Accelerated schedule of hepatitis B vaccination in high-risk youth

T follicular helper cells and antibody response to Hepatitis B virus vaccine in HIV-1 infected children receiving ART

HBV vaccine has 95% efficacy in children to prevent HBV infection and related cancer. We conducted a prospective study in HIV-1 infected children receiving ART (n = 49) and controls (n = 63) to assess humoral and cellular responses to HBV vaccine provided with three doses under an accelerated schedule of 4 weeks apart. At 1 month post-vaccination all children, except 4 HIV-1 infected, displayed protective antibody (ab) titers to HBV vaccine; ab titers were lower in infected children (P < 0.0001). Ab titers decreased (P < 0.0001) in both HIV-1 infected and control children at 6 months. The frequency of circulating Tfh (cTFh) cells was 20.3% for controls and 20.8% for infected children prior to vaccination and remained comparable post-vaccination. Cytokine expression by cTfh cells upon activation with HBV antigen was comparable in the two groups at baseline and 1 month post-vaccination. Higher plasma levels (P < 0.0001) of CXCL13 were found in infected children which correlated with cTfh cell frequency at baseline. In conclusion, a lower ab response to HBV vaccine was measured in HIV-1 infected children. The frequency and activation profile of cTfh cells was comparable in infected children and controls suggesting that cells other than Tfh cells are responsible for impaired ab response to HBV vaccine.

Rapid immunization scheme for spouses of individuals estabilished as hepatitis B carriers during premarital tests

BACKGROUND

The aim of this study was to monitor the cases identified as hepatitis B carriers during premarital tests, to vaccinate their prospective spouses with a rapid vaccination scheme, and to compare the anti-HBs responses with the traditional vaccination scheme.

METHODS

Blood samples of 1250 couple spouses were tested for HBsAg and anti-HBs. HBsAg positive cases' fiancées which were found HBV negative were administered a rapid three-dose vaccination scheme on days 0, 7, and 21. Forty controls with similar age and gender were also were administered three doses of the same vaccine.

RESULTS

Out of 1250 cases (625 couples), 46 (3.6%) were HBsAg positive, and 40 of them aged between 18 and 39 were admitted to the rapid vaccination program.

CONCLUSION

Upon determination of HBsAg positivity in premarital tests, a rapid vaccination program provides early protection, but the 6th and 12th month vaccinations are also required. Anti-HBs response should be monitored.

Schedules for hepatitis B vaccination of risk groups: balancing immunogenicity and compliance

INTRODUCTION

Vaccination is an important tool in hepatitis B prevention. However, several vaccine doses are required to induce long-term protection. Several at-risk groups have difficulties in adhering to the standard vaccination schedule.

OBJECTIVES

This paper aims to review the use of accelerated hepatitis B vaccination schedules, in terms of immunogenicity and compliance.

RESULTS

Accelerated schedules (0.1.2.12 months) or super-accelerated schedules (0.7.21.360 days) have been shown to result in higher proportions of healthy vaccinees reaching anti-HBs antibody levels >or=10 IU/l more rapidly. A fourth completing dose is required to lift antibody levels to an equal height, as does a standard (0.1.6 months) schedule. Accelerated schedules do also increase the uptake of hepatitis B vaccine, that is the proportion of vaccinees who receive three doses. However, completing the schedule with a fourth dose is usually more difficult than completing a standard 0.1.6-month schedule. Several additional tools can help to increase the compliance (eg, reminder systems, outreach services and incentive schemes).

CONCLUSION

For rapid seroconversion and almost immediate protection in the short term, a (super)accelerated schedule could be used in at-risk groups. As long-term protection data with these (super) accelerated schedules have not been documented yet, a fourth dose at month 12 is still required. A shortened schedule (0.1.4 months) might be an alternative worth considering compared with the standard 0.1.6, as it convenes to internationally accepted minimum dose intervals and offers earlier protection. There is a clear need to study the long-term protection and effectiveness of the primary part of (super)accelerated schedules.

