1
|
Sperle I, Lassen SG, Schlaud M, Dörre A, Dudareva S, Poethko-Müller C, Harder T. Prevalence of vaccine-derived hepatitis B surface antibodies in children and adolescents in Germany: results from a population-based survey, 2014-2017. BMC Infect Dis 2024; 24:318. [PMID: 38491438 PMCID: PMC10941582 DOI: 10.1186/s12879-024-09201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION Childhood vaccination against hepatitis B has been recommended in Germany since 1995. WHO defines a primary vaccination series as successful if the initial hepatitis B surface antibody (anti-HBs) level is ≥ 10 IU/L directly after vaccination. Anti-HBs levels vary depending on the number of doses, type of vaccine, and time interval between the last two doses. In 2021, Germany began to recommend three instead of four doses of polyvalent hepatitis-B-containing vaccines. Our aim was to estimate the proportion of vaccinated children in Germany with anti-HBs levels < 10 IU/L, 10-99 IU/L, and ≥ 100 IU/L by number and type of vaccine, and assess if number of doses and compliance with recommended time interval between the last two doses are associated with an anti-HBs level ≥ 10 IU/L when considering type of vaccine and time since last dose. METHODS We used data from a national cross-sectional study (2014-2017) of children (3-17 years). We excluded participants with unknown vaccination dates, unreadable or incomplete vaccination cards, and hepatitis B virus (HBV)-positive participants. We defined a recommended schedule as a vaccination series with at least six months between the two last doses and having three doses or more. We calculated weighted anti-HBs sero-prevalence for three anti-HBs levels: < 10 IU/L, 10-99 IU/L and ≥ 100 IU/L. We fitted two logistic regression models to examine the relationship between number of doses and recommended schedule on anti-HBs levels (≥ 10 IU/L and ≥ 100 IU/L) considering time since last dose and type of vaccine (Infanrix, Hexavac, Monovalent). RESULTS We included 2,489 participants. The weighted proportion of vaccinated children per anti-HBs level was < 10 IU/L: 36.3% [95%CI 34.0-38.7%], 10-99 IU/L: 35.7% [33.2-38.2%] and ≥ 100 IU/L: 28.0% [25.9-30.2%]. We did not find an association between a recommended schedule of three versus four doses and anti-HBs ≥ 10 IU/L or ≥ 100 IU/L. CONCLUSIONS Anti-HBs levels in later childhood were about equal, whether children received three or four doses. This implies that the change in the recommendations does not affect the anti-HBs level among children in Germany. Future studies are needed on the association of anti-HBs levels and adequate sustained protection against HBV.
Collapse
Affiliation(s)
- Ida Sperle
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Sofie Gillesberg Lassen
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- PhD Programme, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Schlaud
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Sandra Dudareva
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Thomas Harder
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
2
|
Muwanda F, Sendagire H, Mboowa G, Kateete DP, Achan B, Mupere E, Kafeero HM, Bagaya BS. A systematic review reveals that African children of 15-17 years demonstrate low hepatitis B vaccine seroprotection rates. Sci Rep 2023; 13:22182. [PMID: 38092870 PMCID: PMC10719251 DOI: 10.1038/s41598-023-49674-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/11/2023] [Indexed: 12/17/2023] Open
Abstract
Childhood HBV immunization remains globally fundamental to the elimination of hepatitis B virus (HBV). However, monitoring proportions of HBV vaccine seroprotection and their determinants among African Pediatric recipients is crucial. This study sought to verify extent of immune protection accorded by the HBV vaccine in African children of up to 17 years of age by pooling the prevalence of seroprotection reported by primary studies conducted in the Northern, Western, and Southern African regions. We included 19 eligible articles out of the 197 initially downloaded, published from 1999 to 2021 from African Journals Online (AJOL), EMBASE, Scopus, and PubMed. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), University of York Centre for Reviews and Dissemination, under the registration number CRD42022361277. Significantly higher (p < 0.0001) proportion of HBV vaccine seroprotection (69.07%) was found among children under 15 years of age than children 15-17 years (32.368%), 95% CI [34.2454-39.0847%]. Whereas successful integration of the HBV vaccine on the extended programs on immunizations (EPI) has been a major achievement in the reduction of HBV infection in Africa, markedly reduced HBV vaccine seroprotection is persistently demonstrated among adolescent children 15-17 years of age. Future studies are required to clarify the need for booster dose vaccination in most at risk populations and age groups.
