1
|
Singh S, Mishra AK, Yachha M, Singh TP, Katiyar H, Kaul A, Dhiman RK, Bhadauria DS, Goel A. Seroprotection achieved with standard four-dose schedule of hepatitis B vaccine in people with chronic kidney disease: A real-life data. Indian J Gastroenterol 2024:10.1007/s12664-024-01685-0. [PMID: 39298024 DOI: 10.1007/s12664-024-01685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/24/2024] [Indexed: 09/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Hepatitis B virus (HBV) infection is common in people with chronic kidney diseases (CKD). The guidelines recommend four doses, 2.0 mL each, of HBV vaccine, given at zero, one, two and six months in these patients. However, real-life data on the effectiveness of this schedule are limited. We retrospectively reviewed the HBV vaccine response in the CKD population. METHODS The study included adult (≥ 18 years) patients with glomerular filtration rate < 60 mL/min, if they had received four doses (each of 2.0 mL volume) of HBV vaccine and anti-HBs titer was measured at ≥ 1 month of the last dose of vaccine. Participants with hepatitis C or human immunodeficiency virus (HIV) coinfection, organ transplant recipients, active or remote malignancy or use of immunosuppressive medication were excluded. Anti-HBs antibody was measured with two different assays with their limits of detection up to 500 mIU/mL and 1000 mIU/mL. The presence of detectable anti-HBs antibody and anti-HBs titer ≥ 10 mIU/mL defined seroconversion and seroprotection, respectively. RESULTS The study included 208 patients (71.9% males; age 44 [33-55] years; CKD stage II/III/IV/V in 1.4%/7.2%/26.4%/64.9%; 46% on maintenance hemodialysis [MHD]). Overall, seroconversion and seroprotection were achieved in 174 (83.7%) and 161 (77.4%) participants and anti-HBs titer, measured three (2-8) months after the fourth dose, was 124 (12-500) mIU/mL. The median anti-HBs antibody levels at ≤ 6, 7-12, 13-24 and 24 months after the fourth doses were 116, 478, 43 and 70 mIU/mL, respectively. Age, body mass index, stage of CKD, serum albumin and dialysis status were not associated with seroprotection (p < 0.05). CONCLUSION A standard vaccination schedule of four 2.0 mL doses of HBV vaccine in CKD patients induces reasonably good and sustained seroprotection.
Collapse
Affiliation(s)
- Surender Singh
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ajay Kumar Mishra
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Monika Yachha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Thakur Prashant Singh
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Harshita Katiyar
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Anupma Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Radha Krishna Dhiman
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Dharmendra Singh Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Amit Goel
- Department of Hepatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| |
Collapse
|
2
|
Tahir A, Shinkafi SH, Alshrari AS, Yunusa A, Umar MT, Hudu SA, Jimoh AO. A Comprehensive Review of Hepatitis B Vaccine Nonresponse and Associated Risk Factors. Vaccines (Basel) 2024; 12:710. [PMID: 39066348 PMCID: PMC11281605 DOI: 10.3390/vaccines12070710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024] Open
Abstract
Hepatitis B virus (HBV) infection remains a significant global health concern worldwide, contributing to high rates of mortality and morbidity, including chronic hepatitis B, cirrhosis, and hepatocellular carcinoma (HCC). Universal vaccination programs have significantly reduced the rate of HBV transmission; however, a subset of individuals fail to develop a protective immune response following vaccination and are termed nonresponders. A comprehensive search strategy using the PubMed, Google Scholar, and Web of Science databases was employed to search for relevant studies using keywords including "hepatitis B vaccine", "vaccine nonresponse", "immunogenicity", "immune response to the hepatitis B vaccine", and "associated risk factors". Factors influencing the vaccine's response include demographic factors, such as age and sex, with increased nonresponse rates being observed in older adults and males. Obesity, smoking, and alcohol consumption are lifestyle factors that decrease the vaccine response. Medical conditions, including diabetes, chronic kidney and liver diseases, HIV, celiac disease, and inflammatory bowel disease, affect the vaccine response. Major histocompatibility complex (MHC) haplotypes and genetic polymorphisms linked to immune regulation are genetic factors that further influence the vaccine's effectiveness. To reduce the global burden of hepatitis B infection, it is essential to understand these factors to improve vaccine effectiveness and develop individualized vaccination strategies.
Collapse
Affiliation(s)
- Albashir Tahir
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto 840001, Nigeria; (A.T.); (A.Y.); (M.T.U.)
- Department of Pharmacology, Faculty of Basic Medical Sciences, Bauchi State University, Gadau 751105, Nigeria
| | - Sa’adatu Haruna Shinkafi
- Department of Microbiology and Parasitology, Usmanu Danfodiyo University Teaching Hospital, Sokoto 23270, Nigeria
| | - Ahmed Subeh Alshrari
- Medical Laboratory Technology Department, Faculty of Applied Medical Science, Northern Border University, Arar 91431, Saudi Arabia;
| | - Abdulmajeed Yunusa
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto 840001, Nigeria; (A.T.); (A.Y.); (M.T.U.)
| | - Muhammad Tukur Umar
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto 840001, Nigeria; (A.T.); (A.Y.); (M.T.U.)
| | - Shuaibu Abdullahi Hudu
- Department of Basic Medical and Dental Sciences, Faculty of Dentistry, Zarqa University, Zarqa 13110, Jordan
- Department of Microbiology and Parasitology, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto 840232, Nigeria
| | - Abdulgafar Olayiwola Jimoh
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto 840001, Nigeria; (A.T.); (A.Y.); (M.T.U.)
| |
Collapse
|
3
|
Kittrakulrat J, Tiankanon K, Kerr SJ, Wattanatorn S, Udomkarnjananun S, Tungsanga S, Chaiteerakij R, Praditpornsilpa K, Eiam-Ong S, Avihingsanon Y, Tiranathanagul K, Vanichanan J, Townamchai N. A Randomized Controlled Study of Efficacy and Safety of Accelerated Versus Standard Hepatitis B Vaccination in Patients With Advanced CKD. Kidney Int Rep 2024; 9:853-862. [PMID: 38770057 PMCID: PMC11103956 DOI: 10.1016/j.ekir.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Hepatitis B virus (HBV) vaccination is crucial for seronegative patients with advanced chronic kidney disease (CKD) for protection during dialysis while preparing for transplantation. A standard regimen for HBV vaccination requires 24 weeks to be completed. An accelerated HBV vaccination regimen completed within 8 weeks has shown early effective seroconversion in healthcare workers. However, data for patients with advanced CKD are limited. Methods A randomized controlled trial was conducted in patients with advanced CKD (estimated glomerular filtration rate [GFR] <30 ml/min per 1.73 m2) and patients on dialysis. The patients were randomly assigned to either a standard HBV vaccination regimen (Engerix B; 40 μg at 0, 4, 8, and 24 weeks) or an accelerated regimen (40 μg at 0, 1, 4, and 8 weeks). The hepatitis B surface antibodies (anti-HBs) were measured at 12, 28, and 52 weeks. Seroconversion were defined as anti-HBs ≥10 IU/l. Results At 12 weeks, among the intention-to-treat (ITT) population of 133 participants (65 in the accelerated and 68 in the standard groups), the accelerated group demonstrated significantly higher rates of seroconversion (83.08% vs. 63.24%, P = 0.01). In the per-protocol (PP) analysis of 125 patients (62 in the standard and 63 in the accelerated groups), the accelerated group exhibited higher seroconversion rate compared with the standard group (85.71% vs. 69.35%, P = 0.03). At 28 and 52 weeks, the seroconversion rates were similar between the 2 groups. Conclusion In patients with advanced CKD, the accelerated HBV vaccination regimen demonstrated a significantly higher seroconversion rate at 12 weeks of vaccination. This finding suggests that the accelerated regimen is an effective option to achieve rapid seroconversion before initiating hemodialysis or before undergoing kidney transplantation.
