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Fonzo M, Palmisano A, Trevisan A, Bertoncello C. The Impact of Smoking on Long-Term Protection Following Hepatitis B Vaccination: A 24-Year Cohort Study. Viruses 2024; 16:1137. [PMID: 39066298 PMCID: PMC11281657 DOI: 10.3390/v16071137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/10/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
The hepatitis B vaccination-induced immune response has been demonstrated to be associated with a number of factors, including age, sex, BMI, and the presence of comorbidities. Additionally, modifiable determinants such as smoking have been identified as influencing the response to vaccination. However, despite the evidence that smokers are at an increased risk of not responding to vaccination, the long-term effects of smoking on antibody persistence remain poorly understood. This study aims to assess the impact of smoking habits on long-term immunity following the primary vaccination cycle. Participants were required to have received a standard three-dose vaccine schedule in childhood, without subsequent doses, and to be between 18 and 24 years of age. Data on age, sex, BMI, age of administration of the first vaccine dose, and time between doses were collected. An antibody concentration < 10 IU/L was considered as non-protective. A total of 2133 individuals were included, 14.2% of whom were smokers. The mean age was 20.28 ± 0.92 years. The probability of having a non-protective antibody concentration was significantly higher in smokers than in non-smokers (AOR: 1.287; 95% CI: 1.002-1.652). The detrimental effects of smoking extend beyond the immediate effects on the vaccine response, also impairing the long-term immune response in individuals who received vaccinations during childhood.
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Affiliation(s)
- Marco Fonzo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (A.P.); (A.T.); (C.B.)
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Asamoah Sakyi S, Badu Gyapong J, Krampah Aidoo E, Effah A, Koffie S, Simon Olympio Mensah O, Arddey I, Boakye G, Opoku S, Amoani B, Amadu Ngala R. Evaluation of Immune Characteristics and Factors Associated with Immune Response following Hepatitis B Vaccination among Ghanaian Adolescents. Adv Virol 2024; 2024:9502939. [PMID: 38827254 PMCID: PMC11142859 DOI: 10.1155/2024/9502939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/24/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024] Open
Abstract
Background WHO recommends HBV-negative babies in high-prevalence (8%) countries receive anti-HBV vaccination. Ghana initiated mass immunization in 2002, but concerns remain about vaccine effectiveness and long-term protection. We evaluated immune characteristics and factors following hepatitis B vaccination among Ghanaian adolescents who received HBV vaccines. Methods In this longitudinal cross-sectional study, 74 participants were enrolled from the Kumasi Metropolis, Ghana. Sociodemographic and lifestyle characteristics of participants were obtained using a questionnaire. Blood samples were obtained before and after booster administration for anti-HBsAg, IL-6, and IL-10 estimations using ELISA kit (Shanghai Chemical Ltd., China). Anti-HBsAg titers ≥10 mIU/ml were considered protective. Statistical analyses were done using SPSS version 26.0 and R programming language, p < 0.05 was considered statistically significant. Results We found 100% seroconversion rate, with 25.7% seroprotection rate (anti-HBsAg >10 mIU/ml). Gender (p=0.009), age (p=0.001), and exercising (p=0.044) were significantly associated with seroprotection. Following booster administration, 59.4% were hyporesponders (10 ≤ anti-HBsAg titre ≤99 mIU/ml) whilst 40.6% were good responders (anti-HBsAg titre ≥100 mIU/ml). Exercise (p=0.034) was significantly associated with immune response after booster administration. Moreover, we reported significant positive correlation between cytokines [IL-6 (r = 0.817, p < 0.001) and IL-10 (r = 0.928, p < 0.001)] and anti-HBsAg titre. Conclusion Approximately two thirds of adolescents vaccinated at birth lack protective levels of antibodies against hepatitis B virus. Booster vaccines could aid in mounting protective levels of anti-HBsAg. Physical exercise was negatively associated with immune response to hepatitis B vaccinations.
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Affiliation(s)
- Samuel Asamoah Sakyi
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Badu Gyapong
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Alfred Effah
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Simon Koffie
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Oscar Simon Olympio Mensah
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Arddey
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Godwin Boakye
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stephen Opoku
- Department of Neurosurgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Benjamin Amoani
- Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Robert Amadu Ngala
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Taşar S, Taşar MA, Saç RÜ, Alioğlu B. Catch-up vaccination and enhanced immunization against hepatitis B, hepatitis A, measles, mumps, rubella and varicella in children with idiopathic thrombocytopenic purpura. J Trop Pediatr 2023; 69:fmad026. [PMID: 37648424 DOI: 10.1093/tropej/fmad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Limited data exist about the vaccination of children with idiopathic thrombocytopenic purpura (ITP) against vaccine preventable diseases. This study identified the vaccination status of children with ITP against hepatitis A, hepatitis B, measles, mumps, rubella and varicella, completed the immunization of children with inadequate immunization, re-evaluated post-vaccination antibody titers and identified probable vaccination-related complications. PATIENTS AND METHODS All of 46 children had chronic ITP were included. Seroconversion of hepatitis A, hepatitis B, varicella, measles, rubella and mumps vaccines was screened. All children with seronegative antibodies against vaccine preventable disease were given a vaccination appointment. Antibody levels were re-measured during a period ranging from 1 to 6 months. Potential complications were detected. RESULTS There were 46 children with a mean age of 12.25 years. All children had chronic ITP and received intravenous immunoglobulin at least once previously. Considering the vaccination status, 50% (23 children) had vaccinations appropriate for their age, 47.8% (22 children) did not know their vaccination status and 2.2% (1 patient) did not have vaccinations. Seven children (15.2%) were seropositive for all antibody types and the remaining 39 children were scheduled for vaccination. Post-vaccination antibody titers confirmed that all children became seropositive for each disease. There was no complication in any patient. CONCLUSION Immunization against hepatitis B, hepatitis A, measles, mumps, rubella and varicella is insufficient in a considerable number of children with ITP, Hepatitis B Virus (HBV) and Hepatitis A Virus (HAV) immunization being the most frequently inadequate. After immunization, adequate seroconversion levels were achievable without complications.
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Affiliation(s)
- Serçin Taşar
- Department of Pediatrics, Ankara Education and Research Hospital, Ankara 06230, Turkey
| | - Medine Ayşin Taşar
- Department of Pediatric Emergency, Ankara Education and Research Hospital, Ankara 06230, Turkey
| | - Rukiye Ünsal Saç
- Department of Pediatrics, Ankara Education and Research Hospital, Ankara 06230, Turkey
| | - Bülent Alioğlu
- Department of Pediatric Hematology, Ankara Education and Research Hospital, Ankara 06230, Turkey
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Cheng TW, Yang JF, Chen YY, Wu KT, Lee MS, Kuo HJ, Lin TC, Wang CL, Hsieh MH, Lin CY, Batsaikhan B, Ho CK, Dai CY. Epidemiology of Chronic Hepatitis B Infection in the Cohort of College Students with Vaccination in Taiwan. Vaccines (Basel) 2023; 11:vaccines11020348. [PMID: 36851225 PMCID: PMC9964940 DOI: 10.3390/vaccines11020348] [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] [Received: 12/31/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
After the mass vaccination project in Taiwan, the prevalence of the hepatitis B virus (HBV) infection for the college-aged population of 18 to 21 years is uncertain. We aimed to investigate the prevalence of hepatitis B markers in different birth cohorts. A total of 38,075 students in universities in Kaohsiung area undergoing entrance examinations between July 2006 to September 2020 were included. Seroprevalence of the hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) status and laboratory data were collected. The seropositive rate of HBsAg was less than 1% for students born after 1991. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST), were significantly higher, and body mass index (BMI) was significantly lower in HBV carriers compared to those who were not carriers (all p < 0.001). Multivariate logistic regression showed that age, male, higher BMI, and positive HBsAg were risk factors of abnormal ALT value. A decrease in the positive rate of anti-HBs which was significantly higher in the cohort of plasma-derived vaccines than recombinant vaccines was found. We concluded that there were decreasing trends in seropositive rates of HBsAg and anti-HBs for students of the college-aged population in the Kaohsiung area. The status of HBsAg was a predictive factor of abnormal ALT levels. The period effect on anti-HBs seropositivity for DNA recombinant vaccine somehow existed.
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Affiliation(s)
- Te-Wei Cheng
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Jeng-Fu Yang
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Yi-Yu Chen
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Kuan-Ta Wu
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Meng-Szu Lee
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Hsiang-Ju Kuo
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Tzu-Chun Lin
- Executive Master of Healthcare Administration, Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Chao-Ling Wang
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Meng-Hsuan Hsieh
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Chia-Yi Lin
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Batbold Batsaikhan
- Department of Internal Medicine, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar 14210, Mongolia
| | - Chi-Kung Ho
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Chia-Yen Dai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Health Management Center, Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Correspondence:
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Lack of relationship between 25-hydoxyvitamin D concentration and a titer of antibodies to hepatitis B surface antigen in children under 12 years of age. PLoS One 2022; 17:e0277473. [DOI: 10.1371/journal.pone.0277473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/27/2022] [Indexed: 11/12/2022] Open
Abstract
The effect of vitamin D levels on the response to the hepatitis B vaccine in childhood and the induced levels of antibodies against the hepatitis B surface antigen (anti-HBs) is not yet well understood. The study aimed to investigate the relationship between age, serum 25-hydroxyvitamin D (25(OH)D) concentration and anti-HBs titer among children under 12 years old. Serum 25(OH)D concentration and anti-HBs titer were determined in 352 healthy Caucasian children with the average age of 4.2 (2.5; 6.3) years. All children were vaccinated with 3 doses of hepatitis B vaccine (Engerix-B, GlaxoSmithKline Pharmaceuticals Limited) in infancy according to the Centers for Disease Control and Prevention recommendations. Only 14.5% of children had an optimal concentration of 25(OH)D ≥ 30 ng/mL and 71.9% children had a seroprotective anti-HBs titer ≥ 10 mIU/mL. Significant negative correlations were found between 25(OH)D, anti-HBs titer and age (r = –0.420, p = 0.000; r = –0.425, p = 0.000, respectively), and a weak positive correlation between 25(OH)D concentration and anti-HBs titer (r = 0.243, p = 0.000). Analysis of six clusters of children demonstrated that age is the main factor affecting anti-HBs titer. One third of children under 12 years of age had nonprotective anti-HBs titer < 10 mIU/mL and around 40% had vitamin D deficiency. We conclude that vitamin D status has no impact on anti-HBs titer in children vaccinated against hepatitis B virus in infancy. Age, so time since the receipt of the last dose of hepatitis B vaccine, is the main factor influencing a decline in anti-HBs titer.
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Lian PCS, Morrish B. Antibody response to an accelerated course of Hepatitis B vaccination. Occup Med (Lond) 2022; 72:446-451. [PMID: 35932245 DOI: 10.1093/occmed/kqac054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are several courses with different dosing intervals for Hepatitis B vaccination. This independent study is looking at the antibody response after three doses of the accelerated course. AIMS The primary aim of the study was to examine data available at an Occupational Health Service for the antibody response to one or if nonresponsive, two accelerated Hepatitis B courses. A secondary aim is to determine if there is a difference in response for different sex and age groups. METHODS This is a retrospective anonymous and blinded study looking at the antibody response in 1032 healthcare personnel given the accelerated course of the Hepatitis B vaccine over a period of over 6 years. An anti-Hbs response 4 months after the start of the vaccination of >10 IU/ml was taken as indicative of a response. RESULTS After one course, 93% of the healthcare personnel developed antibody levels thought to confer immunity. After two courses, nearly 99% of the healthcare personnel had developed an adequate immune response. The response was better in females and <40 years old, a difference that was statistically significant for those aged <40. CONCLUSIONS The accelerated course confers high levels of immunity after 4 months and this supports the current practice of offering the accelerated dose to UK healthcare personnel who can be at immediate and higher risk of infection. Though some groups are less responsive, all groups mount a good response so all those at risk should be encouraged to have this vaccination.