Collapse
Affiliation(s)
- Fahad Muwanda
- Department of Medical Microbiology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, P.O. Box 7689, Kampala, Uganda.
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Hakim Sendagire
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Gerald Mboowa
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
- The African Center of Excellence in Bioinformatics and Data-Intensive Sciences, Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Beatrice Achan
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Hussein Mukasa Kafeero
- Department of Medical Microbiology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, P.O. Box 7689, Kampala, Uganda
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Bernard Ssentalo Bagaya
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| |
Collapse
|
3
|
Romanò L, Tosti ME, Zanetti AR. Beyond 30 years of universal anti-hepatitis B vaccination in Italy: Success and areas of improvement. Vaccine 2022; 40:5542-5543. [PMID: 36008234 DOI: 10.1016/j.vaccine.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Luisa Romanò
- Dipartimento di Scienze Biomediche per la salute, Università degli Studi di Milano, Milano, Italy.
| | - Maria Elena Tosti
- Centro Nazionale per la Salute Globale, Istituto Superiore di Sanità, Roma, Italy
| | - Alessandro R Zanetti
- Dipartimento di Scienze Biomediche per la salute, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
4
|
Lingawi HS, Afifi IK. Seroprotection of Hepatitis B Vaccine in Dental Students Two Decades after Infant Immunization and the Possible Need for Revaccination. Eur J Dent 2022; 17:143-149. [PMID: 35436788 PMCID: PMC9949927 DOI: 10.1055/s-0042-1743151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study aimed to assess hepatitis B surface antibody (anti-HBs) persistence among dental students two decades after infant vaccination and immune response after revaccination or booster dose in nonimmune groups. MATERIALS AND METHODS A cross-sectional study was performed using laboratory reports for anti-HBs performed to dental students at the Umm al-Qura University from 2016 to 2020. Reports were classified according to baseline antibody titer into group I (titer <10 mIU/mL), group II (titer 10 to <100 mIU/mL), and group III (titer ≥100 mIU/mL). The basal antibody titer of each group was correlated to student's gender and birth year and compared with postrevaccination or booster dose titer in groups I and II. STATISTICAL ANALYSIS Data of baseline and postrevaccination anti-HBs antibody titers were analyzed using Statistical Package for Social Science (SPSS). One-way ANOVA was used to compare between different means for antibody titers of students as well as baseline and postrevaccination antibody levels for nonimmune students with nonprotective antibody titers. Pairwise multiple comparison of the difference between baseline and postrevaccination anti-HBs antibody titers were done by post hoc Tukey's honestly significant difference (HSD) test. Chi-squared test was used for comparing between the frequencies. A p-Value of ≤0.05 was considered significant and p < 0.01 was considered highly significant. RESULTS A significant percentage (73.6%) of students had antibody titer <10 mIU/mL, while only 4.8% had antibody titer ≥100 mIU/mL with nonsignificant difference between both genders (χ 2 =3.784, p = 0.151). A statistically nonsignificant difference was also found between the three categories of anti-HBs antibody titers among students with different birth dates (χ 2 = 13.817, p = 0.182). After revaccination of nonimmune students, 100% of them showed strongly protective antibody titers with mean of 842.88 to 844.58 mIU/mL. A highly significant difference was observed between the mean baseline and postrevaccination antibody titers in both genders, with a higher mean of post revaccination (p = 0.000). CONCLUSION Two decades after infant immunization, a significant percentage of dental students failed to maintain the anti-HBs seroprotective titer. So titer measurement should be made compulsory before they begin their clinical training and revaccination or booster dose should be given to nonimmune students to maintain a high protection level.
