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Markopoulos P, Karmiris K, Dimas I, Voudoukis E, Siakavellas S, Axiaris G, Zacharopoulou E, Zampeli E, Tsironi E, Tzouvala M, Papatheodoridis G, Bamias G. Efficacy of Vaccination and Revaccination Against Hepatitis B Virus Using 2 Different Strategies in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2024:izae173. [PMID: 39102755 DOI: 10.1093/ibd/izae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) exhibit an increased risk for acquiring hepatitis B virus (HBV), thus they should be vaccinated preferably, if not already infected or immunized. We assessed the efficacy of HBV vaccination in IBD patients and impact of different factors on the immune response. We also evaluated the success rate of 2 different revaccination strategies in the nonresponders. METHODS This was a retrospective observational cohort study carried out in 5 tertiary centers. All patients were tested for hepatitis B surface antigen, antibodies against hepatitis B surface antigen (anti-HBs), and antibodies against hepatitis B core antigen. Patients tested negative and underwent the standard schedule with 20 µg at 0, 1, and 6 months. Nonresponders (anti-HBs <10 IU/L) were offered a revaccination scheme with either 3 doses of 40 µg at 0, 1, and 6 months or an accelerated scheme with 20 µg at 0, 1, and 2 months. RESULTS A total of 409 patients were included, and 273 (66.7%) of those (females: 49.5%; Crohn's disease [CD]: 56.7%) responded to baseline vaccination. A total of 189 (69.2%) of 273 (females: 48.1%; CD: 60.3%) developed anti-HBs >100 IU/L. Body mass index <30 kg/m2 (P = .017) was positively associated, while diagnosis of CD (P = .013), extensive UC (P <.0001), extraintestinal manifestations (P = .001), and treatment with immunomodulators/anti-tumor necrosis factor (P < .00) negatively affected the response. Revaccination was offered to 103 patients, and 58.3% of them achieved anti-HBs >10 IU/L. Both revaccination strategies were equally effective. CONCLUSIONS IBD patients demonstrate lower response to HBV vaccination compared with the general population. Age, body mass index, type, disease activity, and immunosuppression negatively affect the response. Half of nonresponders may benefit from an enhanced revaccination attempt.
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Affiliation(s)
| | | | - Ioannis Dimas
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - Evangelos Voudoukis
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - Spyridon Siakavellas
- Department of Gastroenterology, General Hospital of Athens LAIKO, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Axiaris
- Department of Gastroenterology, Alexandra General Hospital, Athens, Greece
| | - Eirini Zacharopoulou
- Department of Gastroenterology, Agios Panteleimon General Hospital, Nikaia, Piraeus - Agia Varvara General Hospital of Western Attica, Athens, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology, Alexandra General Hospital, Athens, Greece
| | - Eftychia Tsironi
- Department of Gastroenterology, Metaxa Memorial Cancer Hospital, Piraeus, Greece
| | - Maria Tzouvala
- Department of Gastroenterology, Agios Panteleimon General Hospital, Nikaia, Piraeus - Agia Varvara General Hospital of Western Attica, Athens, Greece
| | - Georgios Papatheodoridis
- Department of Gastroenterology, General Hospital of Athens LAIKO, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Bamias
- Department of Gastroenterology, General Hospital of Athens LAIKO, Medical School of National and Kapodistrian University of Athens, Athens, Greece
- GI Unit, 3rd Department of Internal Medicine, Sotiria General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
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Karime C, Black CN, Cortes P, Kwon JY, Caldera F, Crosby SK, Picco MF, Kinnucan JA, Hashash JG, Farraye FA. Utility of a Third Heplisav-B Dose in Patients With Inflammatory Bowel Disease Without Immunity After 2-Dose Heplisav-B Vaccination. Am J Gastroenterol 2024:00000434-990000000-01157. [PMID: 38717045 DOI: 10.14309/ajg.0000000000002863] [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: 02/20/2024] [Accepted: 04/24/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Hepatitis B virus (HBV) vaccination is recommended in patients with inflammatory bowel disease (IBD). Although the 2-dose Heplisav-B vaccine has proven effective, more than 20% of patients with IBD do not seroconvert. We prospectively evaluated the effectiveness of a third Heplisav-B dose in patients with IBD lacking HBV immunity despite 2-dose vaccination. METHODS Adults with IBD who had received 2-dose Heplisav-B vaccination between 2018 and 2023 were identified. Seroconversion was defined as hepatitis B surface antibody (HBsAb) ≥ 10 IU/L measured at ≥4 weeks after vaccination. Patients who did not seroconvert were prospectively offered a third Heplisav-B dose, followed