Evaluation of immune response to hepatitis B vaccine in healthcare workers at a tertiary care hospital

Measuring Immunoglobulin Titers Among Healthcare Workers After Hepatitis B Vaccination: A Cross-Sectional Study in Kuwait

Introduction Hepatitis B virus (HBV) is a highly infectious disease affecting the liver, causing life-threatening acute and chronic hepatitis. It poses a significant global public health burden and is a major occupational risk for healthcare workers (HCWs) due to transmission through blood and blood products. Given their increased risk compared to the general population, vaccination is crucial in limiting the spread of HBV and protecting HCWs. This study aims to measure the anti-HBs titers of HCWs in the Farwaniyah Health District in Kuwait after completing three doses of the HBV vaccine. Methods This cross-sectional study was conducted in the Farwaniyah Health District of Kuwait between May and July 2023. We collected data from 556 participants from various departments, including physicians, nurses, and laboratory technicians, chosen through simple random sampling. Inclusion criteria included the completion of three doses of the HBV vaccine (Engerix-B recombinant vaccine, GlaxoSmithKline Biologicals, Brentford, UK). Demographic data were collected, and blood samples were tested for hepatitis B surface antigen antibody titers using fourth-generation enzyme-linked immunosorbent assay. Participants were categorized based on sex, age, specialty, and time since the last vaccine dose. The chi-square test and Fisher's exact test assessed differences in categorical variables, with a p-value of <0.05 considered statistically significant. Results The study included 556 participants, with 304 (54.7%) women and 252 (45.3%) men. Participants were assigned into two age groups: 294 (52.9%) were 18 to 40 years old and the remainder (262) were over 40. Most participants were nursing staff (n=392; 70.5%), followed by physicians (n=110; 19.7%) and technicians (n=54; 9.7%). A high proportion (n=340; 61.2%) received their last vaccine dose within the last five years. Overall, 375 (67.4%) HCWs developed sufficient anti-HBs titers of ≥100 mIU/mL while 181 (32.6%) had levels below 100 mIU/mL. Age between 18 and 40 years and receiving the vaccine within the last five years were significantly associated with protective titer levels, while sex was not. Nurses had significantly higher immunity levels compared to doctors and technicians. Conclusions HCWs in the Farwaniyah area of Kuwait generally responded positively to the HBV vaccine. Younger HCWs and those who received the vaccine more recently were more likely to have a protective immune response. Nurses demonstrated higher rates of seroconversion compared to doctors and technicians. These results suggest that HBV vaccination programs should prioritize timely booster doses, especially for older HCWs and those vaccinated long ago. Monitoring antibody levels is crucial to ensure ongoing protection, particularly in high-risk groups such as nurses. Implementing these measures can enhance the effectiveness of HBV vaccination programs, reduce HBV incidence among HCWs, and contribute to a safer healthcare environment. Post-vaccination testing is essential to ensure the safety of all HCWs against HBV.

Multi-View Learning to Unravel the Different Levels Underlying Hepatitis B Vaccine Response

The immune system acts as an intricate apparatus that is dedicated to mounting a defense and ensures host survival from microbial threats. To engage this faceted immune response and provide protection against infectious diseases, vaccinations are a critical tool to be developed. However, vaccine responses are governed by levels that, when interrogated, separately only explain a fraction of the immune reaction. To address this knowledge gap, we conducted a feasibility study to determine if multi-view modeling could aid in gaining actionable insights on response markers shared across populations, capture the immune system's diversity, and disentangle confounders. We thus sought to assess this multi-view modeling capacity on the responsiveness to the Hepatitis B virus (HBV) vaccination. Seroconversion to vaccine-induced antibodies against the HBV surface antigen (anti-HBs) in early converters (n = 21; <2 months) and late converters (n = 9; <6 months) and was defined based on the anti-HBs titers (>10IU/L). The multi-view data encompassed bulk RNA-seq, CD4+ T-cell parameters (including T-cell receptor data), flow cytometry data, and clinical metadata (including age and gender). The modeling included testing single-view and multi-view joint dimensionality reductions. Multi-view joint dimensionality reduction outperformed single-view methods in terms of the area under the curve and balanced accuracy, confirming the increase in predictive power to be gained. The interpretation of these findings showed that age, gender, inflammation-related gene sets, and pre-existing vaccine-specific T-cells could be associated with vaccination responsiveness. This multi-view dimensionality reduction approach complements clinical seroconversion and all single modalities. Importantly, this modeling could identify what features could predict HBV vaccine response. This methodology could be extended to other vaccination trials to identify the key features regulating responsiveness.