Collapse
Affiliation(s)
- Hanadi S. Lingawi
- Preventive Dentistry Department, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia,Address for correspondence Hanadi S. Lingawi, PhD Preventive Dentistry Department, Faculty of Dentistry, Umm Al-Qura UniversityP.O. Box 14405, Makkah 22915Saudi Arabia
| | - Ibtesam K. Afifi
- Basic and Clinical Oral Sciences Department, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia,Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt
| |
Collapse
|
5
|
AlAteeq MA, AlEnazi LM, AlShammari MS, AlAnazi EE, Al-Hababi FH, Alateeq AM. Long-term Immunity Against Hepatitis B Virus After Routine Immunization Among Adults Visiting Primary Care Centers in Riyadh, Saudi Arabia. Cureus 2022; 14:e21266. [PMID: 35178320 PMCID: PMC8842465 DOI: 10.7759/cureus.21266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to determine the persistence of induced immunity against hepatitis B virus (HBV) among adults routinely vaccinated during their infancy and correlate the level of induced immunity with participant characteristics. Methodology This was a cross-sectional study conducted among visitors to primary care centers of the Ministry of Health (MOH) in Riyadh, the Kingdom of Saudi Arabia (KSA) during the period from August 2020 to January 2021. The study population included healthy adults of both genders who had received full doses of the HBV vaccine in infancy. Data related to participant characteristics were collected using a self-administered questionnaire. A blood sample was then taken from each participant to measure the serum level of hepatitis B surface antigen (HBsAg), antibodies against HBsAg (anti-HBs), and antibodies against hepatitis B core antigen (ani-HBc). Results A total of 400 subjects participated in the study; the mean age of the cohort was 25 years. Almost all of them were Saudis (99.30%), and more than half (57.50%) were males. Only 24.30% had an anti-HBs antibodies level of ≥10 IU/L, and all respondents were negative for HBs antigen. No significant association between participant characteristics and anti-HBs antibody levels was found. Conclusion A decline in immunity many years after HBV vaccinations taken in infancy has been well-documented. However, for low-risk populations, the boosting of HBV vaccines is probably unnecessary since the immune memory provides sufficient protection despite low or undetectable anti-HBs antibodies.
Collapse
Affiliation(s)
- Mohammed A AlAteeq
- Family Medicine Department, Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Latifa M AlEnazi
- Academy for Postgraduate Studies in Family Medicine, King Saud Medical City, Ministry of Health, Riyadh, SAU
| | - Modhi S AlShammari
- Family Medicine Residency Training Program, Ministry of Health, AlJouf, SAU
| | - Essa E AlAnazi
- Microbiology Department, Regional Laboratory, Ministry of Health, Riyadh, SAU
| | - Fadel H Al-Hababi
- Microbiology Department, Regional Laboratory, Ministry of Health, Riyadh, SAU
| | - Abdulrahman M Alateeq
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| |
Collapse
|
6
|
Steffen G, Sperle I, Harder T, Sarma N, Beermann S, Thamm R, Bremer V, Zimmermann R, Dudareva S. Hepatitis B vaccination coverage in Germany: systematic review. BMC Infect Dis 2021; 21:817. [PMID: 34391406 PMCID: PMC8364709 DOI: 10.1186/s12879-021-06400-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite being considered as a low prevalence country for hepatitis B (HBV), some populations in Germany are at higher risk of infection. In the context of the World Health Organization's (WHO) viral hepatitis elimination goals, a valid epidemiological data base is needed to plan and monitor the national response. Prevention strategies include general and targeted HBV vaccination programmes. OBJECTIVE The aim of this work was to estimate the HBV vaccination coverage (VC) in the general population (GP) and different population groups in Germany from available evidence and to identify current evidence gaps for future research. METHODS We conducted a systematic review on HBV VC in the general population and populations at high risk of HBV exposure or severe infection in Germany. We included eligible publications (01/01/2017 to 06/06/2020) from databases Embase, Pubmed and Livivo, from a previous scoping review (including data published 01/01/2005-17/03/2017), from the national surveillance system and screened the reference lists of all publications at full text level. Risk of bias was assessed using the Hoy et al. tool. RESULTS We included 68 publications of 67 studies and assigned them to one or more suitable population groups. Twenty-one studies contained data among children/adolescents and three among adults from the GP (VC 65.8-90.5% and 22.9-52.1%, respectively), one among travelers (VC 89.0%), 13 among immunocompromised populations (VC 7.8-89.0%), 16 among populations with occupational risk and 16 with non-occupational risk of HBV exposure (VC 63.6-96.5% and 4.4-84.5%, respectively). CONCLUSION Comprehensive evidence at low risk of bias was identified for children/adolescents. However, 25 years after including HBV in the national immunisation schedule, VC in Germany is still below the 95%-goal defined by WHO. For people at occupational risk of HBV exposure, VC was mostly reported to be over the WHO goal of 80%, but quality of evidence was heterogenous and should be improved. For people at non-occupational risk of HBV exposure, evidence was sparse and of low quality. The low VC highlights the need for future research to plan vaccination programmes targeting these populations.