An accelerated hepatitis B vaccination schedule for young drug users

OBJECTIVE

To determine completion rates for an accelerated hepatitis B vaccine (HBV) program among a population of young drug users.

DESIGN

Between January 2001 and May 2002, a three-dose course of HBV vaccine (0, 7 and 21 days) was offered free to all drug users (aged 22 years or younger) accessing two outreach sites of a youth-focused support and drug treatment service in metropolitan Melbourne, Australia. Clients were offered vaccination in any safe environment of their choice. An audit was conducted on the health records of participating clients.

MAIN OUTCOME MEASURES

Number of completed vaccinations; settings in which vaccinations were completed.

RESULTS

Ninety young people accepted vaccination, with 71% completing the full course. The majority preferred to receive vaccination at drug treatment outreach sites (53%).

CONCLUSIONS

An accelerated vaccination schedule appears acceptable to young drug users, suggesting that vaccination programs can be successful when barriers to immunisation are appropriately identified and addressed.

Compliance and immunogenicity of two hepatitis B vaccination schedules in sex workers in Belgium

OBJECTIVES

To compare the coverage for the third dose and the compliance to two hepatitis B vaccination schedules: 0,1,4 versus 0,1,6 months, in commercial sex workers (CSW) in Belgium; to compare the immunogenicity of the actually administered schedules.

METHODS

In seven health centres in Belgium, hepatitis B vaccination was offered free of charge to CSW. In a randomised, prospective study a commercialised hepatitis B vaccine (Engerix-B 20mcgr) was offered according to one of both schedules. After complete vaccination, bleeding was performed to assess immunogenicity.

RESULTS

Between June 2003 and September 2004, 615 non-immune CSW were enrolled, of whom 52% in the 0,1,4 month schedule (n=322). Coverage of the third dose was 57% overall, 59% (0,1,4) and 54% (0,1,6), respectively. Age, the health centre and drug use significantly influenced the compliance and the coverage of dose 3, whereas the planned vaccination did not. When comparing the immunogenicity results as a function of the actually administered vaccination schedule, immune responses did not significantly differ between CSW receiving the third dose 4-6 months and those receiving it at least 6 months after the first dose. In total, 19 persons (8%) were not protected after a full vaccination course (anti-HBs <10IU/L). Two health centres measured markedly lower anti-HBs levels.

CONCLUSIONS

In this highly mobile at-risk population, a 0,1,4 month schedule is more easy to offer and confers equal protection within a shorter period of time. We therefore propose this 0,1,4 month schedule to vaccinate CSW in the future.

Compliance to hepatitis B vaccination and subsequent development of seroprotection among health care workers of a tertiary care center of Saudi Arabia

BACKGROUND

There is lack of reliable data on compliance to hepatitis B virus (HBV) vaccine and development of seroprotective levels of antibodies among health care workers (HCWs) from the countries with high HBV endemicity such as Saudi Arabia. This study aimed to assess the compliance with HBV vaccine and subsequent levels of seroprotection among HCWs of a large tertiary care center of the Eastern Province of Saudi Arabia.

METHODS

All the HCWs (n = 1302) involved in direct patient care, including 374 (28.7%) physicians, 619 (47.6%) nurses, and 309 (23.7%) technicians, were enrolled for the study. Those having antibody to hepatitis B surface antigens (anti-HBs) levels less than 10 mIU/mL were advised to take 3 doses of yeast-derived recombinant HBV vaccine at 0, 1, and 6 months of 1 mL (20 microg/mL) in the deltoid muscle. Blood samples were checked for anti-HBs antibody levels by enzyme immunoassay during the initial screening of HCWs and 3 months after the third dose of HBV vaccine. The group of physicians included 34.5% (129/374) of consultants, 16.8% (63/374) of specialists, and 48.6% (182/374) of residents.

