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Kramvis A, Mammas IN, Spandidos DA. Exploring the optimal vaccination strategy against hepatitis B virus in childhood (Review). Biomed Rep 2023; 19:48. [PMID: 37383679 PMCID: PMC10293880 DOI: 10.3892/br.2023.1631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023] Open
Abstract
Vaccination against hepatitis B virus (HBV) remains the most effective strategy against HBV infection in humans. The present review summarized the optimal vaccination strategies against HBV in childhood. The following points are discussed: i) When and how the first HBV vaccines were developed; ii) the dosages, schedules and injection routes that are used for HBV vaccination; iii) the contraindications for HBV vaccination in the general paediatric population; iv) the challenges with the use of multivalent vaccines; v) the long-term immunogenicity and duration of protection against HBV; vi) the use of selective HBV vaccination and the hepatitis B immune globulin strategy in HBV-exposed infants; and vii) the effectiveness of the current HBV vaccination schemes. The present review is based on a Paediatric Virology Study Group (PVSG) webinar performed in the context of the 8th Workshop on Paediatric Virology.
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Affiliation(s)
- Anna Kramvis
- Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg 2193, South Africa
| | - Ioannis N. Mammas
- Paediatric Clinic, Aliveri, 34500 Island of Euboea
- First Department of Paediatrics, University of Athens School of Medicine, 11527 Athens, Greece
- Department of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A. Spandidos
- Department of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
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2
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Miller NZ, Goldman GS. Neonatal, Infant, and Under Age Five Vaccine Doses Routinely Given in Developed Nations and Their Association With Mortality Rates. Cureus 2023; 15:e42194. [PMID: 37484788 PMCID: PMC10358295 DOI: 10.7759/cureus.42194] [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] [Accepted: 07/17/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction In 2011, using 2009 data, we published a study demonstrating that among the most highly developed nations, those requiring the most vaccine doses for their infants tended to have the least favorable infant mortality rates (r = 0.70, p < .0001). Twelve years later, we replicated our original study using 2019 data. Linear regression analysis corroborated the positive trend reported in our initial paper (r = 0.45; p < .002). Herein, we broaden our analyses to consider the effect of vaccines on neonatal and under age five mortality rates. Objective We performed several investigations to explore potential relationships between the number of early childhood vaccine doses required by nations and their neonatal, infant, and under age five mortality rates. Methods In this ecological study, we conducted linear regression analyses of neonatal, infant, and under age five vaccine doses required by nations and their neonatal, infant, and under age five mortality rates. All analyses were based on 2019 and 2021 data. We also stratified nations by the number of neonatal vaccine doses required and conducted a one-way ANOVA test and a post hoc Tukey-Kramer test to determine if there were statistically significant differences in the group mean neonatal, infant, and under age five mortality rates of nations that administered zero, one, or two neonatal vaccine doses. Results Linear regression analyses of neonatal vaccine doses required by nations in our 2021 dataset yielded statistically significant positive correlations to rates of neonatal mortality (r = 0.34, p = .017), infant mortality (r = 0.46, p = .0008), and under age five mortality (r = 0.48, p = .0004). Similar results were reported using 2019 data. Utilizing 2021 data, a post hoc Tukey-Kramer test indicated a statistically significant pairwise difference between the mean neonatal mortality rates, mean infant mortality rates, and mean under age five mortality rates of nations requiring zero vs. two neonatal vaccine doses. There was a statistically significant difference of 1.28 deaths per 1000 live births (p < .002) between the mean infant mortality rates among nations that did not give their neonates any vaccine doses and those that required two vaccine doses. Using 2019 and 2021 data, 17 of 18 analyses (12 bivariate linear regressions and six ANOVA and Tukey-Kramer tests) achieved statistical significance and corroborated the findings reported in our original study of a positive association between the number of vaccine doses required by developed nations and their infant mortality rates. Conclusions There are statistically significant positive correlations between mortality rates of developed nations and the number of early childhood vaccine doses that are routinely given. Further investigations of the hypotheses generated by this study are recommended to confirm that current vaccination schedules are achieving their intended objectives.