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Affiliation(s)
- P C S Lian
- Royal Devon and Exeter NHS Foundation Trust and Honorary Clinical Professor University of Exeter, Exeter, UK
| | - B Morrish
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Ocan M, Acheng F, Otike C, Beinomugisha J, Katete D, Obua C. Antibody levels and protection after Hepatitis B vaccine in adult vaccinated healthcare workers in northern Uganda. PLoS One 2022; 17:e0262126. [PMID: 35061771 PMCID: PMC8782524 DOI: 10.1371/journal.pone.0262126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022] Open
Abstract
Hepatitis B vaccine has contributed to the reduction in hepatitis B virus infections and chronic disease globally. Screening to establish extent of vaccine induced immune response and provision of booster dose are limited in most low-and-middle income countries (LMICs). Our study investigated the extent of protective immune response and breakthrough hepatitis B virus infections among adult vaccinated healthcare workers in selected health facilities in northern Uganda. A cross-sectional study was conducted among 300 randomly selected adult hepatitis B vaccinated healthcare workers in Lira and Gulu regional referral hospitals in northern Uganda. Blood samples were collected and qualitative analysis of Hepatitis B surface antigen (HBsAg), Hepatitis B surface antigen antibody (HBsAb), Hepatitis B envelop antigen (HBeAg), Hepatitis B envelop antibody (HBeAb) and Hepatitis B core antibody (HBcAb) conducted using ELISA method. Quantitative assessment of anti-hepatitis B antibody (anti-HBs) levels was done using COBAS immunoassay analyzer. Multiple logistic regression was done to establish factors associated with protective anti-HBs levels (≥ 10mIU/mL) among adult vaccinate healthcare workers at 95% level of significance. A high proportion, 81.3% (244/300) of the study participants completed all three hepatitis B vaccine dose schedules. Two (0.7%, 2/300) of the study participants had active hepatitis B virus infection. Of the 300 study participants, 2.3% (7/300) had positive HBsAg; 88.7% (266/300) had detectable HBsAb; 2.3% (7/300) had positive HBeAg; 4% (12/300) had positive HBeAb and 17.7% (53/300) had positive HBcAb. Majority, 83% (249/300) had a protective hepatitis B antibody levels (≥10mIU/mL). Hepatitis B vaccine provides protective immunity against hepatitis B virus infection regardless of whether one gets a booster dose or not. Protective immune response persisted for over ten years following hepatitis B vaccination among the healthcare workers.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Frances Acheng
- Infectious Disease Institute, College of Health Sciences, Yumbe General Hospital, Makerere University, Yumbe District, Kampala, Uganda
| | - Carol Otike
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - David Katete
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Celestino Obua
- Department of Pharmacology and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
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Bayhan GI, Balli SE, Demir H, Baydar Z. How does the immunogenicity of hepatitis B vaccine change over the years in childhood? Hum Vaccin Immunother 2021; 17:2768-2772. [PMID: 33793388 DOI: 10.1080/21645515.2021.1902724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Hepatitis B is the leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma worldwide. The incidence of HBV infection has significantly decreased with hepatitis B vaccination. Hepatitis B vaccine is administered to children at 0, 1 and 6 months of age according to the national schedule. There is a high rate of protective antibody (anti-HBs) development after hepatitis B vaccination. We conducted the study to investigate how the hepatitis B surface antibody (anti-HBs) positivity rates and the titers change over time in childhood following vaccination. Patients who presented at the general pediatric outpatient clinic of Yenimahalle Education and Training Hospital and the HBsAg and anti-HBs titers were tested for any reason between July 2011 and May 2018 were retrospectively evaluated. The cutoff level for protection by the anti-HBs titer was accepted as ≥10 mIU/mL with lower levels indicating no protection. Anti-HBs positivity was compared by age group. Anti-HBs levels were studied in 4326 children. The mean age of the included in the study was 127 ± 62 months. A protective anti-HBs level (≥10 mIU/mL) was present in 2292 children (69.2%). The highest anti-HBs antibody positivity rate was in the under 3 years' age group. The positivity rate significantly decreased after age 7 years. The HBsAg level was determined in all children in the study and five had a positive result. In conclusion, our study found that the anti-HBs positivity rate and the anti-HBs level decreased with age. However, the anti-HBs antibody result remained positive in more than half of the children.
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Affiliation(s)
- Gulsum Iclal Bayhan
- Department of Pediatric Infectious Disease, Faculty of Medicine, Yenimahalle Educational and Training Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Sidika Elif Balli
- Department of General Pediatrics, Yenimahalle Educational and Training Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Hatice Demir
- Department of General Pediatrics, Yenimahalle Educational and Training Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Zekiye Baydar
- Department of General Pediatrics, Yenimahalle Educational and Training Hospital, Yildirim Beyazit University, Ankara, Turkey
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Hur YJ, Choe SA, Choe YJ, Paek J. Hepatitis B surface antigen and antibody positivity among women of childbearing age after three decades of universal vaccination in South Korea. Int J Infect Dis 2021; 104:551-555. [PMID: 33217571 DOI: 10.1016/j.ijid.2020.11.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We estimated the impact of universal hepatitis B immunization using 18-year data of women who are of childbearing age in South Korea. METHODS We used hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) data of 145,993 women aged 20-49 years during 2001-2018 at the Gangnam CHA Medical Center. Annual prevalences of HBsAg and anti-HBs positivity were calculated and tested for linear trend. We conducted age-period-cohort (APC) analysis to obtain period and cohort effect. RESULTS Overall proportion of HBsAg positivity was 3.5% (n = 5050) and anti-HBs positivity was 75.3% (n = 109,907) during the study period. HBsAg positivity percentage decreased from 5.1% in 2001 to 2.5% in 2018 (P < 0.001) while anti-HBs positivity increased from 59.9% to 75.8% (P = 0.002). Average annual percent change of HBsAg positivity was -5.9% (95% confidence interval (CI): -6.9%, -4.8%). The period and cohort RR curve identified a consistent decrease in HBsAg positivity over time and across generations. CONCLUSIONS We observed a concurrent decrease in HBsAg and an increase in anti-HBs seropositivity among Korean women of childbearing age, implicating success in preventing vertical transmission.
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Affiliation(s)
- Yun Jung Hur
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, 04637, Republic of Korea
| | - Seung-Ah Choe
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, 04637, Republic of Korea; Department of Preventive Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea.
| | - Young June Choe
- Department of Social and Preventive Medicine, Hallym University, Chuncheon, Gangwon-do, 24252, Republic of Korea
| | - Jinyoung Paek
- Department of Laboratory Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, 06135, Republic of Korea
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Vesikari T, Xu J, Johnson DR, Hall J, Marček T, Goveia MG, Acosta CJ, Lee AWT. Hepatitis B and pertussis antibodies in 4- to 5-year-old children previously vaccinated with different hexavalent vaccines. Hum Vaccin Immunother 2020; 16:867-874. [PMID: 31689166 PMCID: PMC7227712 DOI: 10.1080/21645515.2019.1673119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/05/2019] [Accepted: 09/21/2019] [Indexed: 12/17/2022] Open
Abstract
In randomized active-comparator controlled studies, DTaP5-HB-IPV-Hib showed comparable immunogenicity and safety to other licensed vaccines. This study assessed persistence of anti-hepatitis B surface antigen (HBs) and anti-pertussis antibodies, when children were 4 to 5 years of age, 3 to 4 years after initial infant/toddler hexavalent vaccination. This was an extension of 2 European studies in which infants/toddlers received either DTaP5-HB-IPV-Hib or DTaP3-HB-IPV/Hib on a 2 + 1 or 3 + 1 schedule. Primary endpoints included percentages with anti-HBs ≥10 mIU/mL, and anti-pertussis toxin (PT), anti-filamentous hemagglutinin (FHA), anti-pertactin (PRN), and anti-fimbriae types 2 & 3 (FIM) greater than or equal to the lower limit of quantitation (LLOQ). One month after 2 + 1 or 3 + 1 dosing, nearly all toddlers had anti-HBs ≥10 mIU/mL, and responded to the received pertussis antigens. Approximately 3 to 4 years later, 65.8%-70.2% in the DTaP5-HB-IPV-Hib and 82.0%-83.7% in the DTaP3-HB-IPV/Hib groups, respectively, had anti-HBs ≥10 mIU/mL. Percentages of children with pertussis antibodies above LLOQ after 2 + 1 dosing were 58.4% and 41.5% (anti-PT), 80.9% and 88.3% (anti-FHA), 66.1% and 72.6% (anti-PRN), and 94.4% and 3.3% (anti-FIM), in the DTaP5-HB-IPV-Hib and DTaP3-HB-IPV/Hib groups, respectively. This study demonstrated, as expected, waning of hepatitis B and pertussis antibodies during the 3 to 4 years after completion of a 3 + 1 or 2 + 1 hexavalent vaccination schedule. Nonetheless, anti-HBs levels ≥10 IU/mL and detectable antibodies against acellular pertussis antigens persisted in most study participants. The implications of these findings for the long-term prevention of hepatitis B and pertussis are further discussed.
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Affiliation(s)
- Timo Vesikari
- Department of Pediatrics, University of Tampere, Tampere, Finland
| | - Jin Xu
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Jessie Hall
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Michelle G. Goveia
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | - Camilo J. Acosta
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | - Andrew Wen-Tseng Lee
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
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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.
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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.)
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12
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Moghadami M, Dadashpour N, Mokhtari AM, Ebrahimi M, Mirahmadizadeh A. The effectiveness of the national hepatitis B vaccination program 25 years after its introduction in Iran: a historical cohort study. Braz J Infect Dis 2019; 23:419-426. [PMID: 31678055 PMCID: PMC9428176 DOI: 10.1016/j.bjid.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Hepatitis B virus (HBV) is responsible for one of the most common human viral infections. An estimated 257 million people are living with chronic HBV infection worldwide, and mortality has reached 900,000 deaths in recent years. In 2001, the World Health Organization reported a prevalence of chronic hepatitis B infection in Iran between 2–7%. Objective To assess the effect of the national HBV mass vaccination program after 25 years. Methods A retrospective cohort study was conducted in vaccinated and unvaccinated people according to the year of birth. Blood samples were obtained from each enrolled person and data about demographic variables, and medical and vaccination history were collected using a standardized questionnaire. Persons were considered uninfected if they were negative for both HBsAg and anti-HBc. Also, Vaccine effectiveness was measured by calculating the risk of disease among vaccinated and unvaccinated persons and defining the percentage risk reduction of infection in the vaccinated group. Results A total of 2720 persons were interviewed. The rate of HBV breakthrough infection among the vaccinated group was significantly lower than in unvaccinated group. One hundred ninety-four cases with positive HBV markers of infection were identified. The risk ratio of HBV infection was 0.71, 95% CI: 0.54–0.94 (vaccinated/unvaccinated). The estimated vaccination effectiveness against Hepatitis B infection was 29% (95% CI: 6%–46%). Conclusions Iran has successfully combined hepatitis B vaccination into regular immunization programs. The WHO goal of reducing HBsAg prevalence to an equivalent of 1% by 2020 has been reached. With respect to vaccination effectiveness and low prevalence of the disease in the country, catch-up hepatitis B vaccination programs for adolescents can guarantee the immunity of the population.
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Affiliation(s)
- Mohsen Moghadami
- Shiraz University of Medical Sciences, Clinical Microbiology Research Center, Shiraz, Iran.
| | - Nazanin Dadashpour
- Shiraz University of Medical Sciences, School of Medicine, Department of Internal Medicine, Shiraz, Iran.
| | | | - Mostafa Ebrahimi
- Shiraz University of Medical Sciences, Department of Health, Shiraz, Iran.
| | - Alireza Mirahmadizadeh
- Shiraz University of Medical Sciences, Non-communicable diseases research center, Shiraz, Iran.
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13
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Shin HJ, Lee ES, Han SB, Lee JW, Chung NG, Cho B, Kang JH. Serological Changes against Hepatitis B Surface Antigen in Children and Adolescents Receiving Chemotherapy for Acute Leukemia. Mediterr J Hematol Infect Dis 2019; 11:e2019052. [PMID: 31528318 PMCID: PMC6736336 DOI: 10.4084/mjhid.2019.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/09/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Vaccination for hepatitis B virus (HBV) after chemotherapy among pediatric patients with acute Leukemia is still a debated issue. We investigated HBV immunity before and after chemotherapy and assessed immune response to re-vaccination after chemotherapy. METHODS We retrospectively analyzed data of children and adolescents aged <19 years requested for vaccination after chemotherapy for acute leukemia to evaluate hepatitis B surface antibody (HBsAb) status before and after chemotherapy and to identify factors related to HBsAb positivity after chemotherapy. RESULTS Of 89 enrolled patients, 61 (68.5%) with acute leukemia were HBsAb positive before chemotherapy. Of these 61 patients, 48 (78.7%) seroconverted to HBsAb negative status after chemotherapy; there were 76 (85.4%) HBsAb negative patients after chemotherapy. HBsAb positive patients when compared to HBsAb negative patients after chemotherapy had a significantly higher HBsAb positive rate (100.0% vs. 63.2%, p=0.008) before chemotherapy. Following HBsAb testing after one dose of the HBV vaccination, 33 (43.4%) of the 76 HBsAb negative patients seroconverted to an HBsAb positive status. HBsAb positive patients after a single dose of HBV vaccination had a significantly higher HBsAb positive rate at the time of diagnosis compared to HBsAb negative patients (84.8% vs. 48.8%, p=0.001). CONCLUSIONS Based on these results, HBV re-vaccination after chemotherapy is recommended for all children and adolescents with acute leukemia. In addition, further investigation is required to improve the immunogenicity of HBV re-vaccination.