Collapse
Affiliation(s)
- Gyde Steffen
- Department of Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany.
- Translational Epidemiology of DZIF, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Ida Sperle
- Department of Infectious Disease Epidemiology, Unit for Gastrointestinal Infections, Zoonoses and Tropical Infections, Robert Koch Institute, Berlin, Germany
| | - Thomas Harder
- Department of Infectious Disease Epidemiology, Immunisation Unit, Robert Koch Institute, Berlin, Germany
| | - Navina Sarma
- Department of Infectious Disease Epidemiology, Unit for Crisis Management, Outbreak Investigations and Training Programmes, Focal Point for the Public Health Service, Robert Koch Institute, Berlin, Germany
| | - Sandra Beermann
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Roma Thamm
- Department of Epidemiology and Health Monitoring, Unit for Physical Health, Robert Koch Institute, Berlin, Germany
| | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Ruth Zimmermann
- Department of Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| | - Sandra Dudareva
- Department of Infectious Disease Epidemiology, Unit for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
7
|
The positive rates of hepatitis B surface antibody in youths after booster vaccination: a 4-year follow-up study with large sample. Biosci Rep 2021; 41:229067. [PMID: 34151935 PMCID: PMC8415346 DOI: 10.1042/bsr20210182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is still a public issue of the world. Hepatitis B vaccination is widely used as an effective measure to prevent HBV infection. This large-sample study aimed to evaluate the positive rates of hepatitis B surface antibody (anti-HBs) in youths after booster vaccination. METHODS A total of 37,788 participants were divided into two groups according to the baseline levels of anti-HBs before booster vaccination: the negative group (anti-HBs (-)); the positive group (anti-HBs (+)). Participants were tested for anti-HBs levels after receiving a booster vaccine 1 year and 4 years. RESULTS The positive rates of anti-HBs were 34.50%, 73.8% and 67.32% before booster vaccination at 1 year and 4 years after vaccination, respectively. At four years after the booster vaccination, the positive rates of 13 to 18 years were 47.54%, which was the lowest level among all youths age groups. In the anti-HBs (-) group, the positive conversion rates of anti-HBs were 74.62% at 1 year after receiving a booster vaccine, and 67.66% at 4 years after vaccination. In the anti-HBs (+) group, the positive maintenance rates of anti-HBs were 70.16% after 1 year, and 66.66% after 4 years. Compared with the baseline anti-HBs (+) group, the positive rates of the baseline anti-HBs (-) group were higher at 1 year and 4 years after receiving the booster vaccine. CONCLUSIONS The positive rates of anti-HBs declined over time, especially the positive maintenance rates were the lowest at age of 13 to 18 years.
Collapse
|
8
|
Ritscher AM, LeClair-Netzel M, Friedlander NJ, Howard Stewart DN, Wagner M, Kalscheur N, Caldera F, Hayney MS. Cross-sectional study of hepatitis B antibody status in health care workers immunized as children at an academic medical center in Wisconsin. Vaccine 2020; 38:1597-1600. [PMID: 31955961 DOI: 10.1016/j.vaccine.2019.12.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/10/2019] [Accepted: 12/14/2019] [Indexed: 11/25/2022]
Abstract
Individuals who received the hepatitis B vaccine series as young children are entering the healthcare workforce. Our study measured the persistence of antibody to the hepatitis B surface antigen (anti-HBs) at time of employment. Among 986 individuals born in 1991 or more recently with documentation of completion of the hepatitis B vaccine series, 51% had anti-HBs < 10mIU/ml. Of these 507 healthcare workers, 446 (88%) received documented fourth dose of hepatitis B vaccine followed by another anti-HBs ≥ 28 days post vaccination; 11% (50/446 or 5% of the total population) did not mount an anamnestic response. The non-responders were more likely to be male or complete the vaccine series prior to age 7 months. Measuring anti-HBs at the time of hire in this population of healthcare workers who had documentation of hepatitis B series completion as young children may be unnecessary because of the high rate of hepatitis B vaccine protection.