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Affiliation(s)
- Neil Z Miller
- Medical Research, Institute of Medical and Scientific Inquiry, Santa Fe, USA
| | - Gary S Goldman
- Research, Independent Computer Scientist, Bogue Chitto, USA
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3
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Gontasz MM, Chalk BS, Liang C. Improving On-time Administration of the Initial Hepatitis B Vaccine in the NICU. Pediatr Qual Saf 2023; 8:e658. [PMID: 38571739 PMCID: PMC10990374 DOI: 10.1097/pq9.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/05/2023] [Indexed: 04/05/2024] Open
Abstract
Introduction Despite the updated American Academy of Pediatrics recommendation for universal administration of the hepatitis B vaccine for newborns, delays in routine prophylaxis are common in the Neonatal Intensive Care Unit (NICU). Delayed immunization can increase perinatal acquisition risks and lead to subsequent delays in routine childhood immunization. This study aimed to increase the on-time administration of the birth dose of the hepatitis B vaccine from 46% to ≥70% at a level III and level IV NICU within the same health system. Methods The stakeholder group developed project interventions using quality improvement methods, including implementing unit guidelines and a prompt in the progress note template. The outcome measure was the percent on-time administration of the initial hepatitis B vaccine for inborn NICU patients born to hepatitis B-negative mothers. The process measure was the percent on-time administration or a valid reason to delay immunization following the guidelines. Statistical process control P-charts graphically represented the measures to assess for change from January 2019 to May 2021. Results In total, 2192 patients were included. The percent on-time administration improved from 48% to 57%. The percentage of on-time administration or valid reason to delay increased from 76% to 80%. Conclusions Quality improvement methodology facilitated the identification of barriers to on-time hepatitis B prophylaxis in the NICU and the improvement of the timeliness of administration across 2 sites. Guidelines tailored to this population and changes to the progress note template successfully created and sustained change and may benefit other NICUs.
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Affiliation(s)
- Michelle M. Gontasz
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Caroline Liang
- Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, MD
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Ito H, Yamamoto T, Morita S. The effect of men who have sex with men (MSM) on the spread of sexually transmitted infections. Theor Biol Med Model 2021; 18:18. [PMID: 34635123 PMCID: PMC8504019 DOI: 10.1186/s12976-021-00148-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
Sexually transmitted infections (STIs) have remained a worldwide public health threat. It is difficult to control the spread of STIs, not only because of heterogeneous sexual transmission between men and women but also because of the complicated effects of sexual transmission among men who have sex with men (MSM) and mother-to-child transmission. Many studies point to the existence of a ‘bisexual bridge’, where STIs spread from the MSM network via bisexual connections. However, it is unclear how the MSM network affects heterosexual networks as well as mother-to-child transmission. To analyse the effect of MSM on the spread of STIs, we divided the population into four subpopulations: (i) women, (ii) men who have sex with women only (MSW), (iii) men who have sex with both men and women (MSMW), (iv) men who have sex with men exclusively (MSME). We calculated the type-reproduction numbers of these four subpopulations, and our analysis determined what preventive measures may be effective. Our analysis shows the impact of bisexual bridge on the spread of STIs does not outweigh their population size. Since MSM and mother-to-child transmission rates do not have a strong synergistic effect when combined, complementary prevention measures are needed. The methodologies and findings we have provided here will contribute greatly to the future development of public health.
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Affiliation(s)
- Hiromu Ito
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, 852-8523, Japan
| | - Taro Yamamoto
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, 852-8523, Japan
| | - Satoru Morita
- Department of Mathematical and Systems Engineering, Shizuoka University, Hamamatsu, Shizuoka, 432-8561, Japan. .,Department of Environment and Energy Systems, Graduate School of Science and Technology, Shizuoka University, Hamamatsu, Shizuoka, 432-8561, Japan.
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Abstract
Premature infants admitted to the neonatal intensive care unit are at risk for severe infections and infectious complications caused by vaccine-preventable diseases. Both maternal and neonatal vaccination prevent such infections and improve outcomes for premature infants. An understanding of vaccine efficacy, safety, and administration recommendations, as well as reasons for vaccine hesitancy among clinicians and caregivers, facilitate strategies for improving vaccination rates for infants in the neonatal intensive care unit. Timely vaccination of premature infants confers important protection and improves vaccination rates during childhood.