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Affiliation(s)
- Hye Jo Shin
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eui Soo Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Beom Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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Ma JC, Wu ZW, Zhou HS, Gao Z, Hao ZY, Jin F, Zhang YH, Li MJ, Wang F, Li Q, Bi SL, Zhao YL. Long-term protection at 20-31 years after primary vaccination with plasma-derived hepatitis B vaccine in a Chinese rural community. Hum Vaccin Immunother 2019; 16:16-20. [PMID: 31339432 DOI: 10.1080/21645515.2019.1646575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: To assess the long-term protection conferred by plasma-derived hepatitis B vaccine at 20-31y after primary immunization during infancy in Chinese rural community.Method: Participants born between 1986 and 1996, who received a full course of primary vaccination with plasma-derived hepatitis B vaccine and had no experience with booster vaccination were enrolled. An epidemiological investigation was performed, and blood samples were collected to detect hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core antibody (anti-HBc). The positive rate of HBsAg, anti-HBs, and anti-HBc were calculated to evaluate the long-term protection of the plasma-derived hepatitis B vaccine.Results: A total of 949 participants were enrolled in the final analysis. Six subjects were detected to be HBsAg-positive, resulting in a HBsAg carrier rate of 0.63% (6/949). A total of 468 (52.41%) participants maintained a level of anti-HBs antibody ≥10 mIU/mL, with a GMC of 112.20 mIU/mL (95%CI: 97.72 ~ 128.82 mIU/mL). A significant downtrend was observed in the anti-HBs positive rate (P < .001). The average anti-HBc positive rate was 5.90% (56/949), increased with prolongation of immunization (P < .001).Conclusions: The plasma-derived hepatitis B vaccine maintained satisfactory protection at 20-31 y after primary immunization. These results indicate that a booster dose is not necessary. Further studies on the immune memory induced by the plasma-derived hepatitis B vaccine are needed.
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Affiliation(s)
- Jing-Chen Ma
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People's Republic of China
| | - Zhi-Wei Wu
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People's Republic of China
| | - Hai-Song Zhou
- Institute for Hepatitis, Zhengding County Center for Disease Control and Prevention, Zhengding, People's Republic of China
| | - Zhao Gao
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People's Republic of China
| | - Zhi-Yong Hao
- Institute for Hepatitis, Zhengding County Center for Disease Control and Prevention, Zhengding, People's Republic of China
| | - Fei Jin
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People's Republic of China
| | - Yan-Hong Zhang
- Institute for Hepatitis, Zhengding County Center for Disease Control and Prevention, Zhengding, People's Republic of China
| | - Min-Jie Li
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People's Republic of China
| | - Feng Wang
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Qi Li
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People's Republic of China
| | - Sheng-Li Bi
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yu-Liang Zhao
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People's Republic of China
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15
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Abstract
There is substantial variation between individuals in the immune response to vaccination. In this review, we provide an overview of the plethora of studies that have investigated factors that influence humoral and cellular vaccine responses in humans. These include intrinsic host factors (such as age, sex, genetics, and comorbidities), perinatal factors (such as gestational age, birth weight, feeding method, and maternal factors), and extrinsic factors (such as preexisting immunity, microbiota, infections, and antibiotics). Further, environmental factors (such as geographic location, season, family size, and toxins), behavioral factors (such as smoking, alcohol consumption, exercise, and sleep), and nutritional factors (such as body mass index, micronutrients, and enteropathy) also influence how individuals respond to vaccines. Moreover, vaccine factors (such as vaccine type, product, adjuvant, and dose) and administration factors (schedule, site, route, time of vaccination, and coadministered vaccines and other drugs) are also important. An understanding of all these factors and their impacts in the design of vaccine studies and decisions on vaccination schedules offers ways to improve vaccine immunogenicity and efficacy.
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16
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Mahallawi W. Persistence of hepatitis B surface antibody and immune memory to hepatitis B vaccine among medical college students in Madinah. Ann Saudi Med 2018; 38:413-419. [PMID: 30531175 PMCID: PMC6302994 DOI: 10.5144/0256-4947.2018.413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Globally, about 300 million people are infected with hepatitis B virus (HBV). Among the effective approaches to fight HBV infection is immunization. In 1989, an obligatory hepatitis B vaccine program was launched in Saudi Arabia. OBJECTIVE Assess hepatitis B surface antibody (anti-HBs) levels among the medical students before and after receiving booster doses of HBV vaccine. DESIGN Cross-sectional. SETTING Taibah University. SUBJECTS AND METHODS Students born between 1993 and 1995 were recruited in this study from the Occupational Health Clinic. Students were screened for anti-HBs levels using chemiluminescent microparticle immunoassay (CMIA) before and after booster HBV vaccine doses. MAIN OUTCOME MEASURES Anti-HBs levels before and after booster doses. SAMPLE SIZE 335. RESULTS About half of participants (n=164, 49%) had protective anti-HBs levels ( greater than or equal 10 mIU/mL) to the original primary series of HBV vaccine and received no booster doses. The reimaining 171 (51%) participants were at risk of HBV infection since their anti-HBs levels were less than 10 mIU/mL, despite having received the original primary HBV vaccine. The levels of anti-HBs were higher in female than in male students (P less than .001). In addition, female students showed a stronger humoral immune response to the booster vaccine than male students (P less than .001). When participants were given the three boosters, most participants (98.3%) showed anti-HBs levels of greater than or equal 10 mIU/mL. The results also showed a strong correlation between pre-booster and post-booster anti-HBs levels in the greater than or equal 10 mIU/mL group (r2= 0.52, P less than .001) but not in less than 10 mIU/mL group (r2= 0.003, P=.53). CONCLUSION A considerable portion of the participants (about 51%) were at risk of HBV infection since their anti-HBs levels were less than 10 mIU/mL. Booster doses significantly trigger memory immune response and this ensured their protection against the virus. Pre-booster anti-HBs level are a good predictive of post-booster anti-HBs levels in greater than or equal 10 mIU/mL group. LIMITATIONS The sample size was small. Shortage of collaborators. CONFLICT OF INTEREST None.
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Affiliation(s)
- Waleed Mahallawi
- Dr. Waleed Mahallawi, Clinical Laboratory Sciences,, Taibah University,, Prince Naif St. Madinah 42362,, Saudi Arabia, T: +966-14-8618888 ext: 3666, , ORCID: http://orcid.org/0000-0001.6977-9006
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17
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Schwarz TF, Behre U, Adelt T, Donner M, Suryakiran PV, Janssens W, Mesaros N, Panzer F. Long-term antibody persistence against hepatitis B in adolescents 14-15-years of age vaccinated with 4 doses of hexavalent DTPa-HBV-IPV/Hib vaccine in infancy. Hum Vaccin Immunother 2018; 15:235-241. [PMID: 30118633 PMCID: PMC6363144 DOI: 10.1080/21645515.2018.1509658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 11/03/2022] Open
Abstract
We evaluated antibody persistence against hepatitis B virus (HBV) in adolescents previously vaccinated with a hexavalent diphtheria-tetanus-acellular pertussis-HBV-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine (DTPa-HBV-IPV/Hib), as part of the national newborn immunization program in Germany. We also assessed the anamnestic response to a challenge dose of a monovalent HBV vaccine. In this phase 4, open-label, non-randomized study (NCT02798952), 302 adolescents aged 14-15 years, primed in their first 2 years of life with 4 DTPa-HBV-IPV/Hib doses, received one challenge dose of monovalent HBV vaccine. Blood samples were taken before and one month post-vaccination and used to determine antibody levels against hepatitis B surface antigen (HBs). Reactogenicity and safety were also assessed post-challenge dose. Pre-challenge dose, 53.7% of 268 participants included in the according-to-protocol cohort for immunogenicity had anti-HBs antibody concentrations ≥10 mIU/mL (seroprotection cut-off) and 16.8% had anti-HBs antibody concentrations ≥100 mIU/mL. One month post-challenge dose, 93.3% of adolescents had anti-HBs antibody concentrations ≥10 mIU/mL and 87.3% had antibody concentrations ≥100 mIU/mL. An anamnestic response was mounted in 92.5% of adolescents. Injection site pain (in 33.6% of participants) and fatigue (30.2%) were the most frequently reported solicited local and general symptoms, respectively. Six of the 55 unsolicited adverse events reported were considered vaccination-related. Two vaccination-unrelated serious adverse events were reported during the study. Long-term antibody persistence against hepatitis B was observed in 14-15 years old adolescents previously primed in infancy with DTPa-HBV-IPV/Hib. A challenge dose of monovalent HBV vaccine induced strong anamnestic response, with no safety concerns.
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Affiliation(s)
- Tino F. Schwarz
- Institute of Laboratory Medicine and Vaccination Centre, Klinikum Würzburg Mitte, Standort Juliusspital, Würzburg, Germany
| | - Ulrich Behre
- Pediatric Practice, Kehl, Baden-Württemberg, Germany
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18
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Osiowy C. From infancy and beyond… ensuring a lifetime of hepatitis B virus (HBV) vaccine-induced immunity. Hum Vaccin Immunother 2018; 14:2093-2097. [PMID: 29641290 PMCID: PMC6150009 DOI: 10.1080/21645515.2018.1462428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite the long-term efficacy and immune persistence observed following HBV vaccination of infants, the need for a booster dose following infant immunization continues to be deliberated. Evidence from HBV booster dose response studies and long-term immunization program reviews are the basis for the recommendation that a vaccine booster is not necessary. However, further studies continue to emerge and highlight the need for standardization among observational studies in order to appropriately compare outcomes. There is an assumption that neonatal and infant (within 12 months of age) vaccine immune responses are equivalent; however, evidence exists for distinct vaccine responses within the first year of life. HBV vaccine programs have evolved over time, particularly regarding the type and dosage of vaccine used. Several universal neonatal immunization programs initially incorporated a 2.5 μg dosage (Recombivax-HB, Merck). This dosage has been shown in multiple long-term studies and meta-analyses to be associated with a lower primary response, decreased antibody persistence over time, and a reduced booster response 10 to 20 years following immunization. Ongoing surveillance of this and other HBV neonatally-vaccinated populations, particularly in low endemic regions, is necessary to understand the impact on long-term protection in order to ensure lifelong protection against hepatitis B infection.
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Affiliation(s)
- Carla Osiowy
- a National Microbiology Laboratory , Public Health Agency of Canada , Winnipeg , Manitoba , Canada
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19
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Lao TT, Sahota DS, Chan PKS. Three decades of neonatal vaccination has greatly reduced antenatal prevalence of hepatitis B virus infection among gravidae covered by the program. J Infect 2018; 76:543-549. [PMID: 29742467 DOI: 10.1016/j.jinf.2018.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the impact of three decades of hepatitis B vaccination in infancy on antenatal prevalence of hepatitis B surface antigen (HBsAg) carriage in 93,134 Hong-Kong born gravidae managed in 1997-2015. METHODS Annual prevalence of HBsAg carriage on routine antenatal screening was examined with respect to maternal year of birth in three periods i.e. pre-1983 (before availability of vaccination), 1983-1988 (vaccination of infants born to HBsAg-carriers), and after 1988 (universal vaccination). RESULTS Overall HBsAg carriage was 8.3% (7737/93,134), decreasing from 10.5% in 1997 to 6.5% in 2015 (p < 0.001), and from 8.8%, 7.0% to 3.1%, respectively, for the three period-of-birth cohorts (p < 0.001). Annual prevalence decreased from 9.9% in 1997 to 7.5% in 2015 (p < 0.001) in the pre-1983 cohort, but showed neither difference nor trend in the other two cohorts. However, the annual prevalence showed significantly falling trends from the pre-1983 to the post-1988 cohorts for the years 2007-2008 and 2010-2015. CONCLUSIONS A progressive decline in overall annual prevalence of antenatal HBsAg carriage was found, with a consistently significant decline among the three cohorts for the years 2007-2008 and 2010-2015, providing evidence that universal hepatitis B vaccination in infancy has reduced significantly antenatal prevalence of HBsAg carriage in Hong Kong.
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Affiliation(s)
- Terence T Lao
- Departments of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong, China.
| | - Daljit S Sahota
- Departments of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong, China
| | - Paul K S Chan
- Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
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20
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Klinger G, Chodick G, Levy I. Long-term immunity to hepatitis B following vaccination in infancy: Real-world data analysis. Vaccine 2018; 36:2288-2292. [PMID: 29573878 DOI: 10.1016/j.vaccine.2018.03.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/14/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) vaccination has decreased the prevalence of chronic HBV infections and their sequelae. However, whether vaccination at birth provides lifelong protection is unclear. OBJECTIVE To assess long-term immunity following neonatal HBV immunization in a large population-based cohort. METHODS Using the database of a 2 million member sick fund in Israel, we identified all subjects born after introduction of universal HBV vaccination in Israel (January 1992 through December 2014), that were tested for hepatitis B surface antibody (anti-HBs Ab's). Years since vaccination were categorized into 5-year groups and linear trends in the seroprevalence of HBV immunity were calculated. Anamnestic response and presence of Hepatitis B surface antigen (HBs Ag) were assessed. RESULTS Included were 20,634 tested individuals. Mean (±SD) age at testing was 14.8 (±5.4) years. Mean anti-HBs Ab levels declined with time to 16.39 mIU/ml in the 15-20 year group (P < 0.001). The proportion of negative results increased gradually (P < 0.001) to 66.7% after 15 years. Anamnestic response assessment showed that 604 of 644 seronegative subjects (93.8%, 95% CI: 91.6-95.5%) became seropositive after a booster dose. HBs Ag was identified in 91 of the 20,634 (4.4 per 1000 study participants). CONCLUSIONS Following vaccination, anti-HB's Ab's progressively decline, with only a third of the population retaining protective levels after 15 years. In adolescence, anamnestic response shows that nearly all revaccinated adolescents exhibit immunity. A low rate of Hepatitis B infection was demonstrated despite vaccination of nearly all newborns.