Collapse
Affiliation(s)
- Jathurong Kittrakulrat
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Medicine, King Prajadhipok Memorial Hospital, Chanthaburi, Thailand
| | | | - Stephen J. Kerr
- Biostatistics Excellence Center, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Salin Wattanatorn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Suwasin Udomkarnjananun
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Renal Immunology and Renal Transplant Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somkanya Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Nephrology and Immunology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada
| | - Roongruedee Chaiteerakij
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Hemodialysis center, Benchakitti park Hospital, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Renal Immunology and Renal Transplant Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khajohn Tiranathanagul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Hemodialysis center, Benchakitti park Hospital, Bangkok, Thailand
| | - Jakapat Vanichanan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Natavudh Townamchai
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Renal Immunology and Renal Transplant Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
4
|
Al-Busafi SA, Alwassief A. Global Perspectives on the Hepatitis B Vaccination: Challenges, Achievements, and the Road to Elimination by 2030. Vaccines (Basel) 2024; 12:288. [PMID: 38543922 PMCID: PMC10975970 DOI: 10.3390/vaccines12030288] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 10/21/2024] Open
Abstract
Annually, more than 1.5 million preventable new hepatitis B (HBV) infections continue to occur, with an estimated global burden of 296 million individuals living with chronic hepatitis B infection. This substantial health challenge results in over 820,000 annual deaths being attributed to complications such as liver cirrhosis and hepatocellular carcinoma (HCC). The HBV vaccination remains the cornerstone of public health policy to prevent chronic hepatitis B and its related complications. It serves as a crucial element in the global effort to eliminate HBV, as established by the World Health Organization (WHO), with an ambitious 90% vaccination target by 2030. However, reports on global birth dose coverage reveal substantial variability, with an overall coverage rate of only 46%. This comprehensive review thoroughly examines global trends in HBV vaccination coverage, investigating the profound impact of vaccination on HBV prevalence and its consequences across diverse populations, including both high-risk and general demographics. Additionally, the review addresses the essential formidable challenges and facilitating factors for achieving WHO's HBV vaccination coverage objectives and elimination strategies in the coming decade and beyond.
Collapse
Affiliation(s)
- Said A. Al-Busafi
- Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman
| | - Ahmed Alwassief
- Division of Gastroenterology and Hepatology, Department of Medicine, Sultan Qaboos University Hospital, Muscat 123, Oman
| |
Collapse
|
5
|
Girndt M, Houser P, Manllo-Karim R, Ervin JE, Charytan C, Chow S, Symonian-Silver M, Lehrner L, Linfert D, Shemin D, Michelsen A, Xie F, Janssen RS. Long-term immunogenicity and safety of the hepatitis B vaccine HepB-CpG (HEPLISAV-B) compared with HepB-Eng (Engerix-B) in adults with chronic kidney disease. Vaccine 2023; 41:3224-3232. [PMID: 37085451 DOI: 10.1016/j.vaccine.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection remains a significant global burden, especially for patients with chronic kidney disease (CKD) receiving hemodialysis. Three doses of HepB-CpG (HEPLISAV-B® vaccine) induced a superior immune response compared with 4 double doses of HepB-Eng (Engerix-B®) in a phase 3 trial (HBV-17) in adults with CKD. Here we report the long-term immunogenicity and safety of HepB-CpG and HepB-Eng in eligible participants of HBV-17 who enrolled in this optional 34-month follow-up trial (HBV-19). METHODS HBV-19 is a multicenter, open-label, phase 3b trial of adults with CKD who previously received a complete series of HepB-CpG or HepB-Eng in the HBV-17 trial. Participants were assigned to seroprotection categories at enrollment on the basis of their antibody response to hepatitis B surface antigen (anti-HBs) in HBV-17. The objective was to evaluate the durability of seroprotection (defined as an anti-HBs concentration ≥ 10mIU/mL) induced by HepB-CpG and HepB-Eng. Participants whose anti-HBs concentration was below 10mIU/mL received additional HepB-CpG or HepB-Eng doses. RESULTS 147 participants were enrolled; 66.7 % were men, median age was 65.0 years, and 83.7 % were white. The durability of seroprotection in participants with CKD was similar in those who received HepB-CpG and those who received HepB-Eng. Antibody concentrations ≥ 100mIU/mL persisted for longer in HepB-CpG than HepB-Eng recipients, among those with anti-HBs ≥ 100mIU/mL post vaccination. The geometric mean anti-HBs concentration in the HepB-CpG group was significantly higher than in the HepB-Eng group over time (P ≤ 0.0001). The safety profiles were similar between the vaccine groups. CONCLUSIONS Due to the higher antibody levels induced by HepB-CpG in participants with CKD, seroprotection against HBV may be expected to persist longer than that induced by HepB-Eng. CLINICALTRIALS gov: NCT01282762.
Collapse
Affiliation(s)
- Matthias Girndt
- Department of Internal Medicine II, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, Halle 06120, Germany
| | - Patricia Houser
- Amherst Family Practice, 1867 Amherst Street, Winchester, VA 22601, USA
| | - Roberto Manllo-Karim
- Gamma Medical Research, Inc., 222 East Ridge Road, Suite 214, Mcallen, TX 78503, USA
| | - John E Ervin
- Center for Pharmaceutical Research, 1010 Carondelet Drive, Suite 426, Kansas City, MO 64114, USA
| | - Chaim Charytan
- New York-Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - Stephen Chow
- Department of Medicine, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, ON, Canada
| | - Margarita Symonian-Silver
- National Institute of Clinical Research, 1000 Corporate Center Drive, Suite 330, Monterey Park, CA 91754, USA
| | - Lawrence Lehrner
- Kidney Specialists of Southern Nevada, 500 S Rancho Drive, #12, Las Vegas, NV 89106, USA
| | - Douglas Linfert
- Nephrology Associates, 28 White Bridge Pike, Suite 300, Nashville, TN 37205, USA
| | - Douglas Shemin
- Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
| | - Ann Michelsen
- Gemeinschaftspraxis für Innere Medizin, Pferdebachstr. 29, 58455 Witten, Germany
| | - Fang Xie
- Dynavax Technologies Corporation, 2100 Powell Street, Suite 720, Emeryville, CA 94608, USA
| | - Robert S Janssen
- Dynavax Technologies Corporation, 2100 Powell Street, Suite 720, Emeryville, CA 94608, USA.