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Affiliation(s)
- Dustin D Flannery
- Department of Pediatrics, Newborn care at Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA 19107, USA; Division of Neonatology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Kelly C Wade
- Department of Pediatrics, Newborn care at Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA 19107, USA; Division of Neonatology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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6
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Cross-Protection of Hepatitis B Vaccination among Different Genotypes. Vaccines (Basel) 2020; 8:vaccines8030456. [PMID: 32824318 PMCID: PMC7563454 DOI: 10.3390/vaccines8030456] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B (HB) vaccination is the most effective method for preventing HB virus (HBV) infection. Universal HB vaccination containing recombinant HB surface antigens (HBsAg) is recommended. Our data revealed that human monoclonal HB surface antibody (anti-HBs) from individuals inoculated with genotype C-based HB vaccine induced cross-protection against HBV genotype A infection. An in vitro infection model demonstrated anti-HBs-positive sera from individuals inoculated with genotype A- or C-based HB vaccine harbored polyclonal anti-HBs that could bind to non-vaccinated genotype HBV. However, because there were low titers of anti-HBs specific for HBsAg of non-vaccinated genotype, high anti-HBs titers would be required to prevent non-vaccinated genotype HBV infection. Clinically, the 2015 Centers for Disease Control and Prevention guidelines state that periodic monitoring of anti-HBs levels after routine HB vaccination is not needed and that booster doses of HB vaccine are not recommended. However, the American Red Cross suggests that HB-vaccine-induced immune memory might be limited; although HB vaccination can prevent clinical liver injury (hepatitis), subclinical HBV infections of non-vaccinated genotypes resulting in detectable HB core antibody could not be completely prevented. Therefore, monitoring anti-HBs levels after routine vaccination might be necessary for certain subjects in high-risk groups.
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7
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Zhao H, Zhou X, Zhou YH. Hepatitis B vaccine development and implementation. Hum Vaccin Immunother 2020; 16:1533-1544. [PMID: 32186974 PMCID: PMC7482909 DOI: 10.1080/21645515.2020.1732166] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/15/2020] [Indexed: 12/12/2022] Open
Abstract
Vaccination against hepatitis B is the most effective strategy to control HBV infection. The first licensed hepatitis B vaccine was developed by the purification of hepatitis B surface antigen (HBsAg) from plasma of asymptomatic HBsAg carriers. Then, the recombinant DNA technology enabled the development of recombinant hepatitis B vaccine. A series of three doses vaccine can elicit long-term protection more than 30 y. Concurrent use of hepatitis B immunoglobulin and hepatitis B vaccine has substantially reduced the mother-to-child transmission of HBV, nearly zero infection in children of carrier mother with negative hepatitis B e antigen (HBeAg) and 5-10% infection in children of HBeAg-positive mothers. By the end of 2018, 189 countries adopted universal hepatitis B vaccination program, which has dramatically reduced the global prevalence of HBsAg in children <5 y of age, from 4.7% in the prevaccine era to 1.3% in 2015. However, the implementation of universal hepatitis B vaccination in some regions is suboptimal and timely birth dose vaccine is not routinely administered in more than half of newborn infants. Optimal worldwide universal hepatitis B vaccination requires more efforts to overcome the social and economic challenges.
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Affiliation(s)
- Hong Zhao
- Department of Infectious Diseases, The Second Hospital of Nanjing, School of Medicine, Southeast University, Nanjing, China
| | - Xiaoying Zhou
- Department of Internal Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yi-Hua Zhou
- Departments of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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8
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Ito H, Yamamoto T, Morita S. The type-reproduction number of sexually transmitted infections through heterosexual and vertical transmission. Sci Rep 2019; 9:17408. [PMID: 31758036 PMCID: PMC6874657 DOI: 10.1038/s41598-019-53841-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/06/2019] [Indexed: 01/20/2023] Open
Abstract
Multiple sexually transmitted infections (STIs) have threatened human health for centuries. Most STIs spread not only through sexual (horizontal) transmission but also through mother-to-child (vertical) transmission. In a previous work (Ito et al. 2019), we studied a simple model including heterosexual and mother-to-child transmission and proposed a formulation of the basic reproduction number over generations. In the present study, we improved the model to take into account some factors neglected in the previous work: adult mortality from infection, infant mortality caused by mother-to-child transmission, infertility or stillbirth caused by infection, and recovery with treatment. We showed that the addition of these factors has no essential effect on the theoretical formulation. To study the characteristics of the epidemic threshold, we derived analytical formulas for three type-reproduction numbers for adult men, adult women and juveniles. Our result indicates that if an efficient vaccine exists for a prevalent STI, vaccination of females is more effective for containment of the STI than vaccination of males, because the type-reproduction number for adult men is larger than that for adult women when they are larger than one.