by repeat HBsAb measurement. Demographic, clinical, medication, and vaccination data were compared between those who did and did not seroconvert. RESULTS Of 192 patients identified, 71.9% (138/192) seroconverted after 2-dose Heplisav-B vaccination. The 54 patients (28.1%) who did not seroconvert were more likely to be male, have diabetes, chronic kidney disease, or elevated Charlson Comorbidity Index. Of the 54 patients, 30 (55.6%) elected to receive a third Heplisav-B dose, with 56.7% (17/30) achieving seroconversion (median HBsAb titer 376 IU/L, IQR 47-1,000 IU/L) despite a median intervaccination time of 416 days (IQR 90.8-667.8). No differences were noted between patients who did vs did not seroconvert after third-dose vaccination. DISCUSSION In patients with IBD lacking HBV immunity despite 2-dose Heplisav-B vaccination, administration of a third dose resulted in a 56.7% seroconversion rate. Our results suggest that administration of an additional Heplisav-B dose may be an effective strategy in patients lacking immunity despite primary 2-dose vaccination.
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Affiliation(s)
- Christian Karime
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Cecily N Black
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Pedro Cortes
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Joshua Y Kwon
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Freddy Caldera
- Division of Gastroenterology & Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sheena K Crosby
- Department of Pharmacy, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael F Picco
- Inflammatory Bowel Disease Centre, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jami A Kinnucan
- Inflammatory Bowel Disease Centre, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jana G Hashash
- Inflammatory Bowel Disease Centre, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Francis A Farraye
- Inflammatory Bowel Disease Centre, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Karime C, Hashash JG, Farraye FA. Measuring of Postvaccination Hepatitis B Titers in Patients With Inflammatory Bowel Disease: Thoughts for Further Investigation. Clin Gastroenterol Hepatol 2024; 22:201-202. [PMID: 37187325 DOI: 10.1016/j.cgh.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Christian Karime
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Jana G Hashash
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Kerr MD, Johnson WT, McBride DA, Chumber AK, Shah NJ. Biodegradable scaffolds for enhancing vaccine delivery. Bioeng Transl Med 2023; 8:e10591. [PMID: 38023723 PMCID: PMC10658593 DOI: 10.1002/btm2.10591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023] Open
Abstract
Sustained release of vaccine components is a potential method to boost efficacy compared with traditional bolus injection. Here, we show that a biodegradable hyaluronic acid (HA)-scaffold, termed HA cryogel, mediates sustained antigen and adjuvant release in vivo leading to a durable immune response. Delivery from subcutaneously injected HA cryogels was assessed and a formulation which enhanced the immune response while minimizing the inflammation associated with the foreign body response was identified, termed CpG-OVA-HAC2. Dose escalation studies with CpG-OVA-HAC2 demonstrated that both the antibody and T cell responses were dose-dependent and influenced by the competency of neutrophils to perform oxidative burst. In immunodeficient post-hematopoietic stem cell transplanted mice, immunization with CpG-OVA-HAC2 elicited a strong antibody response, three orders of magnitude higher than dose-matched bolus injection. In a melanoma model, CpG-OVA-HAC2 induced dose-responsive prophylactic protection, slowing the tumor growth rate and enhancing overall survival. Upon rechallenge, none of the mice developed new tumors suggesting the development of robust immunological memory and long-lasting protection against repeat infections. CpG-OVA-HAC2 also enhanced survival in mice with established tumors. The results from this work support the potential for CpG-OVA-HAC2 to enhance vaccine delivery.
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Affiliation(s)
- Matthew D. Kerr
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Chemical Engineering ProgramUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Wade T. Johnson
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - David A. McBride
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Chemical Engineering ProgramUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Arun K. Chumber
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Chemical Engineering ProgramUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Nisarg J. Shah
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Chemical Engineering ProgramUniversity of California San DiegoLa JollaCaliforniaUSA
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