Collapse
Affiliation(s)
- Alicia M Ritscher
- School of Pharmacy, University of Wisconsin - Madison. Madison, WI, United States
| | | | | | | | - Mallory Wagner
- Employee Health Services, UW Health, Madison, WI, United States.
| | - Nicole Kalscheur
- Employee Health Services, UW Health, Madison, WI, United States.
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine & Public Health, Madison, WI, United States.
| | - Mary S Hayney
- School of Pharmacy, University of Wisconsin - Madison. Madison, WI, United States.
| |
Collapse
|
9
|
Verso MG, Costantino C, Vitale F, Amodio E. Immunization against Hepatitis B Surface Antigen (HBsAg) in a Cohort of Nursing Students Two Decades after Vaccination: Surprising Feedback. Vaccines (Basel) 2019; 8:vaccines8010001. [PMID: 31861551 PMCID: PMC7157657 DOI: 10.3390/vaccines8010001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022] Open
Abstract
Health-care students can be exposed to biological risks during university training. The persistence of long-term immunogenicity against hepatitis B virus (HBV) was analyzed in a cohort of nursing students two decades after primary vaccination. A total of 520 students were enrolled at the University of Palermo and were evaluated for levels of anti-HBsAg antibodies. The students were examined during the first year of their Degree Course and were checked two years later. All students with anti-HBsAg <10 mIU/mL during their first or third year were boosted within one month. The proportion of students that were vaccinated during adolescence showing anti-HBsAg ≥10 mIU/mL was higher than that observed in students who were vaccinated during infancy (69% versus 31.7%; p-value < 0.001). Receiving HBV vaccination at adolescence was significantly associated with a fourfold increased possibility of having anti-HBsAg titers ≥10 mIU/mL (adj-OR = 4.21, 95% CI: 2.43–7.30). Among the students who were checked at the third year and boosted after the first year (n = 279), those who were vaccinated during infancy showed a higher percentage of antibody titers <10 mIU/mL (20.3% versus 8.7% among vaccinated during adolescence; p < 0.01). This study confirms that HBV vaccination at adolescence might determine a higher long-term persistence of anti-HBsAg titers ≥10 mIU/mL and that anti-HBV booster could increase levels of anti-HBsAg over a relatively short period, especially in subjects who were vaccinated during infancy.
Collapse
Affiliation(s)
- Maria Gabriella Verso
- Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Occupational Health Unit, University of Palermo, Piazza Marina, 61, 90133 Palermo, PA, Italy
- Correspondence: ; Tel.: +39-368-396-7350
| | - Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Section of Hygiene, University of Palermo, Piazza Marina, 61, 90133 Palermo, PA, Italy; (C.C.); (F.V.); (E.A.)
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Section of Hygiene, University of Palermo, Piazza Marina, 61, 90133 Palermo, PA, Italy; (C.C.); (F.V.); (E.A.)
| | - Emanuele Amodio
- Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, Section of Hygiene, University of Palermo, Piazza Marina, 61, 90133 Palermo, PA, Italy; (C.C.); (F.V.); (E.A.)