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Affiliation(s)
- Hiromu Ito
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8523, Japan.,Department of Environmental Sciences, Zoology, University of Basel, 4051, Basel, Switzerland
| | - Taro Yamamoto
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Satoru Morita
- Department of Mathematical and Systems Engineering, Shizuoka University, Hamamatsu, Shizuoka, 432-8561, Japan. .,Department of Environment and Energy Systems, Graduate School of Science and Technology, Shizuoka University, Hamamatsu, Shizuoka, 432-8561, Japan.
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9
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Haber P, Moro PL, Ng C, Lewis PW, Hibbs B, Schillie SF, Nelson NP, Li R, Stewart B, Cano MV. Safety of currently licensed hepatitis B surface antigen vaccines in the United States, Vaccine Adverse Event Reporting System (VAERS), 2005-2015. Vaccine 2017; 36:559-564. [PMID: 29241647 DOI: 10.1016/j.vaccine.2017.11.079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Currently four recombinant hepatitis B (HepB) vaccines are in use in the United States. HepB vaccines are recommended for infants, children and adults. We assessed adverse events (AEs) following HepB vaccines reported to the Vaccine Adverse Event Reporting System (VAERS), a national spontaneous reporting system. METHODS We searched VAERS for reports of AEs following single antigen HepB vaccine and HepB-containing vaccines (either given alone or with other vaccines), from January 2005 - December 2015. We conducted descriptive analyses and performed empirical Bayesian data mining to assess disproportionate reporting. We reviewed serious reports including reports of special interest. RESULTS VAERS received 20,231 reports following HepB or HepB-containing vaccines: 10,291 (51%) in persons <2 years of age; 2588 (13%) in persons 2-18 years and 5867 (29%) in persons >18 years; for 1485 (7.3%) age was missing. Dizziness and nausea (8.4% each) were the most frequently reported AEs following a single antigen HepB vaccine: fever (23%) and injection site erythema (11%) were most frequent following Hep-containing vaccines. Of the 4444 (22%) reports after single antigen HepB vaccine, 303 (6.8%) were serious, including 45 deaths. Most commonly reported cause of death was Sudden Infant Death Syndrome (197). Most common non-death serious reports following single antigen HepB vaccines among infants aged <1 month, were nervous system disorders (15) among children aged 1-23 months; infections and infestation (8) among persons age 2-18 years blood and lymphatic systemic disorders; and general disorders and administration site conditions among persons age >18 years. Most common vaccination error following single antigen HepB was incorrect product storage. CONCLUSIONS Review current U.S.-licensed HepB vaccines administered alone or in combination with other vaccines did not reveal new or unexpected safety concerns. Vaccination errors were identified which indicate the need for training and education of providers on HepB vaccine indications and recommendations.
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Affiliation(s)
- Penina Haber
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, United States.
| | - Pedro L Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, United States
| | - Carmen Ng
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, United States
| | - Paige W Lewis
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, United States
| | - Beth Hibbs
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, United States
| | - Sarah F Schillie
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, United States
| | - Noele P Nelson
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, United States
| | - Rongxia Li
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, United States
| | - Brock Stewart
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, United States
| | - Maria V Cano
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, United States
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Abstract
After the introduction of the hepatitis B vaccine in the United States in 1982, a greater than 90% reduction in new infections was achieved. However, approximately 1000 new cases of perinatal hepatitis B infection are still identified annually in the United States. Prevention of perinatal hepatitis B relies on the proper and timely identification of infants born to mothers who are hepatitis B surface antigen positive and to mothers with unknown status to ensure administration of appropriate postexposure immunoprophylaxis with hepatitis B vaccine and immune globulin. To reduce the incidence of perinatal hepatitis B transmission further, the American Academy of Pediatrics endorses the recommendation of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that all newborn infants with a birth weight of greater than or equal to 2000 g receive hepatitis B vaccine by 24 hours of age.
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11
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Inoue T, Tanaka Y. Hepatitis B virus and its sexually transmitted infection - an update. MICROBIAL CELL 2016; 3:420-437. [PMID: 28357379 PMCID: PMC5354569 DOI: 10.15698/mic2016.09.527] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Epidemiology: incidence and prevalence:
About 5% of the world’s population has chronic hepatitis B virus (HBV)
infection, and nearly 25% of carriers develop chronic hepatitis, cirrhosis, and
hepatocellular carcinoma (HCC). The prevalence of chronic HBV infection in human
immunodeficiency virus (HIV)-infected individuals is 5%-15%; HIV/HBV coinfected
individuals have a higher level of HBV replication, with higher rates of
chronicity, reactivation, occult infection, and HCC than individuals with HBV
only. The prevalence of HBV genotype A is significantly higher among men who
have sex with men (MSM), compared with the rest of the population.