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Affiliation(s)
- Gil Klinger
- Tel Aviv University, Sackler School of Medicine, 55 Chaim Levanon St., Tel Aviv 69978, Israel; Maccabi Health Care Services, Maccabi Institute of Health Services Research, 27 Ha'Mered St., Tel Aviv 68125, Israel; Schneider Children's Medical Center of Israel, Neonatal Intensive Care Unit, 14 Kaplan St., Petach Tikva 49202, Israel.
| | - Gabriel Chodick
- Tel Aviv University, Sackler School of Medicine, 55 Chaim Levanon St., Tel Aviv 69978, Israel; Maccabi Health Care Services, Maccabi Institute of Health Services Research, 27 Ha'Mered St., Tel Aviv 68125, Israel.
| | - Itzhak Levy
- Tel Aviv University, Sackler School of Medicine, 55 Chaim Levanon St., Tel Aviv 69978, Israel; Maccabi Health Care Services, Maccabi Institute of Health Services Research, 27 Ha'Mered St., Tel Aviv 68125, Israel; Schneider Children's Medical Center of Israel, Infectious Disease Unit, 14 Kaplan St., Petach Tikva 49202, Israel.
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21
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Arora A, Singh SP, Kumar A, Saraswat VA, Aggarwal R, Bangar M, Bhaumik P, Devarbhavi H, Dhiman RK, Dixit VK, Goel A, Goswami B, Kapoor D, Madan K, Narayan J, Nijhawan S, Pandey G, Rai RR, Sahu MK, Saraf N, Shalimar, Shenoy T, Thomas V, Wadhawan M. INASL Position Statements on Prevention, Diagnosis and Management of Hepatitis B Virus Infection in India: The Andaman Statements. J Clin Exp Hepatol 2018; 8:58-80. [PMID: 29743798 PMCID: PMC5938334 DOI: 10.1016/j.jceh.2017.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/09/2017] [Indexed: 12/12/2022] Open
Abstract
Hepatitis B Virus (HBV) infection is one of the major causes of morbidity, mortality and healthcare expenditure in India. There are no Indian consensus guidelines on prevention, diagnosis and management of HBV infection. The Indian National Association for Study of the Liver (INASL) set up a taskforce on HBV in 2016, with a mandate to develop consensus guidelines for diagnosis and management of HBV infection, relevant to disease patterns and clinical practices in India. The taskforce first identified contentious issues on various aspects of HBV management, which were allotted to individual members of the taskforce who reviewed them in detail. A 2-day round table discussion was held on 11th and 12th February 2017 at Port Blair, Andaman & Nicobar Islands, to discuss, debate, and finalize the consensus statements. The members of the taskforce reviewed and discussed the existing literature threadbare at this meeting and formulated the 'INASL position statements' on each of the issues. The evidence and recommendations in these guidelines have been graded according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) system with minor modifications. The strength of recommendations (strong: 1, weak: 2) thus reflects the quality (grade) of underlying evidence (A, B, C, D). We present here the INASL position statements on prevention, diagnosis and management of HBV in India.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- ADV, adefovir dipivoxil
- ALT, alanine aminotransferase
- APASL, Asian Pacific Association for the Study of the Liver
- ART, antiretroviral therapy
- AST, aspartate aminotransferase
- Anti-HBe, antibodies to hepatitis B envelope antigen
- CBC, complete blood count
- CDC, Center for Disease Control
- CHB, chronic hepatitis B
- CU-HCC, Chinese University-Hepatocellular Carcinoma
- DAA, direct-acting antiviral
- DILI, drug induced liver injury
- DNA, deoxyribonucleic acid
- EASL, European Association for the Study of the Liver
- ETV, entecavir
- GAG-HCC, Guide with Age, Gender, HBV DNA, Core Promoter Mutations and Cirrhosis-Hepatocellular Carcinoma
- GGT, gamma-glutamyl transferase
- GRADE, Grading of Recommendations Assessment Development and Evaluation
- HBIG, hepatitis B immune globulin
- HBV, hepatitis B virus
- HBeAg, hepatitis B envelope antigen
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HDV, hepatitis D virus
- HIV, human immunodeficiency virus
- IFN-α, interferon alpha
- INASL, Indian National Association for Study of the Liver
- INR, international normalized ratio
- KASL, Korean Association for the Study of the Liver
- LAM, lamivudine
- NA, nucleos(t)ide analogue
- PAGE-B, platelets, age, gender—hepatitis B
- PVNR, primary virological non-response
- PVR, partial virological response
- PegIFN-α, pegylated interferon alpha
- RCT, randomized controlled trial
- REACH-B, risk estimation for hepatocellular carcinoma in chronic hepatitis B
- SOVR, sustained off-therapy virological response
- TAF, tenofovir alafenamide
- TDF, tenofovir disoproxil fumarate
- TDV, telbivudine
- TSH, thyroid-stimulating hormone
- VR, virologic response
- WHO, World Health Organization
- anti-HBs, antibody to hepatitis B surface antigen
- cccDNA, covalently closed circular DNA
- chronic hepatitis
- cirrhosis
- eGFR, estimated glomerular filtration rate
- hepatitis B
- jaundice
- liver failure
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Affiliation(s)
- Anil Arora
- Director, Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Ganga Ram Institute for Postgraduate Medical Education & Research (GRIPMER), Sir Ganga Ram Hospital, New Delhi, India
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Sintusek P, Posuwan N, Wanawongsawad P, Jitraruch S, Poovorawan Y, Chongsrisawat V. High prevalence of hepatitis B-antibody loss and a case report of de novo hepatitis B virus infection in a child after living-donor liver transplantation. World J Gastroenterol 2018; 24:752-762. [PMID: 29456414 PMCID: PMC5807678 DOI: 10.3748/wjg.v24.i6.752] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/05/2018] [Accepted: 01/19/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the seroprevalence of hepatitis B virus (HBV) immunity among previously vaccinated pediatric liver transplant recipients and present a case report of de novo hepatitis B infection after liver transplantation.
METHODS This study focused on children with chronic liver diseases who received primary hepatitis B immunization and had a complete dataset of anti-HBs before and after liver transplantation between May 2001 and June 2017. Medical records were retrospectively reviewed for potential factors relating to HBV immunity loss.
RESULTS In total, 50 children were recruited. The mean time from liver transplantation to anti-HBs testing was 2.53 ± 2.11 years. The mean anti-HBs levels before and after liver transplantation were 584.41 ± 415.45 and 58.56 ± 6.40 IU/L, respectively. The rate of non-immunity (anti-HBs < 10 IU/L) in the participants was 46% (n = 26) at one year, 57% (n = 7) at two years and 82% (n = 17) at > three years following liver transplantation. The potential factors relating to HBV immunity loss after liver transplantation were identified as anti-HBs (P = 0.002), serum albumin (P = 0.04), total bilirubin (P = 0.001) and direct bilirubin (P = 0.003) before liver transplantation. A five-year-old boy with biliary cirrhosis received 4 doses of HBV vaccine with an anti-HBs titer of > 1000 IU/L and underwent liver transplantation; his anti-HBc-negative father was the donor. After liver transplantation, the boy had stenosis of the hepatic artery up to the inferior vena cava anastomosis and underwent venoplasty three times. He also received subcutaneous injections of enoxaparin for 5 mo and 20 transfusions of blood components. Three years and ten months after the liver transplantation, transaminitis was detected with positive tests for HBsAg, HBeAg, and anti-HBc (2169.61, 1706 and 8.45, respectively; cutoff value: < 1.00) and an HBV viral load of 33212320 IU/mL.
CONCLUSION The present study showed that loss of hepatitis B immunity after liver transplantation is unexpectedly common. In our case report, despite high levels of anti-HBs prior to transplantation, infection occurred at a time when, unfortunately, the child had lost immunity to hepatitis B after liver transplantation.
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Affiliation(s)
- Palittiya Sintusek
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nawarat Posuwan
- Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok10330, Thailand
| | - Piyaporn Wanawongsawad
- Excellence Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Suttiruk Jitraruch
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Yong Poovorawan
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Center of Excellence in Clinical Virology, Chulalongkorn University, Bangkok10330, Thailand
| | - Voranush Chongsrisawat
- Division of Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Incidence of Low Seroimmunity to Hepatitis B Virus in Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2017; 65:551-554. [PMID: 28333769 DOI: 10.1097/mpg.0000000000001580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Patients with inflammatory bowel disease (IBD) often receive immunosuppressive therapy, which may make them vulnerable to infections such as hepatitis B. We hypothesized that hepatitis B virus titers are low in the vaccinated pediatric population with IBD. The aims of our study were to identify the incidence of lower titers of hepatitis B surface antibody (HBsAb) and determine which patient factors may be associated with lower HBsAb titers. METHODS Patients with diagnosis of IBD, ages 5 to 18 years, were prospectively enrolled. Patients were confirmed to have had a full series of hepatitis B vaccination. Quantitative serum HBsAb titers were measured and logistic regression analysis with independent variables of age, sex, race, disease phenotype, surgery, medications and a dependent variable of adequate HBsAb titers (> 10 mIU/mL) was performed. RESULTS Of the 116 patients enrolled, 57 were boys and 59 were girls. 75 patients had a diagnosis of Crohn disease; 32 had a diagnosis of ulcerative colitis; and 9 patients had been diagnosed as having indeterminate colitis. At the time of the study, 15 patients were taking corticosteroid, 66 on an immunomodulator, and 53 on a biologic. Sixty percent of patients in the 5- to 10-year age group had protective titers versus 22% to 27% in the older groups, P = 0.04. Only 28% of the 116 patients had HBsAb titers of >10m IU/mL. Twenty percent of the patients taking corticosteroids, 27% taking immunomodulators, and 24% taking biologics were found to be seroimmune. CONCLUSIONS Nearly two-thirds of pediatric patients with IBD have low titers against hepatitis B virus. Titers were highest in the younger patients. No patient-specific variable, such as the use of immunosuppressants, appeared to influence these low titers.
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Stevens CE, Toy P, Kamili S, Taylor PE, Tong MJ, Xia GL, Vyas GN. Eradicating hepatitis B virus: The critical role of preventing perinatal transmission. Biologicals 2017; 50:3-19. [DOI: 10.1016/j.biologicals.2017.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022] Open
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Zanetti A, Desole MG, Romanò L, d'Alessandro A, Conversano M, Ferrera G, Panico MG, Tomasi A, Zoppi G, Zuliani M, Thomas S, Soubeyrand B, Eymin C, Lockhart S. Safety and immune response to a challenge dose of hepatitis B vaccine in healthy children primed 10years earlier with hexavalent vaccines in a 3, 5, 11-month schedule: An open-label, controlled, multicentre trial in Italy. Vaccine 2017. [PMID: 28624307 DOI: 10.1016/j.vaccine.2017.05.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS The strategy of vaccinating infants to prevent hepatitis B virus infection in adolescence or adulthood requires durable immunity. This study investigated responses to a challenge dose of monovalent hepatitis B vaccine in children primed with three doses of either Hexavac® or Infanrix hexa® 10years earlier during infancy. METHODS This open-label, controlled, multicentre study conducted in Italy, enrolled 751 healthy pre-adolescents (aged 11-13years) who were given either Hexavac (n=409) or Infanrix hexa (n=342) at 3, 5 and 11months of life. All participants received a challenge dose of a monovalent hepatitis B vaccine (HBVaxPro® 5µg). The concentrations of antibodies to hepatitis B surface antigen (anti-HBs) were measured before and 1month after the challenge dose. The analysis was descriptive and no formal hypothesis was tested. RESULTS One month post-challenge, 331 participants in the Hexavac cohort [83.6%, 95% CI: 79.6; 87.1] and 324 in the Infanrix hexa cohort [96.4%, 95% CI: 93.8; 98.1] had anti-HBs concentrations ≥10mIU/mL. Before the challenge dose, an anti-HBs concentration of ≥10mIU/mL was found in 94 children in the Hexavac cohort [23.9%, 95% CI: 19.7; 28.4] and in 232 children in the Infanrix hexa cohort [69%, 95% CI: 63.8; 74.0]. Among children with a pre-challenge anti-HBs concentration of <10mIU/mL, 236 [78.7%, 95% CI: 73.6; 83.2] in the Hexavac cohort and 92 [88.5%, 95% CI: 80.7; 93.9] in the Infanrix hexa cohort achieved protective anti-HBs antibody concentrations. No evidence of active hepatitis B disease was observed in either group, and the HBVaxPro challenge dose was well tolerated. CONCLUSIONS These data confirm that immune memory persists in a high percentage of children (>80%) at least 10years after a two-dose primary and booster vaccination schedule with a hexavalent vaccine (Hexavac or Infanrix hexa). TRIAL REGISTRATION EudraCT Number: 2013-001602-28; clinicaltrials.gov: NCT02012998.