| |
Collapse
|
6
|
Youssef DM, El-Shal AS, Elbehidy RM, Fouda MA, Shalaby SM, El Hawy LL, Elsadek AF, Neemat-Allah MAA, Ramadan SM, Gohary A, Arab F, Alsharkawy M, Tolba SAR, Abdelsalam MM, Amin EK, Gehad MH. Hepatitis B Immunization Status in Children with Chronic Kidney Disease: Experience at a Single Center, Egypt. J Clin Med 2023; 12:jcm12051864. [PMID: 36902652 PMCID: PMC10003117 DOI: 10.3390/jcm12051864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 03/03/2023] Open
Abstract
Background: Children with chronic kidney disease (CKD), particularly those who require hemodialysis (HD), are at high risk of hepatitis B virus (HBV) infection. The HBV vaccine non-/hypo-response rate among HD children remains high, and it is critical to investigate the influencing factors and their linkages. The aim of this study was to identify the pattern of HB vaccination response in HD children and to analyze the interference of various clinical and biomedical factors with the immunological response to HB vaccination. Methods: This cross-sectional study included 74 children on maintenance hemodialysis, aged between 3 and 18 years. These children were subjected to complete clinical examination and laboratory investigations. Results: Out of a total of 74 children with HD, 25 (33.8%) were positive for the HCV antibody. Regarding the immunological response to hepatitis B vaccine, 70% were non-/hypo-responders (≤100 IU/mL) and only 30% mounted a high-level response (more than 100 IU/mL). There was a significant relation between non-/hypo-response and sex, dialysis duration, and HCV infection. Being on dialysis for more than 5 years and being HCV Ab-positive were independent variables for non-/hypo-response to HB vaccine. Conclusions: Children with CKD on regular HD have poor seroconversion rates in response to the HBV vaccine, which were influenced by dialysis duration and HCV infection.
Collapse
Affiliation(s)
- Doaa Mohammed Youssef
- Pediatrics Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Amal S. El-Shal
- Medical Biochemistry Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
- Medical Biochemistry and Molecular Biology Department, Armed Forces College of Medicine (AFCM), Cairo 11774, Egypt
- Correspondence: or ; Tel.: +20-1221546634
| | - Rabab M. Elbehidy
- Pediatrics Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Mohamed Adel Fouda
- Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Sally M. Shalaby
- Medical Biochemistry Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Lamiaa Lotfy El Hawy
- Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
| | | | | | - Seham M. Ramadan
- Pediatrics Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Amal Gohary
- Pediatrics Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Faika Arab
- Pediatrics Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Mona Alsharkawy
- Pediatrics Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | | | | | - Ezzat Kamel Amin
- Pediatrics Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Mona Hamed Gehad
- Pediatrics Department, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| |
Collapse
|
7
|
Syamila N, Syahir A, Sulaiman Y, Ikeno S, Tan WS, Ahmad H, Ahmad Tajudin A. Bio-nanogate manipulation on electrode surface as an electrochemical immunosensing strategy for detecting anti-hepatitis B surface antigen. Bioelectrochemistry 2022; 143:107952. [PMID: 34600402 DOI: 10.1016/j.bioelechem.2021.107952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/04/2023]
Abstract
The diagnosis of hepatitis B virus (HBV) and monitoring of the vaccination efficiency against HBV require real-time analysis. The presence of antibody against hepatitis B virus surface antigen (anti-HBsAg) as a result of HBV infection and/or immunization may indicate individual immune status towards HBV. This study investigated the ability of a bio-nanogate-based displacement immunosensing strategy in detecting anti-HBsAg antibody, via nonspecific-binding between polyamidoamine dendrimers encapsulated gold nanoparticles (PAMAM-Au) and the 'antigenic determinant' region (aD) of HBsAg. For this purpose, maltose binding protein harbouring the aD region (MBP-aD) was synthesized as a bioreceptor and immobilized on the screen-printed carbon electrode (SPCE). Following that, PAMAM-Au was deposited on MBP-aD, forming the 'gate' and was used as a monitoring agent. Under optimal conditions, the high specificity of anti-HBsAg antibody towards MBP-aD displaced PAMAM-Au causing the decrement of anodic peak in differential pulse voltammetry (DPV) analysis. The signal changes were proportionally related to the concentration of anti-HBsAg antibody, in a range of 1 - 1000 mIU/mL with a limit of detection (LOD) of 2.5 mIU/mL. The results also showed high specificity and selectivity of the immunosensor platform in detecting anti-HBsAg antibody both in spiked buffer and human serum samples.
Collapse
Affiliation(s)
- Noor Syamila
- Nanobiotechnology Research Group, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Amir Syahir
- Nanobiotechnology Research Group, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Yusran Sulaiman
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Shinya Ikeno
- Department of Biological Functions Engineering, Graduate School of Life Science and System Engineering, Kyushu Institute of Technology, Kitakyushu Science and Research Park, Kitakyushu, Fukuoka, Japan
| | - Wen Siang Tan
- Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Laboratory of Vaccines and Biomolecules, Institute of Bioscience, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Haslina Ahmad
- Department of Chemistry, Faculty of Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Asilah Ahmad Tajudin
- Nanobiotechnology Research Group, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| |
Collapse
|
8
|
Hettenbaugh J, Mullane R, Gillispie G, Shostrom V, Flores L, Fillaus JA, Florescu MC, Murcek D, Tendulkar KK. Hepatitis B Vaccination in Advanced Chronic Kidney Disease: A Quality Improvement Project at a Veteran Affairs Chronic Kidney Disease Clinic. Infect Dis Rep 2021; 13:1036-1042. [PMID: 34940404 PMCID: PMC8701395 DOI: 10.3390/idr13040094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022] Open
Abstract
Hepatitis B vaccination is recommended in all patients with end-stage kidney disease (ESKD). However, only 50–60% of these patients achieve protective antibody levels if immunized after starting dialysis. Strategies to overcome this low seroconversion rate include a 6-month vaccination schedule starting earlier [chronic kidney disease (CKD) stage 4 and 5] to ensure immunity when patients progress to ESKD. We conducted a quality improvement program to immunize pre-dialysis patients. Patients who were found to have a negative baseline serology with a negative hepatitis B surface antibody level (HBsAb) were offered vaccination on a 6-month schedule (0, 1 and 6 months) with one of two available vaccines within the VA system (Recombivax™ or Engerix™). HBsAb titers were checked 3–4 months later, and titers ≥ 12 mIU/mL were indicative of immunity at VA. Patients who did not seroconvert were offered a repeat schedule of three more doses. We screened 198 patients (187 males and 11 females) with CKD 4 and 5 [glomerular filtration rate (GFR) < 29 mL/min/1.73 m2]. The median age of this cohort was 72 years (range 38–92 years). During the study period of 5 years (2015–2020), 10 patients were excluded since their GFR had improved to more than 30 mL/min/1.73 m2, 24 others had baseline immunity and 2 refused vaccination. The hepatitis B vaccination series was not started on 106 patients. Of the remaining 56, 12 patients progressed to ESKD and started dialysis before completion of the vaccination schedule, 6 expired and 1 did not come to clinic in 2020 due to the pandemic. Of the 37 patients who completed the vaccination schedule, 16 achieved seroconversion with adequate HBsAb titers, 10 did not develop immunity despite a second hepatitis B vaccination series, while 11 did not get a second series. Given the low seroconversion rate, albeit in a small cohort, vaccination should be considered in patients with earlier stages of CKD. Other options include studies on FDA approved vaccines of shorter duration. We plan to increase awareness among nephrologists, patients and nursing staff about the importance of achieving immunity against hepatitis B.