Molecular mechanisms of infection, pathology, and
symptomatology: HBV replication begins with entry into the
hepatocyte. Sodium taurocholate cotransporting polypeptide was identified in
2012 as the entry receptor of HBV. Although chronic hepatitis B develops slowly,
HIV/HBV coinfected individuals show more rapid progression to cirrhosis and HCC.
Transmission and protection: The most common sources
of HBV infection are body fluids. Hepatitis B (HB) vaccination is recommended
for all children and adolescents, and all unvaccinated adults at risk for HBV
infection (sexually active individuals such as MSM, individuals with
occupational risk, and immunosuppressed individuals). Although HB vaccination
can prevent clinical infections (hepatitis), it cannot prevent 100% of
subclinical infections. Treatment and curability:
The goal of treatment is reducing the risk of complications
(cirrhosis and HCC). Pegylated interferon alfa and nucleos(t)ide analogues (NAs)
are the current treatments for chronic HBV infection. NAs have improved the
outcomes of patients with cirrhosis and HCC, and decreased the incidence of
acute liver failure.
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Affiliation(s)
- Takako Inoue
- Clinical Laboratory, Nagoya City University Hospital, Nagoya, Japan
| | - Yasuhito Tanaka
- Clinical Laboratory, Nagoya City University Hospital, Nagoya, Japan. ; Department of Virology & Liver unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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McCarthy NL, Gee J, Sukumaran L, Weintraub E, Duffy J, Kharbanda EO, Baxter R, Irving S, King J, Daley MF, Hechter R, McNeil MM. Vaccination and 30-Day Mortality Risk in Children, Adolescents, and Young Adults. Pediatrics 2016; 137:e20152970. [PMID: 26908690 PMCID: PMC6511986 DOI: 10.1542/peds.2015-2970] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE This study evaluates the potential association of vaccination and death in the Vaccine Safety Datalink (VSD). METHODS The study cohort included individuals ages 9 to 26 years with deaths between January 1, 2005, and December 31, 2011. We implemented a case-centered method to estimate a relative risk (RR) for death in days 0 to 30 after vaccination.Deaths due to external causes (accidents, homicides, and suicides) were excluded from the primary analysis. In a secondary analysis, we included all deaths regardless of cause. A team of physicians reviewed available medical records and coroner's reports to confirm cause of death and assess the causal relationship between death and vaccination. RESULTS Of the 1100 deaths identified during the study period, 76 (7%) occurred 0 to 30 days after vaccination. The relative risks for deaths after any vaccination and influenza vaccination were significantly lower for deaths due to nonexternal causes (RR 0.57, 95% confidence interval [CI] 0.38-0.83, and RR 0.44, 95% CI 0.24-0.80, respectively) and deaths due to all causes (RR 0.72, 95% CI 0.56-0.91, and RR 0.44, 95% CI 0.28-0.65). No other individual vaccines were significantly associated with death. Among deaths reviewed, 1 cause of death was unknown, 25 deaths were due to nonexternal causes, and 34 deaths were due to external causes. The causality assessment found no evidence of a causal association between vaccination and death. CONCLUSIONS Risk of death was not increased during the 30 days after vaccination, and no deaths were found to be causally associated with vaccination.