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Affiliation(s)
- Alessandro Zanetti
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy.
| | | | - Luisa Romanò
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy.
| | - Antonio d'Alessandro
- ASL Salerno, Dipartimento di Prevenzione Servizio Epidemiologia e Prevenzione, Via Bruno Grimaldi 60, 84014 Nocera Inferiore, Salerno, Italy.
| | - Michele Conversano
- ASL 1 Taranto, Servizio di Igiene Pubblica, Ospedale Civile Pagliari, Viale Magna Grecia, 74016 Massafra, Taranto, Italy.
| | - Giuseppe Ferrera
- ASP 7 Ragusa, Servizio di Epidemiologia e Prevenzione, Via Aldo Licitra, 11, 97100 Ragusa, Italy.
| | - Maria Grazia Panico
- Servizio di Epidemiologia ASL Salerno, Via Settimio Mobilio, 52, 84100 Salerno, Italy.
| | - Alberto Tomasi
- ASL 2 Lucca, U.O. Igiene e Sanità Pubblica, Dipartimento della Prevenzione, Piazza Aldo Moro, 5, 55012 Capannori, Lucca, Italy.
| | - Giorgio Zoppi
- ASL n. 4 Chiavarese, Dipartimento di Prevenzione, Struttura Complessa Igiene e Sanità Pubblica, Corso Dante, 16043 Chiavari, Genova, Italy.
| | - Massimo Zuliani
- ASS n. 5 "Bassa Friulana", Dipartimento di Prevenzione Servizio di Igiene e Sanità Pubblica c/o Ospedale di Latisana, Via Sabbionera 45, 33053 Latisana, Udine, Italy.
| | - Stéphane Thomas
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367 Lyon Cedex 07, France.
| | - Benoît Soubeyrand
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367 Lyon Cedex 07, France.
| | - Cécile Eymin
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367 Lyon Cedex 07, France.
| | - Stephen Lockhart
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367 Lyon Cedex 07, France.
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Romanò L, Galli C, Tagliacarne C, Tosti ME, Velati C, Fomiatti L, Chironna M, Coppola RC, Cuccia M, Mangione R, Marrone F, Negrone FS, Parlato A, Zotti CM, Mele A, Zanetti AR. Persistence of immunity 18-19 years after vaccination against hepatitis B in 2 cohorts of vaccinees primed as infants or as adolescents in Italy. Hum Vaccin Immunother 2017; 13:981-985. [PMID: 28272974 DOI: 10.1080/21645515.2017.1264795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This study was aimed at assessing the anti-HBs persistence and immune memory 18-19 y after vaccination against hepatitis B in healthy individuals primed as infants or adolescents. We enrolled 405 teenagers (Group A) vaccinated as infants, and 409 young adults (Group B) vaccinated as adolescents. All vaccinees were tested for anti-HBs and anti-HBc antibodies; those found anti-HBc positive were further tested for HBsAg and HBV DNA. Eight individuals belonging to Group B were positive for anti-HBc alone, and were excluded from analysis. Individuals with anti-HBs concentration ≥ 10 mIU/ml were considered protected while those with anti-HBs concentration <10 mIU/ml were offered a booster dose and re-tested 2 weeks later. Overall, 67.9% individuals showed anti-HBs concentrations ≥ 10 mIU/ml (48.9% in Group A vs 87.0% in Group B, p < 0.001). The antibody geometric mean concentration (GMC) was higher in Group B than in Group A (102.5 mIU/ml vs 6.9 mIU/ml; p < 0.001). When boosted, 94.2% of vaccinees with anti-HBs <10 mIU/ml belonging to Group A and 94.7% to Group B showed an anamnestic response. Post-booster GMCs were similar in both groups (477.9 mIU/ml for Group A vs 710.0 mIU/ml for Group B, p = n.s.). Strong immunological memory persists for at least 18-19 y after immunization of infants or adolescents with a primary course of vaccination. Thus, booster doses are not needed at this time, but additional follow up is required to assess the long-life longevity of protection.
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Affiliation(s)
- Luisa Romanò
- a Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano , Milano , Italy
| | - Cristina Galli
- a Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano , Milano , Italy
| | - Catia Tagliacarne
- a Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano , Milano , Italy
| | - Maria Elena Tosti
- b Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute , Istituto Superiore di Sanità , Roma , Italy
| | - Claudio Velati
- c Servizio di Immunoematologia e Medicina Trasfusionale, Policlinico S Orsola Malpighi , Bologna , Italy
| | - Laura Fomiatti
- d Servizio di Immunoematologia e Medicina Trasfusionale, ASST della Valtellina e dell'Alto Lario, Presidio di Sondrio , Sondrio , Italy
| | - Maria Chironna
- e Dipartimento di Scienze Biomediche ed Oncologia Umana , Università di Bari , Bari, Italy
| | - Rosa Cristina Coppola
- f Dipartimento di Sanità Pubblica , Medicina Clinica e Molecolare, Università di Cagliari , Cagliari , Italy
| | - Mario Cuccia
- g Settore Igiene Pubblica, Servizio di Epidemiologia e Prevenzione, ASP Catania , Catania , Italy
| | - Rossana Mangione
- h Servizio di Sanità Pubblica, Epidemiologia e Medicina Preventiva , ASP Agrigento, Distretto di Licata , Licata , Agrigento , Italy
| | - Fosca Marrone
- i UO Pediatria e Consultorio Familiare , Pediatria di Comunità, AUSL della Romagna-Cesena , Cesena , Italy
| | | | - Antonino Parlato
- k Dipartimento di Prevenzione , Servizio Dipartimentale di Epidemiologia e Prevenzione, ASL Napoli 2 Nord , Napoli , Italy
| | - Carla Maria Zotti
- l Dipartimento di Scienze della Sanità Pubblica e Pediatriche , Università di Torino , Torino , Italy
| | - Alfonso Mele
- b Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute , Istituto Superiore di Sanità , Roma , Italy
| | - Alessandro Remo Zanetti
- a Dipartimento di Scienze Biomediche per la Salute , Università degli Studi di Milano , Milano , Italy
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Lao TT. Long-term persistence of immunity after hepatitis B vaccination: Is this substantiated by the literature? Hum Vaccin Immunother 2017; 13:918-920. [PMID: 28277087 DOI: 10.1080/21645515.2016.1267084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Hepatitis B vaccination is held to provide life-long protection against hepatitis B virus (HBV) infection, but evidence for this notion remains wanting, since no studies have assessed the vaccinees in their fourth decade of life. Indeed, there are several reports indicating that despite vaccination in infancy, the prevalence of HBV infection still increased with age in the vaccinees, and that both anti-HBs titer and anamnestic response declined with age. Clearly it is time to clarify the long-term protection conferred by vaccination in infancy, and to implement remedial measures such as booster doses of vaccine in subjects without immunoprotection.
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Affiliation(s)
- Terence T Lao
- a Department of Obstetrics & Gynaecology , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong
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Schistosoma mansoni Infection Can Jeopardize the Duration of Protective Levels of Antibody Responses to Immunizations against Hepatitis B and Tetanus Toxoid. PLoS Negl Trop Dis 2016; 10:e0005180. [PMID: 27926921 PMCID: PMC5142771 DOI: 10.1371/journal.pntd.0005180] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/10/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Schistosomiasis is a disease of major public health importance in sub-Saharan Africa. Immunoregulation begins early in schistosome infection and is characterized by hyporesponsiveness to parasite and bystander antigens, suggesting that a schistosome infection at the time of immunization could negatively impact the induction of protective vaccine responses. This study examined whether having a Schistosoma mansoni infection at the time of immunization with hepatitis B and tetanus toxoid (TT) vaccines impacts an individual's ability to achieve and maintain protective antibody levels against hepatitis B surface antigen or TT. METHODS Adults were recruited from Kisumu Polytechnic College in Western Kenya. At enrollment, participants were screened for schistosomiasis and soil transmitted helminths (STHs) and assigned to groups based on helminth status. The vaccines were then administered and helminth infections treated a week after the first hepatitis B boost. Over an 8 month period, 3 blood specimens were obtained for the evaluation of humoral and cytokine responses to the vaccine antigens and for immunophenotyping. RESULTS 146 individuals were available for final analysis and 26% were S. mansoni positive (Sm+). Schistosomiasis did not impede the generation of initial minimum protective antibody levels to either hepatitis B or TT vaccines. However, median hepatitis B surface antibody levels were significantly lower in the Sm+ group after the first boost and remained lower, but not significantly lower, following praziquantel (PZQ) treatment and final boost. In addition, 8 months following TT boost and 7 months following PZQ treatment, Sm+ individuals were more likely to have anti-TT antibody levels fall below levels considered optimal for long term protection. IL-5 levels in response to in vitro TT stimulation of whole blood were significantly higher in the Sm+ group at the 8 month time period as well. CONCLUSIONS Individuals with schistosomiasis at the start the immunizations were capable of responding appropriately to the vaccines as measured by antibody responses. However, they may be at risk of a more rapid decline in antibody levels over time, suggesting that treating schistosome infections with praziquantel before immunizations could be beneficial. The timing of the treatment as well as its full impact on the maintenance of antibodies against vaccine antigens remains to be elucidated.
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Melhem NM, Mahfouz RA, Kreidieh K, Abdul-Khalik R, El-Khatib R, Talhouk R, Musharrafieh U, Hamadeh G. Potential role of killer immunoglobulin receptor genes among individuals vaccinated against hepatitis B virus in Lebanon. World J Hepatol 2016; 8:1212-1221. [PMID: 27803766 PMCID: PMC5067441 DOI: 10.4254/wjh.v8.i29.1212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/13/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the role of killer immunoglobulin receptor (KIR) genes in responsiveness or non-responsiveness to vaccination against hepatitis B virus.
METHODS We recruited 101 voluntary participants between March 2010 and December 2011. Sera samples from vaccinated and non-vaccinated participants were tested for the presence of anti-HBs antibodies as a measure of protection against hepatitis B, hepatitis B surface antigen and hepatitis B core antibody as indicators of infection by enzyme-linked immunosorbent assay. KIR gene frequencies were determined by polymerase chain reaction.
RESULTS Sera samples from 99 participants were tested for the levels of anti-HBs as an indicator of protection (≥ 10 mIU/mL) following vaccination as defined by the World Health Organization international reference standard. Among the vaccinated participants, 47% (35/74) had anti-HBs titers above 100 mIU/mL, 22% (16/74) had anti-HBs ranging between 10-100 mIU/mL, and 20% (15/74) had values of less than 10 mIU/mL. We report the lack of significant association between the number of vaccine dosages and the titer of antibodies among our vaccinated participants. The inhibitory KIR2DL1, KIR2DL4, KIR3DL1, KIR3DL2, and KIR3DL were detected in more than 95%, whereas KIR2DL2, KIR2DL3, KIR2DL5 (KR2DL5A and KIR2DL5B) were expressed in 56%, 84% and 42% (25% and 29%) of participants, respectively. The observed frequency of the activating KIR genes ranged between 35% and 55% except for KIR2DS4, detected in 95% of the study participants (40.6% 2DS4*001/002; 82.2% 2DS4*003/007). KIR2DP1 pseudogene was detected in 99% of our participants, whereas KIR3DP*001/02/04 and KIR3DP1*003 had frequencies of 17% and 100%, respectively. No association between the frequency of KIR genes and anti-HBs antibodies was detected. When we compared the frequency of KIR genes between vaccinated individuals with protective antibodies titers and those who lost their protective antibody levels, we did not detect a significant difference. KIR2DL5B was significantly different among different groups of vaccinated participants (group I > 100 mIU/mL, group II 10-100 mIU/mL, group III < 10 mIU/mL and group IV with undetectable levels of protective antibodies).
CONCLUSION To our knowledge, this is the first study screening for the possible role of KIR genes among individuals vaccinated against hepatitis B virus (HBV). Our results can be used to design larger studies to better understand the role of KIR genes in protection against or susceptibility to HBV post vaccination.
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Lu IC, Jean MCY, Lin CW, Chen WH, Perng DS, Lin CW, Chuang HY. Predictive factors for anti-HBs status after 1 booster dose of hepatitis B vaccine. Medicine (Baltimore) 2016; 95:e5023. [PMID: 27684874 PMCID: PMC5265967 DOI: 10.1097/md.0000000000005023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In Taiwan, infants need to receive 3 doses of hepatitis B virus (HBV) vaccine under the public health policy from the government. However, there are many young adults who even though received complete HBV vaccination in their childhood would lose the positive response of anti-hepatitis B surface antibody (HBs) and need the booster dose of HBV vaccine. The aim of our study is to determine the powerful predictive factor for screening the candidates who need only 1 booster dose of HB vaccine then they can regain positive postbooster anti-HBs status (≧10 mIU/mL) or protective postbooster anti-HBs status (≧100 mIU/mL).We recruited 103 university freshmen who were born after July 1986 with complete HBV vaccination in childhood, but displayed negative results for hepatitis B surface antigen and anti-HBs levels at their health examinations upon university entry. They received 1 booster dose of HB vaccine, and their anti-HBs titers were rechecked 4 weeks after the booster administration. Multivariate analysis logistic regression for positive postbooster anti-HBs status (≧10 mIU/mL, model 1) and protective postbooster anti-HBs status (≧100 mIU/mL, model 2) was done with predictive factors of prebooster anti-HBs level, body mass index, serum glutamate pyruvate transaminase level, and sex.Twenty-four students got positive postbooster anti-HBs status (10-100 mIU/mL) and 50 students got protective postbooster anti-HBs status (≧100 mIU/mL). In the model of multivariate analysis logistic regression for positive postbooster anti-HBs status (≧10 mIU/mL), prebooster anti-HBs level was the strongest predictive factor. The odds ratio was 218.645 and the P value was 0.001. Even in the model of multivariate analysis logistic regression for protective postbooster anti-HBs status (≧100 mIU/mL), prebooster anti-HBs level was still the strongest predictive factor, but the odds ratio of a protective booster effect was 2.143, with 95% confidence interval between 1.552 and 2.959, and the P value was less than 0.001.Prebooster anti-HBs level can be the powerful predictive factor for positive postbooster anti-HBs status (≧10 mIU/mL) and protective postbooster anti-HBs status (≧100 mIU/mL). According to the result of this study, if someone received complete HBV vaccination in childhood, but displayed negative results for hepatitis B surface antigen and anti-HBs levels around 2 decades later, 1 booster dose of HBV vaccine could help him or her to regain positive postbooster anti-HBs status (≧10 mIU/mL) under the strong predictive factor of prebooster anti-HBs level higher than 1 mIU/mL. The other 2 HBV vaccines could be saved and the case could also save money and time.