Collapse
Affiliation(s)
- Jacob Hettenbaugh
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Ryan Mullane
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Gayle Gillispie
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Valerie Shostrom
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Linda Flores
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Jennifer A. Fillaus
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Marius C. Florescu
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Denise Murcek
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Ketki K. Tendulkar
- Department of Internal Medicine, Division of Nephrology, University of Nebraska Medical Center, Omaha, NE 68138, USA; (J.H.); (R.M.); (G.G.); (V.S.); (L.F.); (J.A.F.); (M.C.F.); (D.M.)
- VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
- Correspondence: ; Tel.: +1-402-559-9227
| |
Collapse
|
9
|
Shah NJ, Aloysius MM, Sharma NR, Pallav K. Advances in treatment and prevention of hepatitis B. World J Gastrointest Pharmacol Ther 2021. [DOI: 10.4292/wjg.v12.i4.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
10
|
Shah NJ, Aloysius MM, Sharma NR, Pallav K. Advances in treatment and prevention of hepatitis B. World J Gastrointest Pharmacol Ther 2021; 12:56-78. [PMID: 34316384 PMCID: PMC8290928 DOI: 10.4292/wjgpt.v12.i4.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis B (CHB) continues to contribute to worldwide morbidity and mortality significantly. Scientists, clinicians, pharmaceutical companies, and health organizations have dedicated substantial Intellectual and monetary resources to finding a cure, increasing immunization rates, and reducing the global burden of CHB. National and international health-related organizations including the center for disease control, the national institute of health, the American Association for the study of liver disease (AASLD), The European association for the study of the Liver (EASL), The Asia Pacific association for the study of the Liver (APASL) and the world health organization release periodic recommendations for disease prevention and treatment. Our review of the most recent guidelines by EASL, AASLD, APASL, and Taiwan Association for the Study of the Liver revealed that an overwhelming majority of cited studies were published before 2018. We reviewed Hepatitis B-related literature published 2018 onwards to identify recent developments and current barriers that will likely direct future efforts towards eradicating hepatitis B. The breakthrough in our understanding of the hepatitis B virus life cycle and resulting drug development is encouraging with significant room for further progress. Data from high-risk populations, most vulnerable to the devastating effects of hepatitis B infection and reactivation remain sparse. Utilization of systems approach, optimization of experimental models, identification and validation of next-generation biomarkers, and precise modulation of the human immune response will be critical for future innovation. Within the foreseeable future, new treatments will likely complement conventional therapies rather than replace them. Most Importantly, pragmatic management of CHB related population health challenges must be prioritized to produce real-world results.
Collapse
Affiliation(s)
- Niraj James Shah
- Department of Internal Medicine, Digestive Disease, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Mark M Aloysius
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, United States
| | - Neil Rohit Sharma
- Department of Internal Medicine, Interventional Oncology and Surgical Endoscopy, Parkview Regional Medical Center, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
| | - Kumar Pallav
- Department of Internal Medicine, Interventional Oncology and Surgical Endoscopy, Parkview Regional Medical Center, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
| |
Collapse
|
11
|
Knowledge, Attitudes and Practices of Flu Vaccination in Hemodialysis Patients. Vaccines (Basel) 2021; 9:vaccines9020077. [PMID: 33498996 PMCID: PMC7912544 DOI: 10.3390/vaccines9020077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/04/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hemodialysis (HD) patients have an increased risk of morbidity and mortality due to infections. Despite the positive effect of vaccinations, the implementation of this method of prophylaxis is low. OBJECTIVES This study aimed to explore the knowledge, attitudes and practices of flu vaccination among HD patients of two different dialysis centers. METHODS A total of 193 patients (mean age 63.6 years), who voluntarily agreed to participate in an anonymous survey related to influenza vaccination, were enrolled in this cross-sectional study. RESULTS A total of 45% of patients declared that they took regular, annual flu vaccination. In this group, 87.4% believed that vaccinations were effective. This opinion strongly correlated with the frequency of regular vaccinations (r = 0.56, p < 0.01). Multivariate logistic regression revealed that this opinion is an independent predictor of regular vaccinations with adjusted OR 9.86 (95% CI 4.36, 22.33). Groups of patients who had been irregularly or never vaccinated reject vaccinations for the following reasons: fear of adverse events-29.2%, conviction that vaccination was ineffective-26.4%, and lack of information about vaccination-22.6%. CONCLUSION Knowledge among HD patients about the benefits of vaccinations is poor. Therefore, educational activities are required. Active vaccination promotion and education of patients rejecting this method of prevention play a key role in improving standards of care for HD patients.
Collapse
|
12
|
Mysore P, Khinkar RM, McLaughlin D, Desai S, McMahon GM, Ulbricht C, Mendu ML. Improving hepatitis B vaccination rates for advanced chronic kidney disease patients: a quality improvement initiative. Clin Exp Nephrol 2021; 25:501-508. [PMID: 33411114 PMCID: PMC7788540 DOI: 10.1007/s10157-020-02013-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
Introduction Chronic kidney disease (CKD) patients are vulnerable to hepatitis B, and immunization prior to end stage kidney disease is recommended to optimize seroconversion. Our institution undertook a process improvement approach to increase hepatitis B vaccination in stage 4 and 5 CKD patients. Methods Four strategies were utilized such as: (1) Electronic health record (EHR)-based CKD registry to identify patients, (2) EHR-based physician/nurse reminders, (3) a co-located nurse appointment for vaccine administration, and (4) information sharing and provider awareness effort. The CKD registry was utilized to identify patients with stage 4 or 5 CKD, with at least two clinic visits in the prior 2 years, who had not received the hepatitis B vaccine or did not have serologic evidence of immunity. Target monthly vaccination rate was set at 75%, based on clinic leadership, nephrologist, and nurse consensus. Results A total of 239 patients were included in the study period, from November 2018 to January 2019 (observation period) and from February 2019 to September 2019 (intervention period). Monthly vaccination rate improved from 48% in November 2018 to the target rate of 75% by the end of the intervention (August and September 2019). There was a statistically significant increase from the rate of vaccination at a unique patient level in the first month of the baseline period, compared to the last month of the intervention period (51 vs. 75% p = 0.03). Conclusions Utilizing a nurse-led approach to hepatitis B vaccination, coupled with EHR-based tools, along with continuous monitoring of performance, helped to improve hepatitis B vaccination among CKD stage 4 and 5 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-020-02013-4.
