological malignancies. Br J Haematol 2007; 136:699-712. [PMID: 17338776 DOI: 10.1111/j.1365-2141.2006.06465.x] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The prevalence of hepatitis B virus (HBV) infection in patients with haematological malignancies is increased compared with the general population worldwide. HBV reactivation is common following chemotherapy and is associated with a high mortality despite prompt anti-viral treatment. HBV reactivation may necessitate interruption of chemotherapy with adverse prognostic consequences for the haematological disease. Chemotherapy-induced immune suppression may lead to increased HBV replication. Immune reconstitution within the weeks and months following recovery from chemotherapy may be associated with a flare of hepatitis B manifested by hepatocellular injury. Risk factors associated with HBV reactivation include detectable hepatitis B surface antigen (HBsAg), HBV DNA, Hepatitis B e (HBeAg) antigen, antibodies to hepatitis B core antigen (anti-HBc), treatment with corticosteroids, young age and male gender. Lamivudine is effective during HBV reactivation due to immune suppression. Clinical trials have demonstrated that pre-emptive antiviral treatment with lamivudine is superior to deferred treatment. Current recommendations emphasise screening for HBV infection in all haematology patients, particularly prior to chemotherapy. Patients who are HBsAg positive or HBV DNA positive should receive pre-emptive treatment with lamivudine before chemotherapy. The duration of lamivudine treatment may be prolonged commensurate with the degree of immunosuppression. HBV naïve patients should be immunised against hepatitis B, as should haematopoietic stem cell donors. In summary, overt and occult HBV pose a serious, but preventable, threat. Pre-treatment screening of patients at risk should be practiced diligently by all clinicians that treat patients with malignancies.
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Affiliation(s)
- Gadi Lalazar
- Liver Unit, Departments of Medicine, Hadassah-Hebrew University Hospital, Jerusalem, Israel
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Locquet C, Marande JL, Choudat D, Vidal-Trecan G. Hepatitis B vaccination in women healthcare workers: a seroepidemiological survey. Eur J Epidemiol 2007; 22:113-9. [PMID: 17295098 DOI: 10.1007/s10654-006-9094-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Accepted: 12/12/2006] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess the concentration and kinetics of antibody response after hepatitis B vaccination among women healthcare workers. DESIGN Longitudinal retrospective seroepidemiological survey among women vaccinated against hepatitis B working in a university hospital and followed-up in an occupational health department. A structured form was used to collect socio-demographic characteristics, clinical data, age at vaccination, vaccination schedule, measurement of antibodies to hepatitis B surface antigen (anti-HBs antibody). Subjects were considered seronegative against hepatitis B when anti-HBs antibody concentration was less than 10 mIU/ml. SETTING A 1260-bed general hospital in Paris, France. PARTICIPANTS All women healthcare workers visiting the occupational health department between January 1997 1st and December 2000 31st and who had a measurement of anti-HBs antibody. RESULTS Irrespective of the age at the primary vaccination, 810 (92%) women were seropositive (anti-HBs antibody > or = 10 mIU/ml). Only 22 women (4.5%) vaccinated before 26 years of age were seronegative, against 46 (13.2%) vaccinated after 25 years of age (p < 0.001). Seven years after vaccination, 78% of women were still seropositive. An inadequate vaccination schedule (adjusted hazard ratio (HR), 3.0; 95% confidence interval [CI], 1.6-5.5) and an age greater than 25 years at primary vaccination (HR, 2.6; 95% CI, 1.5-4.4) were associated with being seronegative against hepatitis B. CONCLUSIONS Despite vaccination, some women healthcare workers were seronegative against hepatitis B virus. Vaccinating early in the career of a health-care worker using an adequate schedule seems key-elements to guarantee an anti-HBs measurement > or =10 mIU/ml.
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Affiliation(s)
- C Locquet
- Service de Médecine du Travail, Faculté de Médecine, Université Paris Descartes, 45, rue des Saints-Pères, 75006, Paris, France.
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Jaffe D, Papadopoulos EB, Young JW, O'reilly RJ, Prockop S, Kernan NA, Jakubowski A, Boulad F, Perales MA, Castro-Malaspina H, Small TN. Immunogenicity of recombinant hepatitis B vaccine (rHBV) in recipients of unrelated or related allogeneic hematopoietic cell (HC) transplants. Blood 2006; 108:2470-5. [PMID: 16763208 PMCID: PMC1895570 DOI: 10.1182/blood-2006-04-006981] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 05/24/2006] [Indexed: 12/31/2022] Open
Abstract
Current European and US guidelines for recombinant hepatitis B vaccine (rHBV) after hematopoietic-cell transplantation (HCT) vary. The European Group for Blood and Marrow Transplantation (EBMT) recommends rHBV starting 6 to 12 months after HCT. Immunization is optional in the Centers for Disease Control and Prevention (CDC) guidelines. Nevertheless, rHBV is required for re-entry to school and certain workplaces. To determine the immunogenicity of rHBV following HCT, the prevaccine and postvaccine titers of 292 allogeneic transplant recipients who were immunized with rHBV were analyzed. Immunization was initiated in patients off immunosuppression who achieved specific minimal milestones of immune competence. Overall, 64% of patients seroconverted. In multivariate analyses, response was adversely affected by age older than 18 years (P < .01) and history of prior chronic graft-versus-host disease (GVHD; P < .001) but not by donor type or by use of T-cell depletion, adoptive immunotherapy, or rituximab. By comparison, 89% of rHBV nonresponders mounted a 3-fold or greater rise in polio titers following 3 doses of inactivated poliovirus. These data demonstrate that the rate of seroconversion following rHBV is lower in allogeneic HC transplant recipients compared with age-matched healthy controls. The data emphasize the need to document prevaccine and postvaccine titers to ensure response and suggest that immunization guidelines based on time interval from HCT, irrespective of immune competence, may not ensure adequate protection against certain vaccine-preventable diseases.
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Affiliation(s)
- Dana Jaffe
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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