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Affiliation(s)
- Natalie L. McCarthy
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Address correspondence to Natalie L. McCarthy, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-D26, Atlanta, GA 30333. E-mail:
| | - Julianne Gee
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lakshmi Sukumaran
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Eric Weintraub
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Duffy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elyse O. Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Roger Baxter
- Kaiser Permanente of Northern California, Oakland, California
| | | | - Jennifer King
- Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; and
| | - Rulin Hechter
- Kaiser Permanente Southern California, Pasadena, California
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13
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Moro PL, Arana J, Cano M, Lewis P, Shimabukuro TT. Deaths Reported to the Vaccine Adverse Event Reporting System, United States, 1997-2013. Clin Infect Dis 2015; 61:980-7. [PMID: 26021988 DOI: 10.1093/cid/civ423] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/14/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vaccines are among the safest medical products in use today. Hundreds of millions of vaccinations are administered in the United States each year. Serious adverse reactions are uncommon. However, temporally associated deaths can occur following vaccination. Our aim was to characterize main causes of death among reports submitted to the US Vaccine Adverse Event Reporting System (VAERS), a spontaneous vaccine safety surveillance system. METHODS We searched VAERS for US reports of death after any vaccination from 1 July 1997 through 31 December 2013. Available medical records, autopsy reports, and death certificates were reviewed to identify cause of death. RESULTS VAERS received 2149 death reports, most (n = 1469 [68.4%]) in children. Median age was 0.5 years (range, 0-100 years); males accounted for 1226 (57%) reports. The total annual number of death reports generally decreased during the latter part of the study period. Most common causes of death among 1244 child reports with available death certificates/autopsy reports included sudden infant death syndrome (n = 544 [44%]), asphyxia (n = 74 [6.0%]), septicemia (n = 61 [4.9%]), and pneumonia (n = 57 [4.6%]). Among 526 adult reports, most common causes of death included diseases of the circulatory (n = 247 [46.9%]) and respiratory systems (n = 77 [14.6%]), certain infections and parasitic diseases (n = 62 [11.8%]), and malignant neoplasms (n = 20 [3.8%]). For child death reports, 79.4% received >1 vaccine on the same day. Inactivated influenza vaccine given alone was most commonly associated with death reports in adults (51.4%). CONCLUSIONS No concerning pattern was noted among death reports submitted to VAERS during 1997-2013. The main causes of death were consistent with the most common causes of death in the US population.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jorge Arana
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria Cano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paige Lewis
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom T Shimabukuro
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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McNeil MM, Gee J, Weintraub ES, Belongia EA, Lee GM, Glanz JM, Nordin JD, Klein NP, Baxter R, Naleway AL, Jackson LA, Omer SB, Jacobsen SJ, DeStefano F. The Vaccine Safety Datalink: successes and challenges monitoring vaccine safety. Vaccine 2014; 32:5390-8. [PMID: 25108215 PMCID: PMC6727851 DOI: 10.1016/j.vaccine.2014.07.073] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/08/2014] [Accepted: 07/21/2014] [Indexed: 11/27/2022]
Abstract
The Vaccine Safety Datalink (VSD) is a collaborative project between the Centers for Disease Control and Prevention (CDC) and 9 health care organizations. Established in 1990, VSD is a vital resource informing policy makers and the public about the safety of vaccines used in the United States. Large linked databases are used to identify and evaluate adverse events in over 9 million individuals annually. VSD generates rapid, important safety assessments for both routine vaccinations and emergency vaccination campaigns. VSD monitors safety of seasonal influenza vaccines in near-real time, and provided essential information on the safety of influenza A (H1N1) 2009 monovalent vaccine during the recent pandemic. VSD investigators have published important studies demonstrating that childhood vaccines are not associated with autism or other developmental disabilities. VSD prioritizes evaluation of new vaccines; searches for possible unusual health events after vaccination; monitors vaccine safety in pregnant women; and has pioneered development of biostatistical research methods.
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Affiliation(s)
- Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Julianne Gee
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Edward A Belongia
- Marshfield Clinic Research Foundation, Marshfield, WI, United States
| | - Grace M Lee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente, Denver, CO, United States
| | - James D Nordin
- HealthPartners Institute for Education and Research, Minneapolis, MN, United States
| | - Nicola P Klein
- Vaccine Study Center, Kaiser Permanente of Northern California, Oakland, CA, United States
| | - Roger Baxter
- Vaccine Study Center, Kaiser Permanente of Northern California, Oakland, CA, United States
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | | | - Saad B Omer
- Kaiser Permanente Center for Health Research, Atlanta, GA, United States
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, United States
| | - Frank DeStefano
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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McCarthy NL, Weintraub E, Vellozzi C, Duffy J, Gee J, Donahue JG, Jackson ML, Lee GM, Glanz J, Baxter R, Lugg MM, Naleway A, Omer SB, Nakasato C, Vazquez-Benitez G, DeStefano F. Mortality rates and cause-of-death patterns in a vaccinated population. Am J Prev Med 2013; 45:91-97. [PMID: 23790993 DOI: 10.1016/j.amepre.2013.02.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/10/2012] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Determining the baseline mortality rate in a vaccinated population is necessary to be able to identify any unusual increases in deaths following vaccine administration. Background rates are particularly useful during mass immunization campaigns and in the evaluation of new vaccines. PURPOSE Provide background mortality rates and describe causes of death following vaccination in the Vaccine Safety Datalink (VSD). METHODS Analyses were conducted in 2012. Mortality rates were calculated at 0-1 day, 0-7 days, 0-30 days, and 0-60 days following vaccination for deaths occurring between January 1, 2005, and December 31, 2008. Analyses were stratified by age and gender. Causes of death were examined, and findings were compared to National Center for Health Statistics (NCHS) data. RESULTS Among 13,033,274 vaccinated people, 15,455 deaths occurred between 0 and 60 days following vaccination. The mortality rate within 60 days of a vaccination visit was 442.5 deaths per 100,000 person-years. Rates were highest in the group aged ≥85 years, and increased from the 0-1-day to the 0-60-day interval following vaccination. Eleven of the 15 leading causes of death in the VSD and NCHS overlap in both systems, and the top four causes of death were the same in both systems. CONCLUSIONS VSD mortality rates demonstrate a healthy vaccinee effect, with rates lowest in the days immediately following vaccination, most apparent in the older age groups. The VSD mortality rate is lower than that in the general U.S. population, and the causes of death are similar.