Collapse
Affiliation(s)
- Priyanka Mysore
- Department of Nephrology, Health Sciences Center, University of Manitoba, Winnipeg, MB, Canada
| | - Roaa M Khinkar
- Department of Clinical Pharmacy, College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
- Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, One Brigham Circle, Second Floor, Office No. BC-2-WS 34, 1620 Tremont Street, Boston, MA, 02120, USA.
| | - Donna McLaughlin
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sonali Desai
- Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, One Brigham Circle, Second Floor, Office No. BC-2-WS 34, 1620 Tremont Street, Boston, MA, 02120, USA
- Rheumatology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gearoid M McMahon
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Catherine Ulbricht
- Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, One Brigham Circle, Second Floor, Office No. BC-2-WS 34, 1620 Tremont Street, Boston, MA, 02120, USA
| | - Mallika L Mendu
- Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, One Brigham Circle, Second Floor, Office No. BC-2-WS 34, 1620 Tremont Street, Boston, MA, 02120, USA
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Oud JA, Evers D, Middelburg RA, de Vooght KMK, van de Kerkhof D, Visser O, Péquériaux NCV, Hudig F, van der Bom JG, Zwaginga JJ. Association between renal failure and red blood cell alloimmunization among newly transfused patients. Transfusion 2020; 61:35-41. [PMID: 33295653 PMCID: PMC7839777 DOI: 10.1111/trf.16166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Renal failure and renal replacement therapy (RRT) affect the immune system and could therefore modulate red blood cell (RBC) alloimmunization after transfusion. STUDY DESIGN AND METHODS We performed a nationwide multicenter case-control study within a source population of newly transfused patients between 2005 and 2015. Using conditional multivariate logistic regression, we compared first-time transfusion-induced RBC alloantibody formers (N = 505) with two nonalloimmunized recipients with similar transfusion burden (N = 1010). RESULTS Renal failure was observed in 17% of the control and 13% of the case patients. A total of 41% of the control patients and 34% of case patients underwent acute RRT. Renal failure without RRT was associated with lower alloimmunization risks after blood transfusion (moderate renal failure: adjusted relative rate [RR], 0.82 [95% confidence interval (CI), 0.67-1.01]); severe renal failure, adjusted RR, 0.76 [95% CI, 0.55-1.05]). With severe renal failure patients mainly receiving RRT, the lowest alloimmunization risk was found in particularly these patients [adjusted RR 0.48 (95% CI 0.39-0.58)]. This was similar for patients receiving RRT for acute or chronic renal failure (adjusted RR, 0.59 [95% CI, 0.46-0.75]); and adjusted RR, 0.62 [95% CI 0.45-0.88], respectively). CONCLUSION These findings are indicative of a weakened humoral response in acute as well as chronic renal failure, which appeared to be most pronounced when treated with RRT. Future research should focus on how renal failure and RRT mechanistically modulate RBC alloimmunization.
Collapse
Affiliation(s)
- Josine A Oud
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorothea Evers
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karen M K de Vooght
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan van de Kerkhof
- Department of Clinical Chemistry and Hematology, Catharina Hospital, Eindhoven, The Netherlands
| | - Otto Visser
- Department of Hematology, Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | - Nathalie C V Péquériaux
- Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
14
|
Interaction study of peptide-PAMAM as potential bio-nanogate for detecting anti-hepatitis B surface antigen. Colloids Surf B Biointerfaces 2019; 185:110623. [PMID: 31735420 DOI: 10.1016/j.colsurfb.2019.110623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/09/2019] [Accepted: 10/30/2019] [Indexed: 12/23/2022]
Abstract
Bio-nanogate involves synthesized or natural molecules as a 'gate' towards bioreceptors and responds upon the presence of targeted analytes in nanoscale dimension. Development of bio-nanogate improves analyte selectivity and signal response across various types of biosensors. The versatility of PAMAM dendrimers to form conjugates with guest molecules, such as proteins can be utilized in forming a bio-nanogate. PAMAM interaction with peptide bioreceptor for antibody detection is of interest in this study. This study investigated the interaction of synthesized immunogenic 'a' determinant (aD) region of hepatitis B virus surface antigen (HBsAg) with PAMAM G4 and anti-HBsAg antibody, as a potential bio-nanogate for anti-HBsAg detection. The aD peptide fused with maltose binding protein (MBP), was confirmed with Western blotting. Nano-Differential Scanning Fluorimetry (nano-DSF) study revealed that the interaction of MBP-aD with anti-HBsAg indicated a higher thermal stability as compared to its interaction with PAMAM G4. Electrochemical impedance spectroscopy showed that a higher binding constant of MBP-aD interaction with anti-HBsAg (0.92 μM-1) was observed at maximum saturation, as compared with PAMAM G4 (0.07 μM-1). Thermodynamic parameters demonstrated that MBP-aD interacted with anti-HBsAg and PAMAM G4, through van der Waals and hydrogen bonding. These analyses suggest that the weak interaction of MBP-aD and PAMAM G4 may form a potential bio-nanogate. It is hypothesized that the presence of anti-HBsAg has a higher affinity towards MBP-aD which may displace PAMAM G4 in the anti-HBsAg detection system. This interaction study is crucial as an initial platform of using peptide-PAMAM as a bio-nanogate in an antibody detection system.
Collapse
|
15
|
Kengibe PY, Makulo JRR, Nlandu YM, Lepira FB, Sumaili EK, Bukabau JB, Mbendi CN, Ahuka SM, Tshimpi AW, Ngoma PK, Mangani NN, Mbendi SN. Response to single dose hepatitis B vaccine in Congolese non-HIV hemodialysis patients: a prospective observational study. Pan Afr Med J 2019; 34:122. [PMID: 33708291 PMCID: PMC7906547 DOI: 10.11604/pamj.2019.34.122.19603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/24/2019] [Indexed: 01/12/2023] Open
Abstract
Introduction Because of the cost, in the hemodialysis centers of Kinshasa, the double dose of hepatitis B (HBV) vaccine is administered only to HIV infected patients while other patients receive a single dose. This study aimed to evaluate the single-dose vaccination Protocol and identify determinants of seroconversion's lack of anti-HBs after vaccination schedule. Methods 56 non-HIV chronic hemodialysis patients serologically negative for HBs Ag, anti-HBs and anti-HBc were selected between January 2014 and December 2016. The recombinant DNA vaccine (Euvax B®20 μg) was administered intramuscularly in the deltoid muscle at days 0, 30, 60 and 180. Serum anti-HBs titer was assayed at day 240. The endpoint was seroconversion, defined as anti-HBs titer ≥ 10 IU/l (10-99 IU/l = low protective vaccine response; ≥ 100 IU/l = highly protective vaccine response). Anti-HBs titer < 10 IU/l defined a lack of seroconversion. A Logistic regression model was used to identify factors associated with the lack of seroconversion. Results In the study group (mean age 55.6± 15.1 years; 73 % men, 36% diabetic and 86% hypertensive), low and highly protective vaccine responses were seen in 32% and 50% respectively versus 18% of patient had a lack of seroconversion. CRP > 6 mg/L (aOR: 8.96), hypoalbuminemia (aOR: 6.50) and KT/V < 1.2 (aOR: 3.70) were associated with the lack of seroconversion. Conclusion Half of the patients in the study had either a lack or low protective vaccine response. Patient-related factors and hemodialysis parameters were the main factors associated with the lack of anti-HbS seroconversion. These results highlight the need to maximize doses of vaccine in all patients.