RESULTS

An overall HBV vaccine compliance rate of 71.6% (932/1302) was observed among HCWs including that of 79.5% (492/619) among nurses, 78.3% (242/309) among technicians, and 52.9% (198/374) among physicians. Thus, physicians recorded the lowest compliance (OR, 3.211; 95% CI, 2.259-4.567; P < .0001) to HBV vaccine. Among physicians, the lowest compliance of 42.3% (77/182) was observed in residents (OR, 3.690; 95% CI, 1.067-3.703; P < .0001). The overall seroprotection after vaccination was achieved in 92.2% of the compliant HCWs, and 7.8% of them failed to mount adequate response to HBV vaccine. Nonresponders included mainly the physicians (OR, 2.229; P = .05)-consultants in particular (OR, 3.476; P < .0001). The mean age of nonresponders was higher than those who mounted an adequate anti-HBs response (46.7 +/- 6.3 vs. 32.2 +/- 3.3 years OR, 1.845; 95% CI, 0.999-3.414; P < .05).

CONCLUSIONS

Poor compliance to HBV vaccine among physicians--residents in particular-is an issue of immense concern, which demands close examination and identification of the specific action that needs to be taken to enhance the uptake of the vaccine by this target population.

Comparison of the accelerated and classic vaccination schedules against Hepatitis B: three-week Hepatitis B vaccination schedule provides immediate and protective immunity

Background

Hepatitis B virus infection although preventable by vaccination remains an important health issue throughout the world due to its morbidity, mortality and economical losses. Early seroprotection is desirable for people at high risk of exposure. The aim of this study was to determine whether three-week hepatitis B vaccination (on days 0, 10 and 21) provide seroprotection or not.

Methods

The 120 subjects enrolled into the study were divided into two groups and vaccinated by the classic (months 0, 1, and 2) or the accelerated (days 0, 10, and 21) schedules and antibody response determined on days 30, 60, and 90 and, if below 10 mIU/ml^-1, again on day 180. For each individual in the classic group (B) three subjects were enrolled in the accelerated group (A). Recombinant hepatitis B vaccine (Gen-Hevac B, Pasteur) was given as 20 micrograms intramuscular injections via the deltoid muscle. A booster dose on day 365 was administered for each group. Family members of hepatitis B carriers and volunteer health personnel were enrolled into group A. To the B group only volunteers who wanted vaccination against hepatitis B were included.

Results

After three doses of vaccine, Anti-HBs titers reached protective levels in both groups. The number of vaccinees with seroprotective levels of Anti-HBs (≥10 mIU/ml^-1) on day 30 was 53 (58.9%) in group A and 9 (30.0%) in group B (p < 0.05). On day 60, there was no difference between group A and B, with response rates of 84.4% (n = 76) and 80.0% (n = 24) respectively (p > 0.05). On day 90 there was no difference between group B and group A; with 26 (86.7%) and 79 (87.7%) responders respectively. In both groups those with Anti-HBs levels <10 mIU/ml^-1 attained protective levels by day 180.

Conclusion

In this study, the three-week vaccination provided protective antibody titers within a shorter time compared to the classic schedule. Therefore, in order to provide rapid antibody production against hepatitis B virus, the accelerated vaccination schedule seems to be a good preference.

Recombinant hepatitis B vaccine (Engerix-B): a review of its immunogenicity and protective efficacy against hepatitis B