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Affiliation(s)
| | | | | | | | | | - James G Donahue
- Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | | | - Grace M Lee
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jason Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Roger Baxter
- Kaiser Permanente Vaccine Study Center, Oakland, Southern California
| | | | | | | | - Cynthia Nakasato
- Kaiser Permanente Center for Health Research Hawaii, Honolulu, Hawaii
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17
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Xu S, Zhang L, Nelson JC, Zeng C, Mullooly J, McClure D, Glanz J. Identifying optimal risk windows for self-controlled case series studies of vaccine safety. Stat Med 2010; 30:742-52. [DOI: 10.1002/sim.4125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 09/22/2010] [Indexed: 11/05/2022]
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Use of the Australian Childhood Immunisation Register for vaccine safety data linkage. Vaccine 2010; 28:4308-11. [DOI: 10.1016/j.vaccine.2010.04.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 11/22/2022]
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20
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Shepard CW, Finelli L, Fiore AE, Bell BP. Epidemiology of hepatitis B and hepatitis B virus infection in United States children. Pediatr Infect Dis J 2005; 24:755-60. [PMID: 16148839 DOI: 10.1097/01.inf.0000177279.72993.d5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Before the era of routine hepatitis B vaccination, an estimated 24,000 children acquired hepatitis B virus (HBV) infection each year in the United States. Childhood hepatitis B immunization has led to significant declines in the incidence and prevalence of HBV infection in U.S. children. Because the greatest burden of hepatitis B is caused by complications of hepatocellular carcinoma and cirrhosis in adults who were infected with HBV as children, most of the benefits of vaccination have yet to be realized. Reaching the goal of eliminating HBV transmission to children likely will require increasing vaccination coverage, ensuring timely administration of postexposure immunoprophylaxis to prevent more perinatal infections, and continued evaluation of the impact of immunization recommendations.
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Affiliation(s)
- Colin W Shepard
- Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
PURPOSE OF REVIEW Hepatitis B virus infection is prevalent worldwide and is a significant cause of morbidity and mortality particularly in Asia. Adults chronically infected with hepatitis B virus remain a significant potential source of sexually transmitted hepatitis B. The purpose of this article is to review the recent literature relating to hepatitis B virus transmission with particular emphasis on sexual transmission and efforts to prevent spread. RECENT FINDINGS The introduction of hepatitis B virus vaccine and the implementation of universal childhood vaccination for hepatitis B in some countries have led to a dramatic reduction in the number of children with chronic hepatitis B. However, recent reports suggest that we are not as successful in preventing infection by sexual transmission. It is clear that sexual transmission of hepatitis B virus is still widespread and is a major problem in certain high-risk groups such as men who have sex with men, intravenous drug users, prisoners and sex workers. Significant problems remain with respect to education and vaccination within these groups. SUMMARY Hepatitis B virus remains a major health burden but it is preventable by education and vaccination. Greater resources are required to expand vaccination to the at-risk, sexually active adult populations if the World Health Organization ideal of hepatitis B virus eradication is to be realized and the burden of hepatitis B virus-related morbidity and mortality contained.
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Affiliation(s)
- Mark Atkins
- Department of Microbiology, Chelsea and Westminster Hospital, Fulham Road, London, UK.
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