Collapse
Affiliation(s)
- Pitchou Yemasai Kengibe
- Division of Hepato-gastroenterology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Robert Risassy Makulo
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.,Hemodialysis Unit of Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo
| | - Yannick Mayamba Nlandu
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Ernest Kiswaya Sumaili
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Charles Nlombi Mbendi
- Division of Hepato-gastroenterology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Steve Mundeke Ahuka
- Division of Microbiology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Antoine Wola Tshimpi
- Division of Hepato-gastroenterology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.,Climy Medical Center of Hepato-gastroenterology, Kinshasa, Democratic Republic of the Congo
| | - Patrick Kisoko Ngoma
- Division of Hepato-gastroenterology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nseka Nazaire Mangani
- Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Sebastien Nsukini Mbendi
- Division of Hepato-gastroenterology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| |
Collapse
|
16
|
Garthwaite E, Reddy V, Douthwaite S, Lines S, Tyerman K, Eccles J. Clinical practice guideline management of blood borne viruses within the haemodialysis unit. BMC Nephrol 2019; 20:388. [PMID: 31656166 PMCID: PMC6816193 DOI: 10.1186/s12882-019-1529-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022] Open
Abstract
Some people who are receiving dialysis treatment have virus infection such as hepatitis B, hepatitis C and/or HIV that is present in their blood. These infections can be transmitted to other patients if blood is contaminated by the blood of another with a viral infection. Haemodialysis is performed by passing blood from a patient through a dialysis machine, and multiple patients receive dialysis within a dialysis unit. Therefore, there is a risk that these viruses may be transmitted around the dialysis session. This documents sets out recommendations for minimising this risk.There are sections describing how machines and equipment should be cleaned between patients. There are also recommendations for dialysing patients with hepatitis B away from patients who do not have hepatitis B. Patients should be immunised against hepatitis B, ideally before starting dialysis if this is possible. There are guidelines on how and when to do this, for checking whether immunisation is effective, and for administering booster doses of vaccine. Finally there is a section on the measures that should be taken if a patient receiving dialysis is identified as having a new infection of hepatitis B, hepatitis C or HIV.
Collapse
Affiliation(s)
| | - Veena Reddy
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Simon Lines
- Norwich and Norfolk University Hospitals NHS Foundation Trust, Norwich, UK
| | - Kay Tyerman
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Eccles
- Patient Representative, c/o The Renal Association, Bristol, UK
| |
Collapse
|
17
|
Amjad A, Kumar J, Chaudary N, Kumar K, Nazar CMJ, Khan K. Hepatitis B Vaccination Status in Chronic Kidney Disease: Experience at Pakistan Institute of Medical Sciences. Cureus 2019; 11:e5282. [PMID: 31583197 PMCID: PMC6768832 DOI: 10.7759/cureus.5282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/30/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To know the status of vaccination against hepatitis B in chronic kidney disease patients, and to see the association of vaccination status with various factors. Materials and Methods A cross-sectional observational study was conducted in the Department of Nephrology, Pakistan Institute of Medical Sciences, Islamabad, from December 2015 to May 2016. Patients reporting in the outpatient department or admitted with the diagnosis of chronic kidney disease, whether on dialysis or not, were included in the study. Patient's information like the status of hepatitis B vaccination, age, gender, socioeconomic status, education and duration of chronic kidney disease were collected on a specially designed proforma. Results A total of 451 patients were included in the study, 57.43% were male and 42.57% were female. Mean age was 43.76±17.12 years. About 69% of the patients were from low socioeconomic class, 31% from the middle or higher middle class. Most of the patients were either uneducated (32.59%) or only had eight years of school education (33.04%). Only 19.9% of patients were vaccinated against hepatitis B virus. Conclusion Status of vaccination against hepatitis B virus in chronic kidney disease patients is not satisfactory. It is strongly associated with socioeconomic class.
Collapse
Affiliation(s)
- Amna Amjad
- Nephrology, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Jais Kumar
- Nephrology, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Noureen Chaudary
- Medicine, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Kishore Kumar
- Nephrology, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | | | - Khushal Khan
- Gastroenterology, Shifa International Hospital, Islamabad, PAK
| |
Collapse
|
18
|
Dimitrov Y, Ducher M, Kribs M, Laurent G, Richter S, Fauvel JP. Variables linked to hepatitis B vaccination success in non-dialyzed chronic kidney disease patients: Use of a bayesian model. Nephrol Ther 2019; 15:215-219. [PMID: 31129001 DOI: 10.1016/j.nephro.2019.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis B vaccination is recommended for chronic kidney disease (CKD) patients before starting dialysis. We performed an analyis aimed to describe the clinical and biological parameters related to the success of vaccination in CKD patients before starting dialysis. METHODS We extracted data of 170 non-dialyzed patients who were offered hepatitis B vaccination from a register. They received a first vaccination of 40μg followed by boosters after one, two and six months. Patients were considered protected if their hepatitis B antibody level was >10IU/L, three months apart. A logistic regression and a Bayesian model were used to describe the relationships between variables and the success of vaccination. RESULTS Vaccination protected 50.6% of the patients. Model adjustment to the data was higher using the Bayesian model compared to the logistic regression (with area under the ROC curve of 0.955±0.007 vs 0.775±0.066 respectively). The Bayesian model's robustness studied using a 10 fold cross validation showed a percentage of misclassified subjects of 12.4±1.8%, a sensitivity of 87.7±0.3%, a specificity of 87.5±0.3%, a positive predictive value of 87.8±0.3% and negative predictive value of 87.4±0.2%. As classified by the Bayesian model, the variables most related to successful vaccination were, in descending order: age, eGFR, protidemia, albuminemia, cause of renal failure, gender, previous vaccination and weight. CONCLUSION The Bayesian network confirmed that both kidney function and nutritional status of patients are important factors to explain the success of vaccination against hepatitis B in CKD patients before dialysis. For research purposes, before an external validation, the network can be used online at www.hed.cc/?s=Bhepatitis&n=ReseauhepatiteBsup10.neta.
Collapse
Affiliation(s)
- Yves Dimitrov
- Nephrology Department, centre hospitalier de Haguenau, 64, avenue du professeur Leriche, 67500 Haguenau, France.
| | - Michel Ducher
- Pharmacy Department, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - Marc Kribs
- Nephrology Department, centre hospitalier de Haguenau, 64, avenue du professeur Leriche, 67500 Haguenau, France
| | - Guillaume Laurent
- Nephrology Department, centre hospitalier de Haguenau, 64, avenue du professeur Leriche, 67500 Haguenau, France
| | | | - Jean-Pierre Fauvel
- Hospices civils de Lyon, université Claude-Bernard Lyon 1, 69000 Lyon, France
| |
Collapse
|
19
|
da Silva EN, Baker A, Alshekaili J, Karpe K, Cook MC. A randomized trial of serological and cellular responses to hepatitis B vaccination in chronic kidney disease. PLoS One 2018; 13:e0204477. [PMID: 30303980 PMCID: PMC6179249 DOI: 10.1371/journal.pone.0204477] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/07/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with an increased risk of hepatitis B infection and impaired seroconversion to hepatitis B vaccine (HBV). Studies examining augmented vaccine schedules to enhance seroconversion have so far been inconclusive. Furthermore, the defects responsible for impaired vaccine immunity in CKD have not yet been identified. METHODS We studied serological and cellular responses to HBV in CKD to identify a defect in vaccine-induced cellular responses that could account for impaired seroconversion in CKD and clarify the effects of an augmented vaccine dose schedule. We compared these results with responses to seasonal influenza vaccination (Fluvax). RESULTS We found a clear benefit in rates and magnitude of seroconversion after an augmented 40mcg HBV dose schedule in CKD. This permitted comparison of responders and non-responders. Serological non-responders with CKD exhibited reduction in CXCR3+CCR6- CXCR5+ memory T cells at baseline. Unlike Fluvax, HBV elicited a poor plasmablast (PB) response. Both vaccinations induced activation of the CXCR3+CCR6- CCR7- subset of circulating T follicular helper cells (cTFH), although this response was impaired in CKD after HBV. CONCLUSIONS CKD confers a specific T cell defect that contributes to the impaired seroconversion to HBV.