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Affiliation(s)
- I-Cheng Lu
- Department of Family Medicine, E-Da Hospital
- I-Shou University
- Department of Occupational Medicine, E-Da Hospital
- Kaohsiung Medical University
| | - Mei-Chu Yen Jean
- Department of Family Medicine, E-Da Hospital
- I-Shou University
- Department of Occupational Medicine, E-Da Hospital
| | - Chi-Wei Lin
- Department of Family Medicine, E-Da Hospital
- I-Shou University
| | - Wei-Hung Chen
- I-Shou University
- Kaohsiung Medical University
- Department of Anesthesia, E-Da Hospital
| | - Daw-Shyong Perng
- I-Shou University
- Kaohsiung Medical University
- Department of Hepatology and Gastroenterology Medicine, E-Da Hospital
| | - Chih-Wen Lin
- I-Shou University
- Kaohsiung Medical University
- Department of Hepatology and Gastroenterology Medicine, E-Da Hospital
| | - Hung-Yi Chuang
- Kaohsiung Medical University
- Department of Environmental and Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan ROC
- Correspondence: Hung-Yi Chuang, Department of Public Health, Kaohsiung Medical University, and Department of Environmental and Occupational Medicine, Kaohsiung Medical University Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan, ROC (e-mail: )
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Impact and long-term protection of hepatitis B vaccination: 17 years after universal hepatitis B vaccination in Tunisia. Epidemiol Infect 2016; 144:3365-3375. [PMID: 27535719 DOI: 10.1017/s0950268816001849] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) vaccination has been part of the Expanded Programme of Immunization (EPI) in Tunisia since 1995. The aim of this study was to evaluate, for the first time, the impact of mass vaccination in Tunisia 17 years after this programme was implemented, and in parallel, assess the long-term persistence of anti-HBs antibody in the vaccinated Tunisian population. A total of 1422 students were recruited (703 vaccinated, 719 non-vaccinated). HBV seromarkers were checked. None of the students from either group had positive HBsAg. The overall prevalence of anti-HBc was 0·8%. A Significantly higher prevalence of anti-HBc was noted in unvaccinated students than in vaccinated (1·4% vs. 0·3%, P = 0·02). The overall seroprotection rate (anti-HBs titre ⩾10 mIU/ml) was 68·9% in vaccinated subjects. Seroprotection rates and geometric mean titres decreased significantly with increasing age, reflecting waning anti-HBs titre over time. No significant difference was detected between seroprotection rates and gender or students' area of origin. Incomplete vaccination was the only factor associated with an anti-HBs titre <10 mIU/ml. This study demonstrates the excellent efficacy of the HBV vaccination programme in Tunisia 17 years after its launch. However, a significant decline of anti-HBs seroprotection has been observed in ⩾15-year-old adolescents which places them at risk of infection. Additional studies are needed in hyperendemic regions in Tunisia.
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Qawasmi M, Samuh M, Glebe D, Gerlich WH, Azzeh M. Age-dependent decrease of anti-HBs titers and effect of booster doses using 2 different vaccines in Palestinian children vaccinated in early childhood. Hum Vaccin Immunother 2016; 11:1717-24. [PMID: 25996579 DOI: 10.1080/21645515.2015.1041687] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Immunization against hepatitis B virus (HBV) has proven to be highly effective and led to significant reduction of new infections worldwide. However, protective immunity measured by anti-HBs titers may decrease to critical levels in the years after basal immunization, particularly in case of exposure to HBV variants different from the vaccine strain. We tested 400 Palestinian children between one and 19 years of age for their anti-HBs titer, challenged the immune memory of those with low or absent anti-HBs with 2 types of hepatitis B vaccines and determined thereafter the anti-HBs titer. At the age of one, 92.2% of the children presented with protective anti-HBs titers (≥ 10 mIU/ml) with the majority having ≥ 100 mIU/ml. Protective immunity was still high at ages 2 (87.5%) and 4 (95%), declining by age 5 and 6 (from 69.2% to 66.7%) and down to an average of 39.8% between the ages of 7 and 19. 160 children with a nonprotective or low immune response challenged with either the yeast-derived Engerix-B or the mammalian cell-derived preS1-containing Sci-B-Vac vaccine showed an anamnestic immune response. 92.4% and 85.9% of the children challenged with one dose Sci-B-Vac and Engerix-B presented with anti-HBs titers >100 mIU/ml respectively. Our results reveal that vaccine-induced protective anti-HBs titers against HBV decrease rapidly beyond the age of 6 in Palestinian children, but can be strongly enhanced with a single booster vaccine dose, independent of brand and antigen composition. Our data suggest that a booster vaccine dose against HBV during school years may be useful.
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Affiliation(s)
- Mohammad Qawasmi
- a Virology Research Laboratory; Medical Research Center; Al-Quds University ; Abu Dies-East Jerusalem, Palestine
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Markers of Protection in Children and Adolescents Six to Fourteen Years After Primary Hepatitis B Vaccination in Real Life: A Pilot Study. Pediatr Infect Dis J 2016; 35:286-91. [PMID: 26569192 DOI: 10.1097/inf.0000000000000994] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Not many data are available on long-term immunity against hepatitis B (HB) for children vaccinated under real-life conditions. METHODS Two hundred and thirty-two children and adolescents vaccinated 6-14 years earlier in pediatric practices were examined for conditions of vaccination and markers of protection as anti-HBs, anamnestic response to a booster dose and cell-mediated immunity. RESULTS Fifty-six percent of the participants were vaccinated according to the German vaccination recommendations (group 1). In 44.0% (group 2), these recommendations were not followed. Anti-HBs concentrations of ≥10 IU/L were found in 53.1% of group 1 and 45.1% of group 2 participants. A booster dose resulted in 91 of 99 participants in having an anamnestic response, in 3 (5.9%) of group 1 and 5 (10.4%) of group 2 anti-HBs remained below 10 IU/L. In group 1, postbooster anti-HBs concentration was inversely correlated with time since the last vaccination. Cellular immune responses were seen in only 5% of revaccinated individuals before the booster, increasing to 30% thereafter. CONCLUSIONS Under real-life conditions about half of vaccinees have lost protecting antibodies 6-14 years after vaccination in infancy, but in approximately 90% of them, immune memory was demonstrated. However, as memory may wane, revaccination at a time when boostability is still present might be considered.
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Lao TT. Immune persistence after hepatitis B vaccination in infancy - Fact or fancy? Hum Vaccin Immunother 2016; 12:1172-6. [PMID: 26810256 DOI: 10.1080/21645515.2015.1130195] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The hepatitis B vaccine has been introduced for more than 3 decades. In Hong Kong, excellent vaccine coverage through an efficient public health care system, together with supplemental programmes and easy availability of the vaccine, meant that most young pregnant women, and university students at entrance, should have been protected. Yet significant correlations in the prevalence of HBV infection with age were found in these groups of subjects, increasing from low to high endemicity rates from late teenage to the early twenties. This can only be attributed to vaccine failure, and there is cumulating evidence that several factors are involved, including the failure to respond to a primary series of hepatitis B vaccination in infancy, the waning of antibody titer with age, and loss of anamnestic response in a significant portion of the vaccinees. The duration of protection conferred by hepatitis B vaccination in infancy should be re-examined and remedial measures undertaken if its long term protection is found to be insufficient. Otherwise, the efforts to control HBV infection, especially in high endemicity regions, with universal vaccination in infancy would be rendered futile.
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Affiliation(s)
- Terence T Lao
- a Department of Obstetrics & Gynaecology , The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , Hong Kong SAR , PRC
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Brunskole Hummel I, Zitzmann A, Erl M, Wenzel JJ, Jilg W. Characteristics of immune memory 10-15 years after primary hepatitis B vaccination. Vaccine 2015; 34:636-642. [PMID: 26718687 DOI: 10.1016/j.vaccine.2015.12.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/08/2015] [Accepted: 12/11/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS The definition of immune memory after hepatitis B vaccination is still under debate. Therefore, we analysed hepatitis B surface antigen (HBsAg)-specific memory in more detail by investigating the kinetics of humoral and cellular responses after hepatitis B booster vaccination. METHODS The anti-HBs kinetics of 23 individuals with anti-HBs titres below 10 IU/l, who had been vaccinated 10-15 years ago, was monitored at day 0, 3, 7, 14 and 28 after booster vaccination. HBsAg-specific IFNγ- and IL5-secreting cells in enriched CD4(+) fraction were measured at day 0, 7 and 28 post-booster by enzyme-linked immunospot assay (ELISpot). RESULTS 22 of 23 subjects showed similar anti-HBs kinetic curves, including 3 of 4 subjects who did not reach anti-HBs titres of 10 IU/l. The steep anti-HBs increase started between day 3 and 7 and peaked around day 14. A plateau or only minimal changes were visible between day 14 and 28. 17.4% of subjects showed pre-booster cellular responses, and this rate had increased to 47.8% and 56.5% after 7 and 28 days, respectively. The kinetic patterns of T cell responses differed considerably among subjects. A dominance of Th2 responses (IL5 secretion) over Th1 responses (IFNγ secretion) could be observed. CONCLUSIONS The presence of B cell memory could be shown by a typical anamnestic anti-HBs response curve after a booster dose in all but one individual. In contrast, T cell responses to booster vaccination, which occurred in approximately 50% of participants, were rather heterogeneous.
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Affiliation(s)
- Irena Brunskole Hummel
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
| | - Anita Zitzmann
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
| | - Monika Erl
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
| | - Jürgen J Wenzel
- Institute of Clinical Microbiology and Hygiene, University Medical Centre Regensburg, 93053 Regensburg, Germany.
| | - Wolfgang Jilg
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
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Hartal M, Yavnai N, Galor I, Avramovich E, Sela T, Kayouf R, Tzurel-Ferber A, Greenberg LJ, Halperin T, Levine H. Seroprevalence of anti-HBs antibodies at young adulthood, before and after a booster vaccine dose, among medical personnel vaccinated in infancy. Vaccine 2015; 33:4878-85. [DOI: 10.1016/j.vaccine.2015.07.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/20/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
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Abstract
Hepatitis B and A account for considerable morbidity and mortality worldwide. Immunization is the most effective means of preventing hepatitis B and A. However, the immune response to both hepatitis vaccines seems to be reduced in HIV-infected subjects. The aim of this review was to analyze the immunogenicity, safety, long-term protection and current recommendations of hepatitis B and A vaccination among HIV-infected adults. The factors most frequently associated with a deficient level of anti-HBs or IgG anti-HAV after vaccination are those related to immunosuppression (CD4 level and HIV RNA viral load) and to the frequency of administration and/or the amount of antigenic load per dose. The duration of the response to both HBV and HAV vaccines is associated with suppression of the viral load at vaccination and, in the case of HBV vaccination, with a higher level of antibodies after vaccination. In terms of safety, there is no evidence of more, or different, adverse effects compared with HIV-free individuals. Despite literature-based advice on the administration of alternative schedules, revaccination after the failure of primary vaccination, and the need for periodic re-evaluation of antibody levels, few firm recommendations are found in the leading guidelines.
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Affiliation(s)
- G Mena
- a Department of Preventive Medicine & Care Quality ; Hospital General Universitario de Castellón ; Castellón de la Plana , Spain
| | - A L García-Basteiro
- b ISGlobal; Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona ; Barcelona , Spain.,c Centro de Investigação em Saúde deg Manhiça (CISM) ; Manhiça, Maputo , Mozambique
| | - J M Bayas
- b ISGlobal; Barcelona Ctr. Int. Health Res. (CRESIB); Hospital Clínic - Universitat de Barcelona ; Barcelona , Spain.,d Department of Preventive Medicine & Epidemiology ; Hospital Clínic de Barcelona; Universitat de Barcelona ; Barcelona , Spain
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Yin J, Ji Z, Liang P, Wu Q, Cui F, Wang F, Liang X, Zhuang G. The doses of 10 μg should replace the doses of 5 μg in newborn hepatitis B vaccination in China: A cost-effectiveness analysis. Vaccine 2015; 33:3731-8. [PMID: 26057138 DOI: 10.1016/j.vaccine.2015.05.082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 05/11/2015] [Accepted: 05/27/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify whether Chinese current series of three 5 μg doses for newborn hepatitis B vaccination should be replaced by the series of three 10 μg doses. METHODS A cost-effectiveness analysis was conducted from the societal perspective based on the constructed decision tree-Markov model. Model parameters were estimated from published literatures, government documents and our surveys. The expected cost and effectiveness were compared between the 3-dose 5 μg series (the 5 μg strategy) and the 3-dose 10 μg series (the 10 μg strategy), and the incremental cost-effectiveness ratio (ICER, additional cost per quality-adjusted life-years gained) was calculated. Threshold values of the efficacy difference of the two series for the ICER=0, 1 and 3 times per capita gross domestic product were analyzed under different scenarios to understand whether the 10 μg strategy should replace the 5 μg strategy according to the recommendation of World Health Organization. RESULTS The 10 μg strategy would be cost-saving compared with the 5 μg strategy under the base-case scenario. Under keeping all the other parameters at the base-case values or further adjusting any one of them to the value most unfavorable to the 10 μg strategy, as long as the efficacy of 3-dose 10 μg series was slightly higher than that of 3-dose 5 μg series, the 10 μg strategy would be cost-effective, highly cost-effective, or even cost-saving. Even under the most pessimistic scenario, i.e. all the other parameters, but the discount rate, at the values most unfavorable to the 10 μg strategy, the 10 μg strategy would be cost-effective if the efficacy difference reached higher than 1.23 percentage point. CONCLUSION For newborn hepatitis B vaccination in China, the 10 μg strategy should be cost-effective, even more possibly highly cost-effective or cost-saving compared with the current 5 μg strategy. The doses of 10 μg should be considered to replace the doses of 5 μg in newborn hepatitis B vaccination in China.