| |
Collapse
|
10
|
Prevalence, incidence and residual risk of transfusion-transmitted hepatitis B virus infection in Italy from 2009 to 2018. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:409-417. [PMID: 31846606 DOI: 10.2450/2019.0245-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND In Italy, the use of nucleic acid testing for hepatitis B virus (HBV) in donor screening has allowed the detection of infections in the window phase, as well as the presence of occult infections which could potentially be transmitted. The aim of this study was to analyse the trends of epidemiological data focused on HBV infection in blood donors and to estimate the residual risk of transmitting HBV from both the window phase and occult infection over a 10-year period in Italy. MATERIALS AND METHODS Data were obtained from the Italian Haemovigilance System which includes the results of screening tests for transfusion transmissible infections. During the period of this survey (2009-2018), the molecular methods used for HBV screening were transcription-mediated amplification and polymerase chain reaction tests. Prevalence and incidence were calculated. The residual risk was estimated by applying the incidence-window period model for acute cases and a more recently reported model for estimating the risk due to occult infections. RESULTS A total of 17,424,535 blood donors and 30,842,794 donations were tested for HBV. Altogether, 6,250 donors tested positive for HBV markers: 4,782 (175.6×105) were first time donors and 1,468 (10.0×105) were repeat donors. The prevalence of HBV markers in first time donors was 275.9×105 in 2009, declining to 143.6×105 in 2018. The incidence of new infections was 3.37×105 in 2009 and 2.17×105 in 2018. The overall residual risk for HBV amounted to 1 in 2,566,854 donations calculated as the sum of risks of both acute infections in the window period (1 in 5,835,306 donations) and occult infections (1 in 4,582,270 blood units). DISCUSSION In Italy, the residual risk of transfusing a blood unit infected with HBV, both from window phase and occult infections, is currently very low, amounting to levels that can be considered tolerable.
Collapse
|
11
|
STEFANATI A, BOLOGNESI N, SANDRI F, DINI G, MASSA E, MONTECUCCO A, LUPI S, GABUTTI G. Long-term persistency of hepatitis B immunity: an observational cross-sectional study on medical students and resident doctors. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E184-E190. [PMID: 31650052 PMCID: PMC6797890 DOI: 10.15167/2421-4248/jpmh2019.60.3.1315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/29/2019] [Indexed: 12/14/2022]
Abstract
Hepatitis B virus (HBV) is a main cause of chronic and acute hepatitis. Healthcare workers (HCWs), including medical students and resident doctors, have an occupational risk of HBV infection. The study aimed to evaluate the long-term persistence of protective anti-HBs antibody levels in healthcare students and resident doctors at risk for occupational exposure to HBV at 15 years after primary vaccination course. Further objective was to evaluate the anamnestic response observed in non-seroprotected subjects receiving a booster dose. Data were collected from the clinical documentation filled in during the occupational medical check of medical students and resident doctors undergoing Occupational Health Surveillance by the University of Ferrara. Of the 621 included individuals, 27.7% had an anti-HBs concentration < 10 mIU/mL. Subjects vaccinated during infancy had more frequently a concentration < 10 mIU/mL than those vaccinated during adolescence (42.7% vs 6.9%; p-value < 0.001). Multivariate analysis confirmed the statistical significance of the vaccination age. 94 subjects who had an anti-HBs concentration < 10 mIU/mL received a booster dose. The proportion of subjects who had an anamnestic response was higher in those vaccinated in infancy rather than during adolescence (94.1% vs 77.8% respectively). These findings suggest that the anti-HBs concentration decreases below 10 mIU/mL more frequently in subjects vaccinated during infancy. Immunological memory seems to persist after the decline of the anti-HB titer, as observed in response to a booster dose. In conclusion, vaccinated subjects at increased risk of HBV infection should be monitored and a booster dose administered if anti-HBs titer is below 10 mIU/mL.