Collapse
Affiliation(s)
- Elizabeth N da Silva
- Division of Immunology and Infection, John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia.,Translational Research Unit, Canberra Hospital, Garran, ACT, Australia.,Department of Immunology, Canberra Hospital, Garran, ACT, Australia
| | - Alan Baker
- Department of Immunology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Jalila Alshekaili
- Division of Immunology and Infection, John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia.,Translational Research Unit, Canberra Hospital, Garran, ACT, Australia
| | - Krishna Karpe
- Department of Renal Medicine, The Canberra Hospital, Garran, ACT, Australia
| | - Matthew C Cook
- Division of Immunology and Infection, John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia.,Translational Research Unit, Canberra Hospital, Garran, ACT, Australia.,Department of Immunology, Canberra Hospital, Garran, ACT, Australia
| |
Collapse
|
20
|
Increased but stable isoagglutinin titers in hemodialysis patients. J Nephrol 2018; 32:121-127. [DOI: 10.1007/s40620-018-0512-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022]
|
21
|
Miller-Handley H, Paulsen G, Hooper DK, Lake M, Lazear D, Danziger-Isakov L. Durability of the hepatitis B vaccination in pediatric renal transplant recipients. Clin Transplant 2018; 32:e13247. [DOI: 10.1111/ctr.13247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Hilary Miller-Handley
- Department of Internal Medicine; Pediatrics at University of Cincinnati and Cincinnati Children's Hospital; Cincinnati OH USA
- Division of Pediatric Infection Disease; Cincinnati Children's Hospital; Cincinnati OH USA
| | - Grant Paulsen
- Division of Pediatric Infection Disease; Cincinnati Children's Hospital; Cincinnati OH USA
| | - David K. Hooper
- Division of Nephrology; Cincinnati Children's Hospital; Cincinnati OH USA
| | - Michael Lake
- Division of Pharmacy; Cincinnati Children's Hospital; Cincinnati OH USA
| | - Danielle Lazear
- Division of Pharmacy; Cincinnati Children's Hospital; Cincinnati OH USA
| | - Lara Danziger-Isakov
- Division of Pediatric Infection Disease; Cincinnati Children's Hospital; Cincinnati OH USA
| |
Collapse
|
22
|
Factors affecting responsiveness to hepatitis B immunization in dialysis patients. Int Urol Nephrol 2017; 49:1845-1850. [PMID: 28620716 DOI: 10.1007/s11255-017-1616-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/09/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are widespread health problems all over the world and have high morbidity and mortality. Hemodialysis patients are more frequently exposed to these viruses as they have poor immune system and frequently undergo parenteral interventions. The vaccination against HBV prevents infection and it has been recommended for the prevention of HBV infection in all susceptible dialysis patients. This study aimed to determine the seroprevalence of HBV and HCV infections and analyzed the factors affecting inadequate response to HBV vaccine in dialysis patients. METHODS The data for 584 dialysis patients that were followed up at seven dialysis centers were analyzed. The patients received four doses of 40 μg recombinant hepatitis B vaccine at 0, 1, 2, and 6 months and were tested for anti-HBs titer after one month of completion of vaccination. If patients showed a titer of anti-HBs <10 IU/mL, an additional 40 μg in four vaccine doses was administered immediately and they were retested for the anti-HBs following the same schedule. The patients were divided into two groups: responders and non-responders. RESULTS HBsAg and anti-HCV seroprevalence was 3.4% and 10.3%, respectively. After vaccination schedule, 264 (83.5%) patients had antibody response to HBV vaccine and 52 (16.5%) had no response. Hepatitis B vaccine unresponsiveness is more common in the patients with hepatitis C positivity (p = 0.011), BMI >30 (p = 0.019), over the age of 65 years (p = 0.009), and duration of dialysis treatment >5 years (p = 0.001). There was no statistically significant difference between gender, causes of renal disease, erythropoietin treatment, and the type of dialysis. CONCLUSION Hepatitis C infection, obesity, being elderly, and having long hemodialysis period reduced the hepatitis B vaccination response in hemodialysis patients.
Collapse
|
23
|
Tavakoli A, Moghoofei M, Mostafaei S, Ghaffari H, Monavari SH, Alavian SM. Prevalence of hepatitis B surface antigen among hemodialysis patients from Middle Eastern countries: a systematic review and meta-analysis. Future Virol 2017. [DOI: 10.2217/fvl-2017-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aim: The aim of this study was to determine the overall prevalence of hepatitis B surface antigen (HBsAg) among hemodialysis patients reported from the Eastern Mediterranean Regional Office of the WHO (EMRO) countries and the Middle East. Methods: Several databases such as PubMed, ISI Web of Science, MEDLINE and Scopus were searched for publications reporting HBsAg prevalence among hemodialysis patients up to December 2016. Results: From all the samples, the pooled prevalence of HBsAg was estimated (95% CI) to be 4.4% (4.4–4.5%). Conclusion: The prevalence of HBsAg in hemodialysis units in the Middle Eastern countries is decreasing over the recent years. Nevertheless, it is important to conduct more studies in these regions to achieve more representative results.