Antibody response to an accelerated course of Hepatitis B vaccination

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.

The metabolic hormone adiponectin affects the correlation between nutritional status and pneumococcal vaccine response in vulnerable indigenous children

Background

Almost 200 million children worldwide are either undernourished or overweight. Only a few studies have addressed the effect of variation in nutritional status on vaccine response. We previously demonstrated an association between stunting and an increased post-vaccination 13-valent pneumococcal conjugate vaccine (PCV13) response. In this prospective study, we assessed to what extent metabolic hormones may be a modifier in the association between nutritional status and PCV13 response.

Methods

Venezuelan children aged 6 weeks to 59 months were vaccinated with a primary series of PCV13. Nutritional status and serum levels of leptin, adiponectin and ghrelin were measured upon vaccination and their combined effect on serum post-vaccination antibody concentrations was assessed by generalized estimating equations multivariable regression analysis.

Results

A total of 210 children were included, of whom 80 were stunted, 81 had a normal weight and 49 were overweight. Overweight children had lower post-vaccination antibody concentrations than normal weight children (regression coefficient -1.15, 95% CI -2.22 –-0.072). Additionally, there was a significant adiponectin-nutritional status interaction. In stunted children, higher adiponectin serum concentrations were associated with lower post-PCV13 antibody concentrations (regression coefficient -0.19, 95% CI -0.24 –-0.14) while the opposite was seen in overweight children (regression coefficient 0.14, 95% CI 0.049–0.22).

Conclusion

Metabolic hormones, in particular adiponectin, may modify the effect of nutritional status on pneumococcal vaccine response. These findings emphasize the importance of further research to better understand the immunometabolic pathways underlying vaccine response and enable a future of optimal personalized vaccination schedules.

Determinants of hepatitis B vaccination status in health care workers of two secondary care hospitals of Sindh, Pakistan: a cross-sectional study

BACKGROUND

Health care workers (HCWs) are at high risk of Hepatitis B virus (HBV) transmission. Hepatitis B vaccination is effective in protecting against HBV infection. Different factors influence HCW vaccination status such as lack of knowledge & awareness, cost, availability, and hesitancy. This study aimed to determine Hepatitis B vaccination status and factors influencing vaccination status in HCWs of two secondary care hospitals at Sindh, Pakistan.

METHODS

A cross-sectional study was conducted in two secondary care hospitals of Sindh, Pakistan. A total of 252 doctors, nurses, laboratory, and other HCWs were asked about the HBV vaccination coverage using a structured tool. Multivariable ordinal logistic regression was used to determine the association of participant's characteristics, vaccination knowledge with HBV vaccination coverage considering p-value ≤0.05 significant. Odds ratios with 95% confidence interval (CI) were reported.

RESULTS

Our study found that 64.9% doctors, 75.18% nurses, 58.3% allied HCWs, 40.0% laboratory staff, and 70.8% housekeeping staff were completely vaccinated. HCWs stated job entry requirement as the primary reason for complete vaccination (AOR 4.6, 95% CI 1.5-5.3) from the disease. HCWs working in Aga Khan hospital Karachi and who have received vaccination before working in that hospital had four-time higher odds for hepatitis B vaccination (AOR 4.3, 95% CI 1.7-4.9).

CONCLUSION

Two-third of the HCWs were completely vaccinated in secondary care hospitals in Sindh, Pakistan. Hepatitis B vaccination should be made a job entry requirement to achieve more complete vaccination numbers. Vaccination policies require to implement for all part-timers and full-timer health care workers.