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Affiliation(s)
- Juan Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Zhenhao Ji
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Peifeng Liang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Qian Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China
| | - Fuqiang Cui
- Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Fuzhen Wang
- Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, China.
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Liao X, Liang Z. Strategy vaccination against Hepatitis B in China. Hum Vaccin Immunother 2015; 11:1534-9. [PMID: 25881006 PMCID: PMC4514356 DOI: 10.4161/21645515.2014.980206] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/28/2014] [Accepted: 09/09/2014] [Indexed: 11/19/2022] Open
Abstract
Hepatitis B (HB) is a serious public health problem in China. Up to now, the hepatitis B virus (HBV) vaccination was the most cost-effective way to prevent HBV infection. Since 1992, when the Chinese government prioritized implementing the HBV vaccinations for newborns, China began to see a larger reduction in HBV infections. For children under 5 years, the prevalence of hepatitis B surface antigen (HBsAg) has decreased to 1.0%. However, many additional challenges for the prevention and control of HBV infection in China remain. There is a lack of knowledge of the significant impact of the HBV vaccination for the general public with 93 million HBV carriers and chronic HBV patients as infection sources. Therefore, the HBV vaccine application should focus on the optimization of immunization strategies according to HBV prevalence characteristics, improve the public's knowledge of HBV vaccinations, and help to ensure the protective effects of the HBV vaccine.
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Affiliation(s)
- Xueyan Liao
- National Institutes for Food and Drug Control No.2; Tiantan Xili; Beijing, China
| | - Zhenglun Liang
- National Institutes for Food and Drug Control No.2; Tiantan Xili; Beijing, China
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Hepatitis B vaccine response among infants born to hepatitis B surface antigen-positive women. Vaccine 2015; 33:15-6. [DOI: 10.1016/j.vaccine.2014.05.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/28/2014] [Accepted: 05/07/2014] [Indexed: 11/19/2022]
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Trevisan A, Nicolli A, Chiara F. Hepatitis B: prevention, protection and occupational risk. Future Virol 2015. [DOI: 10.2217/fvl.14.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT Since 1992, the inclusion of HBV vaccination has been recommended by the WHO for all immunization programs implemented by nations. In Europe, the introduction of HBV vaccination has markedly reduced the incidence of acute HBV, and before the introduction of HBV vaccine, healthcare workers (HCW) were at considerable risk of infection. The present review discusses the main problems regarding three fundamental issues in hospital settings: prevention of HBV in HCW, protection induced by vaccination (problems regarding nonresponders) and risk for HCW exposed to blood-borne pathogens (occupational risk). The screening of HBV markers plays a decisive role in evaluating the degree of immune coverage in subjects exposed to biological risk and permits an increase in immune coverage through vaccine implementation.
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Affiliation(s)
- Andrea Trevisan
- Department of Cardiologic, Thoracic & Vascular Sciences, University of Padova, Via Giustiniani 2, I-35128 Padova, Italy
| | - Annamaria Nicolli
- Department of Cardiologic, Thoracic & Vascular Sciences, University of Padova, Via Giustiniani 2, I-35128 Padova, Italy
| | - Federica Chiara
- Department of Cardiologic, Thoracic & Vascular Sciences, University of Padova, Via Giustiniani 2, I-35128 Padova, Italy
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Momeni N, Ahmad Akhoundi MS, Alavian SM, Shamshiri AR, Norouzi M, Mahboobi N, Moosavi N, Jazayeri SM. HBV vaccination status and response to hepatitis B vaccine among Iranian dentists, correlation with risk factors and preventive measures. HEPATITIS MONTHLY 2014; 15:e20014. [PMID: 25741367 PMCID: PMC4344650 DOI: 10.5812/hepatmon.20014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 12/06/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies showed that HBV vaccination and consequent level of antibody are not completely adequate among dentists despite performance of highly exposure prone procedures. OBJECTIVES The objectives of the study were to evaluate the levels of responsiveness to HBV vaccine and to determine the occupational factors associated among dental staff. MATERIALS AND METHODS In total, 1612 dental health care workers were recruited. The level of anti-HBs was tested using a commercially enzyme-linked immunosorbent assay (ELISA). Data on demographic, risk factors associated with dental practice and level of protective procedures and occupational exposure aspects were collected through self-reported questionnaires. RESULTS Of 1538 vaccinated individuals, 55 (3.7%), 126 (8.4%) and 1309 (87.9%) had received one, two and full three doses of vaccine, respectively. One-hundred-seventy-six (11.5%) were nonimmune (anti-HBs < 10 IU/mL) and 1362 (88.5%) were immune (anti-HBs > 10 IU/ mL). 392/542 (72.3%) of dentists who received their third dose of vaccination less than five years before the commencement of study were completely immune compared to those who had completed all three recommended doses in a longer period (308/491, 64.3%) (P = 0.001). Fifty-eight (3.59%) of participants did not receive any HBV vaccine at all; however, they had positive results for anti-HBs, indicating a past HBV infection. Statistically, the levels of anti-HBs were significantly associated with gender, age, duration of dental practice engagement and regularly use of mask, glasses and shield. CONCLUSIONS Since dental care workers have a high risk of exposure to hepatitis virus, they should be advised to receive hepatitis B vaccine and it should be confirmed if they have acquired immunity to HBV by testing the level of anti-HBs.
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Affiliation(s)
- Nafiseh Momeni
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Sadegh Ahmad Akhoundi
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
- Orthodontic Department, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, IR Iran
| | | | - Ahmad Reza Shamshiri
- Research Center for Caries Prevention, Dentistry Research Institute, Department of Community Oral Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mehdy Norouzi
- Hepatitis B Molecular Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Nima Mahboobi
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Nilufar Moosavi
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Mohammad Jazayeri
- Hepatitis B Molecular Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Seyed Mohammad Jazayeri, Hepatitis B Molecular Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, P. O. Box: 14155-6446, Tehran, IR Iran. Tel/Fax: +98-2188992660, E-mail:
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Lao TT, Sahota DS, Law LW, Cheng YKY, Leung TY. Age-specific prevalence of hepatitis B virus infection in young pregnant women, Hong Kong Special Administrative Region of China. Bull World Health Organ 2014; 92:782-9. [PMID: 25378739 PMCID: PMC4221762 DOI: 10.2471/blt.13.133413] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 06/23/2014] [Accepted: 07/08/2014] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the age-specific prevalence of hepatitis B virus (HBV) infection in young pregnant women in Hong Kong Special Administrative Region (SAR), China, and to determine whether an increase in prevalence occurs during adolescence. Methods HBV prevalence was quantified using data from routine antenatal screening for hepatitis B surface antigen (HBsAg) in 10 808 women aged 25 years or younger born in Hong Kong SAR and managed at a single hospital between 1998 and 2011. The effect on prevalence of maternal age, parity and birth before or after HBV vaccine availability in 1984 was assessed, using Spearman’s correlation and multiple logistic regression analysis. Findings Overall, 7.5% of women were HBsAg-positive. The prevalence ranged from 2.3% to 8.4% in those aged ≤ 16 and 23 years, respectively. Women born in or after 1984 and those younger than 18 years of age were less likely to be HBsAg-positive (odds ratio, OR: 0.679; 95% confidence interval, CI: 0.578–0.797) and (OR: 0.311; 95% CI: 0.160–0.604), respectively. For women born before 1984, there was no association between HBsAg carriage and being younger than 18 years of age (OR: 0.60; 95% CI: 0.262–1.370) Logistic regression analysis showed that the prevalence of HBsAg carriage was influenced more by the woman being 18 years old or older (adjusted OR, aOR: 2.80; 95% CI: 1.46–5.47) than being born before 1984 (aOR: 1.42; 95% CI: 1.21–1.67). Conclusion Immunity to HBV in young pregnant women who had been vaccinated as neonates decreased in late adolescence.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Daljit S Sahota
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Lai-Wa Law
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Yvonne K Y Cheng
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, China
| | - Tak-Yeung Leung
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong Special Administrative Region, China
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Middleman AB, Baker CJ, Kozinetz CA, Kamili S, Nguyen C, Hu DJ, Spradling PR. Duration of protection after infant hepatitis B vaccination series. Pediatrics 2014; 133:e1500-7. [PMID: 24843060 DOI: 10.1542/peds.2013-2940] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Little is known about duration of protection after the infant primary series of hepatitis B (HB) vaccine in settings of low HB endemicity. This study sought to determine the proportion of adolescents immunized as infants who had protective titers of antibody to hepatitis B surface antigen (anti-HBs) before and after a challenge dose of vaccine. METHODS US-born 16- through 19-year-olds who received a recombinant HB vaccine 3-dose series initiated within 7 days of birth (group 1) or at ≥4 weeks of age (group 2) and completed by 12 months of age were enrolled. Participants had serologic testing before and 2 weeks after randomization to receive a challenge dose of 10 µg or 20 µg of Engerix-B. Baseline and postchallenge levels of anti-HBs were compared by group, challenge dosage, and demographic and behavioral characteristics. RESULTS At baseline, 24% had protective anti-HBs levels of ≥10 IU/mL; 92% achieved protective levels after challenge dose. Although group 1 had a lower proportion of seroprotection at baseline, group and challenge dosage were not associated with postchallenge proportion of seroprotection. Being in group 2, higher test dosage, higher baseline geometric mean titer, and nonwhite race were associated with significantly higher geometric mean titer after challenge dose. CONCLUSIONS More than 90% of study participants immunized against HB as infants exhibited a seroprotective response to a challenge dose of vaccine. Duration of protection from the primary infant HB vaccine series extended through the adolescent years in the setting of low HB endemicity.
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Affiliation(s)
- Amy B Middleman
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
| | - Carol J Baker
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Claudia A Kozinetz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Saleem Kamili
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chi Nguyen
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Dale J Hu
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Saffar H, Ajami A, Saffar MJ, Shojaei J, Sotudeh-Anvari M, Shams-Esfandabad K, Khalilian AR. Prevalence of hepatitis B virus seromarkers in young adults vaccinated at birth; impact on the epidemiology of hepatitis B infection in iran. HEPATITIS MONTHLY 2014; 14:e17263. [PMID: 24829589 PMCID: PMC4013494 DOI: 10.5812/hepatmon.17263] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/02/2014] [Accepted: 03/08/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The epidemiological impact and the duration of protection provided by infant hepatitis B (HB) vaccination are unknown. OBJECTIVES This study was designed to determine the hepatitis B virus (HBV) infection seromarkers in young adults who have been vaccinated against HBV as the first group of Iranian neonates during 1993 and 1994. PATIENTS AND METHODS We recruited 510 young adults with a history of complete HB vaccination at birth. HBV seromarkers (HB surface antigen (HBs Ag), antibody against HBs Ag (Anti-HBs), and antibody against HB core antigen (Anti-HBc) were measured using ELISA method. Anti-HBs titers ≥ 10 IU/L were considered protective and titers more than 300 IU/L were indicative of a natural boosting. Positive results for Anti-HBc and HBs Ag were considered as breakthrough infection and possible vaccine failure, respectively. The history of acute symptomatic clinical hepatitis was also investigated. RESULTS Anti-HBs seropositivity rate was detected in 224 of 510 [95% CI: 39-47] young adults. Breakthrough infection (positive sera for Anti-HBc without chronic infection) was observed in 18 [95% CI: 2.5-3.5] subjects. There were neither HBs Ag positive results nor symptomatic hepatitis cases. CONCLUSIONS The study results indicated that the neonatal HBV immunization induced a long-term protection against HBV and was very efficacious in reducing chronic HBV infection rate in vaccinated young adults in Iran.