Engerix-B (Hep-B[Eng]) is a noninfectious recombinant DNA vaccine containing hepatitis B surface antigen (HBsAg). It is produced from genetically engineered yeast (Saccharomyces cerevisiae). Intramuscular Hep-B(Eng) [0-, 1-, 6-month schedule] has excellent immunogenicity in healthy neonates and infants, children, adolescents and adults, with seroprotection rates of 85-100% seen approximate, equals 1 month after the final dose of vaccine; seroprotection was defined as an antibody against HBsAg (anti-HBs) titre of > or =10 IU/L. The use of alternative Hep-B(Eng) immunisation schedules (e.g. a 0-, 1-, 2-, 12-month schedule in neonates and infants, 0-, 12-, 24-month or two-dose schedules in children and adolescents, and accelerated schedules in adults) have also been associated with high rates of seroprotection. Seroprotection rates were generally similar with Hep-B(Eng) and the recombinant vaccine Recombivax HB (Hep-B[Rax]) or plasma-derived vaccines (PDVs) approximate, equals 1 month after the final dose (although anti-HBs geometric mean titres were significantly higher with Hep-B[Eng] than with Hep-B[Rax]). One month after the final dose, adults had significantly higher seroprotection rates with the recombinant triple-antigen vaccine Bio-Hep-B (Hep-B[Bio]) than with Hep-B(Eng), although seroprotection rates in healthy infants were similar with Hep-B(Eng) and Hep-B(Bio). Hep-B(Eng) had excellent immunogenicity in several groups considered at high risk of acquiring hepatitis B (e.g. neonates born to hepatitis B carrier mothers and healthcare workers). The immunogenicity of Hep-B(Eng) was reduced in patients with conditions associated with impaired immune function (e.g. patients undergoing haemodialysis or being treated for malignancy), although it had good immunogenicity in patients with diabetes mellitus.Hep-B(Eng) had excellent protective efficacy against HBsAg carriage in healthy infants and children, and in neonates born to hepatitis B carrier mothers (protective efficacy of 95-99%). Hep-B(Eng) also demonstrated good protective efficacy in a number of other high-risk groups. Hep-B(Eng) is generally well tolerated with a tolerability profile similar to that of Hep-B(Rax), Hep-B(Bio) and PDVs. In conclusion, Hep-B(Eng) is a well established, highly immunogenic hepatitis B vaccine with good tolerability and excellent protective efficacy; it offers flexibility through a variety of immunisation schedules. In addition, it appears that Hep-B(Eng) confers immunity for at least 10 years. Hep-B(Eng) has an important role in mass vaccination campaigns against hepatitis B, as well as in groups considered at high risk of acquiring hepatitis B.

Intramuscular versus intradermal administration of anti-hepatitis B vaccine in non-cirrhotic hepatitis C patients

Intradermal vaccination has been proposed as an alternative for the administration of anti-hepatitis B vaccine. Patients (n=66) with chronic viral hepatitis C without cirrhosis were randomised into two groups (intramuscular, n=38; and intradermal, n=28) for prospective immunisation with 20 microg recombinant vaccine, using an ultra-rapid schedule (doses at 0, 15 and 30 days). Sero-conversion (antibody level >/=10 mU/ml) in the intramuscular group was reached by 20, 40 and 72% of patients at days 15, 30 and 60 compared to 4, 8 and 36% for the intradermal group (P=0.010 at day 60). Additionally, levels rose more rapidly in the intramuscular group (P=0.004). Our results do not support the use of intradermal route of immunisation against HBV in HCV patients.

Measles-mumps-rubella and hepatitis B vaccination uptake in adolescents: a survey in metropolitan Melbourne

OBJECTIVE

To measure the uptake of preadolescent measles-mumps-rubella (MMR) and adolescent hepatitis B vaccinations and assess the influence of certain demographic factors on the uptake of these vaccines.

DESIGN

Prevalence surveys of uptake rates of preadolescent (school Year 6; age 10-11 years) MMR and adolescent (school Year 9; age 13-14 years) hepatitis B vaccination.

SETTING

City of Darebin, an inner northern metropolitan region of Melbourne, 1996.

SUBJECTS

1160 Year 6 school students (580 boys) and 1102 Year 9 school students (548 boys).

INTERVENTION

School-based vaccination program administered by Darebin Council.

RESULTS

83% of Year 6 students were vaccinated with the MMR vaccine (84.1% of girls and 81.9% of boys). 71.6% of Year 9 students completed the full course of hepatitis B vaccination (68.9% of boys and 74.2% of girls). There was a higher uptake of MMR in non-government primary schools, but no other demographic factors (sex, economic status, non-English-speaking background, parental education, school class size) were associated.

CONCLUSIONS

These uptake rates do not meet National Health and Medical Research Council (NHMRC) recommendations. Further study is required to determine and quantify the factors that affect vaccination uptake in adolescence. Programs may then be developed to improve vaccination uptake.