Collapse
Affiliation(s)
- A. STEFANATI
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Correspondence: Armando Stefanati, University of Ferrara, Department of Medical Sciences, via Fossato di Mortara 64b, 44121 Ferrara, Italy - Tel. +39 0532 455569 - Fax. +39 0532 205066 - E-mail:
| | - N. BOLOGNESI
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - F. SANDRI
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Ferrara, Italy
| | - G. DINI
- Postgraduate School of Occupational Medicine, Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital of Genoa, Italy
| | - E. MASSA
- Postgraduate School of Occupational Medicine, Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital of Genoa, Italy
| | - A. MONTECUCCO
- Postgraduate School of Occupational Medicine, Department of Health Sciences, University of Genoa, Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital of Genoa, Italy
| | - S. LUPI
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - G. GABUTTI
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| |
Collapse
|
12
|
Zhao YL, Han BH, Zhang XJ, Pan LL, Zhou HS, Gao Z, Hao ZY, Wu ZW, Ma TL, Wang F, Li Q, Bi SL, Ma JC. Immune persistence 17 to 20 years after primary vaccination with recombination hepatitis B vaccine (CHO) and the effect of booster dose vaccination. BMC Infect Dis 2019; 19:482. [PMID: 31146699 PMCID: PMC6543564 DOI: 10.1186/s12879-019-4134-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/27/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND To assess the immune persistence conferred by a Chinese hamster ovary (CHO)-derived hepatitis B vaccine (HepB) 17 to 20 years after primary immunization during early life. METHODS Participants born between 1997 and 1999 who received a full course of primary vaccination with HepB (CHO) and who had no experience with booster vaccination were enrolled. Blood samples were required from each participant for measurement of hepatitis B surface antibody (anti-HBs), surface antigen and core antibody levels. For those who possessed an anti-HBs antibody < 10 mIU/mL, a single dose of HepB was administered, and 30 days later, serum specimens were collected to assess the booster effects. RESULTS A total of 1352 participants were included in this study. Of these, 1007 (74.5%) participants could retain an anti-HBs antibody ≥10 mIU/mL, with a geometric mean concentration (GMC) of 57.4 mIU/mL. HBsAg was detected in six participants, resulting in a HBsAg carrier rate of 0.4% (6/1352). Of those participants with anti-HBs antibodies < 10 mIU/mL, after a challenge dose, 231 (93.1%) presented an anti-HBs antibody ≥10 mIU/mL, with a GMC of 368.7 mIU/mL. A significant increase in the anti-HBs positive rate (≥ 10 mIU/mL) after challenge was observed in participants with anti-HBs antibodies between 2.5 and 10 mIU/mL and participants boosted with HepB (CHO), rather than those with anti-HBs antibodies < 2.5 mIU/mL and those boosted with HepB (SC). CONCLUSION Since satisfactory immune protection against HBV infection conferred by primary vaccination administered 17-20 years ago was demonstrated, there is currently no urgent need for booster immunization.
Collapse
Affiliation(s)
- Yu-Liang Zhao
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, 97 Huai'an East Road, Yuhua District, Shijiazhuang, 050021, Hebei Province, People's Republic of China.
| | - Bi-Hua Han
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, 97 Huai'an East Road, Yuhua District, Shijiazhuang, 050021, Hebei Province, People's Republic of China
| | - Xin-Jiang Zhang
- Zhengding County Center for Disease Control and Prevention, Zhengding, 050800, People's Republic of China
| | - Lu-Lu Pan
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, 97 Huai'an East Road, Yuhua District, Shijiazhuang, 050021, Hebei Province, People's Republic of China
| | - Hai-Song Zhou
- Zhengding County Center for Disease Control and Prevention, Zhengding, 050800, People's Republic of China
| | - Zhao Gao
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, 97 Huai'an East Road, Yuhua District, Shijiazhuang, 050021, Hebei Province, People's Republic of China
| | - Zhi-Yong Hao
- Zhengding County Center for Disease Control and Prevention, Zhengding, 050800, People's Republic of China
| | - Zhi-Wei Wu
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, 97 Huai'an East Road, Yuhua District, Shijiazhuang, 050021, Hebei Province, People's Republic of China
| | - Tian-Li Ma
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, 97 Huai'an East Road, Yuhua District, Shijiazhuang, 050021, Hebei Province, People's Republic of China
| | - Feng Wang
- Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Changing District, Beijing, 100052, People's Republic of China
| | - Qi Li
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, 97 Huai'an East Road, Yuhua District, Shijiazhuang, 050021, Hebei Province, People's Republic of China
| | - Sheng-Li Bi
- Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Changing District, Beijing, 100052, People's Republic of China
| | - Jing-Chen Ma
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, 97 Huai'an East Road, Yuhua District, Shijiazhuang, 050021, Hebei Province, People's Republic of China
| |
Collapse
|