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Affiliation(s)
- Hiva Saffar
- Department of Pathology, Shariaty Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abolghasem Ajami
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Mohammed Jafar Saffar
- Pediatric Infectious Diseases Ward, Boali-Cina Hospital, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding Author: Mohammed Jafar Saffar, Pediatric Infectious Diseases Ward, Boali-Cina Hospital, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel: +98-1512233018, Fax: +98-1512234506, E-mail:
| | - Jalil Shojaei
- Provincial Center for Diseases Control and Prevention, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Maryam Sotudeh-Anvari
- Department of Pathology, Shariaty Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Kiarash Shams-Esfandabad
- Department of Pathology, Shariaty Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ali Reza Khalilian
- Department of Statistics, Mazandaran University of Medical Sciences, Sari, IR Iran
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Spada E, Romanò L, Tosti ME, Zuccaro O, Paladini S, Chironna M, Coppola RC, Cuccia M, Mangione R, Marrone F, Negrone FS, Parlato A, Zamparo E, Zotti CM, Mele A, Zanetti AR. Hepatitis B immunity in teenagers vaccinated as infants: an Italian 17-year follow-up study. Clin Microbiol Infect 2014; 20:O680-6. [PMID: 24528380 DOI: 10.1111/1469-0691.12591] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/30/2014] [Accepted: 02/09/2014] [Indexed: 01/05/2023]
Abstract
We assessed the persistence of hepatitis B surface antigen antibody (anti-HBs) and immune memory in a cohort of 571 teenagers vaccinated against hepatitis B as infants, 17 years earlier. Vaccinees were followed-up in 2003 and in 2010 (i.e. 10 years and 17 years after primary vaccination, respectively). When tested in 2003, 199 vaccinees (group A) had anti-HBs <10 mIU/mL and were boosted, 372 (group B) were not boosted because they had anti-HBs ≥10 mIU/mL (n = 344) or refused booster (n = 28) despite anti-HBs <10 mIU/mL. In 2010, 72.9% (416/571) of participants had anti-HBs ≥10 mIU/mL (67.3% in group A vs. 75.8% in group B; p 0.03). The geometric mean concentrations (GMCs) were similar in both groups. Between 2003 and 2010, anti-HBs concentrations in previously boosted individuals markedly declined with GMC dropping from 486 to 27.7 mIU/mL (p <0.001). Fifteen vaccinees showed a marked increase of antibody, possibly due to natural booster. In 2010, 96 individuals (37 of group A and 59 of group B) with anti-HBs <10 mIU/mL were boosted; all vaccinees of the former group and all but two of the latter had an anamnestic response. Post-booster GMC was higher in group B (895.6 vs. 492.2 mIU/mL; p 0.039). This finding shows that the immune memory for HBsAg persists beyond the time at which anti-HBs disappears, conferring long-term protection.
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Affiliation(s)
- E Spada
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanitá, Rome; Dipartimento di Malattie Infettive, Parassitarie e Immunomediate, Istituto Superiore di Sanità, Rome
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47
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Norouzirad R, Shakurnia AH, Assarehzadegan MA, Serajian A, Khabazkhoob M. Serum levels of anti-hepatitis B surface antibody among vaccinated population aged 1 to 18 years in ahvaz city southwest of iran. HEPATITIS MONTHLY 2014; 14:e13625. [PMID: 24497878 PMCID: PMC3909642 DOI: 10.5812/hepatmon.13625] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/08/2013] [Accepted: 11/17/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The duration of protection following primary series vaccination against hepatitis B is unknown in children and adolescents. It has been shown that the level of anti-hepatitis B surface antigen antibodies (anti HBs Ab) declines over years after vaccination. OBJECTIVES The aim of this study was to estimate the long-term immunity against hepatitis B virus infection among children and adolescents who had received a complete hepatitis B vaccination series during infancy. PATIENTS AND METHODS In a cross-sectional study, the - anti-HBsAb levels of 840 vaccinated children and adolescents were determined by enzyme-linked immunosorbent assay. RESULTS Hepatitis B seroprotection rates (anti HBsAb ≥ 10 IU/L) among vaccinated children and adolescents aged 1 and 18 years were 90% and 48.9%, respectively. The declining trend of geometric mean titer of anti-HBsAb levels was observed as changed from 272.3 IU/L to 94.1 IU/L in 1 and 18-year-old population, respectively. A significant negative correlation was found between age and anti-HBsAb levels (r = - 0.220, P = 0.0001). CONCLUSIONS The results showed a declining trend in anti-HBsAb titers over the time after vaccination against hepatitis B virus in our region. Further studies are warranted to establish the need for a booster dose in cases that are at risk of hepatitis B virus infection.
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Affiliation(s)
- Reza Norouzirad
- Biochemistry Department, Faculty of Medicine, Dezful University of Medical Sciences, Dezful, IR Iran
| | - Abdol Hussein Shakurnia
- Health Research Institue, Infectious and Tropical Diseases Research Center, Immunology Department, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding Author: Abdol Hussein Shakurnia, Health Research Institue, Infectious and Tropical Diseases Research Center, Immunology Department, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Golestan Blvd, Ahvaz, IR Iran. Tel: +98-9163132602, Fax: +98-6113332036, E-mail:
| | - Mohammad-Ali Assarehzadegan
- Immunology Department, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Amirarsalan Serajian
- Health Education Research Group, Jahade Daneshgahi of Khouzestan, Ahvaz, IR Iran
| | - Mehdi Khabazkhoob
- Epidemiology Department, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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48
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Bagheri-Jamebozorgi M, Keshavarz J, Nemati M, Mohammadi-Hossainabad S, Rezayati MT, Nejad-Ghaderi M, Jamalizadeh A, Shokri F, Jafarzadeh A. The persistence of anti-HBs antibody and anamnestic response 20 years after primary vaccination with recombinant hepatitis B vaccine at infancy. Hum Vaccin Immunother 2014; 10:3731-6. [PMID: 25483689 PMCID: PMC4514033 DOI: 10.4161/hv.34393] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 07/25/2014] [Accepted: 08/08/2014] [Indexed: 01/16/2023] Open
Abstract
Hepatitis B (HB) vaccine induces protective levels of antibody response (anti-HBs≥10 mIU/mL) in 90-99% of vaccinees. The levels of anti-HBs antibody decline after vaccination. The aim of this study was to evaluate the persistence of anti-HBs antibodies and immunologic memory in healthy adults at 20 years after primary vaccination with recombinant HB vaccine. Blood samples were collected from 300 adults at 20 years after primary HB vaccination and their sera were tested for anti-HBs antibody by ELISA technique. A single booster dose of HB vaccine was administered to a total of 138 subjects, whose anti-HBs antibody titer was <10 mIU/mL. The sera of subjects were re-tested for the anti-HBs antibody levels at 4 weeks after booster vaccination. At 20 years after primary vaccination 37.0% of participants had protective levels of antibody with geometric mean titer (GMT) of 55.44±77.01 mIU/mL. After booster vaccination, 97.1% of vaccinees developed protective levels of antibody and the GMT rose from 2.35±6.49 mIU/mL to 176.28±161.78 mIU/mL. 125/138 (90.6%) of re-vaccinated subjects also showed an anamnestic response to booster vaccination. At 20 years after primary vaccination with HB vaccine, low proportion of the subjects had protective levels of antibody. However, the majority of the re-vaccinated subjects developed protective levels of anti-HBs and showed an anamnestic response after booster vaccination. Additional follow-up studies are necessary to determine the duration of immunological memory.
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Key Words
- Anti-HBc antibody, antibody to HBcAg
- Anti-HBs antibody, antibody to HBsAg
- ELISA, Enzyme-linked immunosorbent assay
- EPI, Expanded Program on Immunization
- GMT, Geometric mean titer
- HB, Hepatitis B
- HBV, Hepatitis B virus
- HBcAg, Hepatitis B core antigen
- HBsAg, Hepatitis B surface antigen
- WHO, World Health Organization
- anamnestic response
- anti-HBs antibody
- hepatitis B vaccine
- mIU/mL, milli-international units per milliliter
- persistence
- protection
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Affiliation(s)
- Masoomeh Bagheri-Jamebozorgi
- Molecular Medicine Research Center; Rafsanjan University of Medical Sciences; Rafsanjan, Iran
- Department of Immunology; School of Medicine; Rafsanjan University of Medical Sciences; Rafsanjan, Iran
| | - Jila Keshavarz
- Molecular Medicine Research Center; Rafsanjan University of Medical Sciences; Rafsanjan, Iran
- Department of Immunology; School of Medicine; Rafsanjan University of Medical Sciences; Rafsanjan, Iran
| | - Maryam Nemati
- Department of Immunology; School of Medicine; Kerman University of Medical Sciences; Kerman, Iran
| | | | - Mohammad-Taghi Rezayati
- Department of Immunology; School of Medicine; Rafsanjan University of Medical Sciences; Rafsanjan, Iran
| | - Mohsen Nejad-Ghaderi
- Health Vice-Chancellor; Rafsanjan University of Medical Sciences; Rafsanjan, Iran
| | - Ahmad Jamalizadeh
- Health Vice-Chancellor; Rafsanjan University of Medical Sciences; Rafsanjan, Iran
| | - Fazel Shokri
- Department of Immunology; School of Public Health; Tehran University of Medical Sciences; Tehran, Iran
| | - Abdollah Jafarzadeh
- Molecular Medicine Research Center; Rafsanjan University of Medical Sciences; Rafsanjan, Iran
- Department of Immunology; School of Medicine; Rafsanjan University of Medical Sciences; Rafsanjan, Iran
- Department of Immunology; School of Medicine; Kerman University of Medical Sciences; Kerman, Iran
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49
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Ivanova L, Kyoseva M, Metodiev K, Stojkova J. Serologic Hepatitis B Virus Immunity in Health Care Workers. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Health care workers (HCWs) are at high risk of blood borne infections including Hepatitis B virus (HBV) infection. HBV vaccination is recommended for HCWs but post vaccination testing of immune response (anti-HBs) is not routinely performed. In our study information on immune response after the first immunization schedule of HCWs is not available. By reason of the questions regarding long lasting immunity, we decided to assess the anti-HBs of HCWs who wished to check immune response after different times of vaccination and also unvaccinated persons in St. Marina University Hospital, Varna, Bulgaria. After informed consent, 341 HCWs were investigated. They were divided into 3 groups according to their status: Group A had no history of vaccination against HBV, Group B had no complete vaccination schedule and Group C had complete vaccination data. Of Group C, 32 had been vaccinated more than 10 years previously, 111 - 10–5 years previously and 48 - < 5 years previously. Quantitative detection of antibody to HBsAg (anti-HBs) by commercial ELISA was carried out. A total, positive immune response was detected in 35.6% (group A), 66.2% (group B) and 80.1% (group C) of HCWs investigated. Of Group C positive immune response was detected in 68.7%, 81.1% and 85.4% respectively of the time of vaccination. Detectable anti-HB was found in HCWs without HBV immunization, probably after unknown exposure to HBV. The lack of information regarding immune response after the first immunization schedule makes the interpretation of no detectible anti-HBs level 5–10 years post-immunization difficult. For the HCWs with anti-HBs loss, counseling for booster vaccine dose and consequent testing is mandatory.
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Affiliation(s)
- L. Ivanova
- Department of Microbiology and Virology, Medical University, Varna, University Hospital “St. Marina”, Laboratory of Clinical Microbiology and Virology, Varna, Bulgaria
| | - M. Kyoseva
- Occupational Health Service, University Hospital “St. Marina”, Varna, Bulgaria
| | - K. Metodiev
- Department of Preclinical and Clinical Sciences, Medical University, Varna, Bulgaria
| | - J. Stojkova
- Department of Microbiology and Virology, Medical University, Varna, University Hospital “St. Marina”, Laboratory of Clinical Microbiology and Virology, Varna, Bulgaria
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50
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Eng NF, Bhardwaj N, Mulligan R, Diaz-Mitoma F. The potential of 1018 ISS adjuvant in hepatitis B vaccines: HEPLISAV™ review. Hum Vaccin Immunother 2013; 9:1661-72. [PMID: 23732907 PMCID: PMC3906263 DOI: 10.4161/hv.24715] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/08/2013] [Accepted: 04/16/2013] [Indexed: 12/18/2022] Open
Abstract
Hepatitis B (HBV) virus infects the liver, and upon chronic infection, can cause liver cirrhosis and hepatocellular carcinoma. Despite universal vaccination programs against the virus, HBV still affects over 2 billion people worldwide, with over 240 million developing a chronic infection. While current alum-adjuvanted vaccines have shown efficacy in promoting seroprotection in healthy adults, 5-10% of immune-competent populations fail to achieve long-lasting seroprotection from these formulations. Furthermore, a large proportion of immunocompromised patients fail to achieve seroprotective antibody titers after receiving these vaccines. A novel vaccine candidate, HEPLISAV™, uses immunostimulatory sequences (ISS), in its formulation that helps induce a robust humoral and cell mediated immunity against HBV. In Phase III clinical trials, HEPLISAV™ has been shown to elicit seroprotective antibody titers with fewer immunizations. Similar safety profiles are demonstrated when compared with current HBV vaccines. For these reasons, HEPLISAV™ is an attractive vaccine to combat this global disease.
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Affiliation(s)
- Nelson F Eng
- Advanced Medical Research Institute of Canada; Sudbury, ON Canada
| | - Nitin Bhardwaj
- Advanced Medical Research Institute of Canada; Sudbury, ON Canada
| | - Rebecca Mulligan
- Advanced Medical Research Institute of Canada; Sudbury, ON Canada
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