Collapse
Affiliation(s)
- Ahmad Tavakoli
- Baqiyatallah Research Center for Gastroenterology & Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Moghoofei
- Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Shayan Mostafaei
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hadi Ghaffari
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology & Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
- Middle East Liver Disease (MELD) Center, Tehran, Iran
| |
Collapse
|
24
|
Assing K, Nielsen C, Jakobsen M, Scholze A, Nybo M, Soerensen G, Mortensen S, Vejen K, Barington T, Bistrup C. Evidence of perturbed germinal center dynamics, but preserved antibody diversity, in end-stage renal disease. IMMUNITY INFLAMMATION AND DISEASE 2016; 4:225-234. [PMID: 27957330 PMCID: PMC4879468 DOI: 10.1002/iid3.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/11/2016] [Accepted: 04/15/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION End-stage renal disease (ESRD) is associated with increased infectious susceptibility and with reduced vaccine responses consistent with compromised humoral immunity. Whether the compromised humoral immunity is due to reduced antibody diversity (reduced somatic hypermutation [SHM]) or altered germinal center (GC) dynamics is not known. The GC-derived chemokine CXCL13 as well as peripheral T follicular helper cells (pTFH) reflect GC dynamics, but have, similar to SHM, never been characterized in relation to ESRD. METHODS Serum CXCL 13 was determined by ELISA. PTFH were flow-cytometrically defined as CD4+ CD45RA- CCR7+ CXCR5+ lymphocytes. Apoptotic lymphocyte subsets were in addition annexin V+. SHM was determined, by next-generation sequencing and bioinformatics, as nucleotide mutations within the IgG VH (comprising the important antigen-binding domains of IgG, CDR1, and CDR2). RESULTS Elevated CXCL13 levels characterized ESRD (n = 19; [median] 90 pg/ml, P < 0.01) (controls, n = 18; 62 pg/ml). ESRD pTFH frequencies (n = 19; 11.6% [of CD4+ memory T cells], P < 0.02*, *Bonferroni corrected) (controls, n = 22; 14.9%) and concentrations (n = 19; 0.03 × 109/L, P < 0.02*) (controls, n = 22; 0.07 × 109/L) were reduced. ESRD pTFH were more apoptotic (n = 9; 25.7%, P = 0.04*) (controls, n = 10; 15.9%). SHM did not discriminate between ESRD (n = 10; 7.4%, P = 0.21) and controls (n = 10; 8.4%). CONCLUSIONS Elevated CXCL13 levels, reduced pTFH levels, and increased pTFH apoptosis suggest that perturbed GC dynamics, and not reduced antibody diversity, underlie the diminished vaccine responses and the compromised humoral immunity in ESRD. However, largely preserved SHM provides a rationale for pursuing vaccination in relation to ESRD.
Collapse
Affiliation(s)
- Kristian Assing
- Department of Clinical Immunology Odense University Hospital Odense Denmark
| | - Christian Nielsen
- Department of Clinical Immunology Odense University Hospital Odense Denmark
| | - Marianne Jakobsen
- Department of Clinical Immunology Odense University Hospital Odense Denmark
| | - Alexandra Scholze
- Clinical Research UnitDepartment of NephrologyOdense University HospitalOdenseDenmark; Institute of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Mads Nybo
- Department of Clinical Biochemistry Odense University Hospital Odense Denmark
| | - Grete Soerensen
- Department of Nephrology Odense University Hospital Odense Denmark
| | - Sussie Mortensen
- Department of Clinical Immunology Odense University Hospital Odense Denmark
| | - Knud Vejen
- Department of Clinical Immunology Odense University Hospital Odense Denmark
| | - Torben Barington
- Department of Clinical Immunology Odense University Hospital Odense Denmark
| | - Claus Bistrup
- Department of Nephrology Odense University Hospital Odense Denmark
| |
Collapse
|
25
|
Adejumo OA, Akinbodewa AA, Okaka EI, Alli OE, Ibukun IF. Chronic kidney disease in Nigeria: Late presentation is still the norm. Niger Med J 2016; 57:185-9. [PMID: 27397961 PMCID: PMC4924403 DOI: 10.4103/0300-1652.184072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) has become a public health problem in Nigeria. Efforts are being geared toward early diagnosis and prevention of CKD. This study involved the evaluation of the referral pattern and mode of presentation of CKD patients at first contact in a tertiary health institution. PATIENTS AND METHODS Patients' records over an 18 month period were retrieved and the following information extracted: Sociodemographic data, referral hospital, mode of presentation, etiology of CKD, packed cell volume, blood pressure, and estimated glomerular filtration rate (GFR) at first presentation. RESULTS There were 202 CKD patients with a male: female ratio of 1.7:1 and a mean age of 48.15 ± 16.69 years. The median estimated GFR of the patients at presentation was 3.17 ml/min/1.73 m(2). The common etiologies of CKD were chronic glomerulonephritis, hypertension, diabetes mellitus, obstructive nephropathy in 69 (34.2%), 47 (23.3%), 38 (18.8%), and 21 (10.4%) respectively. Among these patients, 111 (55%) and 98 (48.6%) had moderate to severe hypertension and anemia, respectively, 173 (85.6%) presented in CKD Stage 5, 101 (50%) required urgent hemodialysis whereas 123 (60.9%) required in-hospital admission. Only (18) 9% of these CKD patients presented by self-referral while (103) 51% were referred from secondary and private health facilities. CONCLUSION Most Nigerian CKD patients still present very late to nephrologists implying that the present preventive strategies have not yielded desired results. Early diagnosis and referral of CKD patients could be better achieved through regular education of the public and retraining of health workers especially those in primary and secondary health institutions.
Collapse
Affiliation(s)
- Oluseyi A. Adejumo
- Kidney Care Centre, University of Medical Sciences, Ondo City, Ondo State, Nigeria
| | | | - Enajite I. Okaka
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | - Oladimeji E. Alli
- Kidney Care Centre, University of Medical Sciences, Ondo City, Ondo State, Nigeria
| | - Ifedayo F. Ibukun
- Kidney Care Centre, University of Medical Sciences, Ondo City, Ondo State, Nigeria
| |
Collapse
|
26
|
Vilajeliu A, Sequera VG, García-Basteiro AL, Sicuri E, Aldea M, Velasco C, Bayas JM. Immunogenicity and immunization costs of adjuvanted versus non-adjuvanted hepatitis B vaccine in chronic kidney disease patients. Hum Vaccin Immunother 2016; 12:2317-21. [PMID: 27105182 DOI: 10.1080/21645515.2016.1168955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Hepatitis B virus (HBV) vaccination is recommended for all susceptible chronic pre-hemodialysis and hemodialysis patients. This study assessed the immunogenicity of HBV vaccines (adjuvanted and non-adjuvanted) in chronic kidney disease patients vaccinated at the Hospital Clinic of Barcelona (Spain) between January 2007 and July 2012. In addition, the costs for the health system were evaluated accor-ding to the proportion of vaccine responders after receiving either vaccine. Patients receiving 3 doses of hepatitis B adjuvanted vaccine were 3 times more likely to seroconvert than patients immunized with non-adjuvanted vaccines, OR 3.56 (95% CI 1.84-6.85). This resulted in fewer patients requiring a second course of HBV vaccination and fewer outpatient visits, saving more than €9,500 per 100 patients. The higher immunogenicity of the adjuvanted HBV vaccine would counterbalance the lower costs associated with the non-adjuvanted vaccine.
Collapse
Affiliation(s)
- Alba Vilajeliu
- a Department of Preventive Medicine and Epidemiology , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
| | - Víctor-Guillermo Sequera
- a Department of Preventive Medicine and Epidemiology , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
| | - Alberto L García-Basteiro
- b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona , Barcelona , Spain.,c Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique.,d Amsterdam Institute for Global Health and Development (AIGHD) , Amsterdam , The Netherlands
| | - Elisa Sicuri
- b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona , Barcelona , Spain.,e Department of Infectious Disease Epidemiology , Health Economics Group, School of Public Health, Imperial College London , London , UK
| | - Marta Aldea
- a Department of Preventive Medicine and Epidemiology , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
| | - César Velasco
- a Department of Preventive Medicine and Epidemiology , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
| | - José M Bayas
- a Department of Preventive Medicine and Epidemiology , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona , Barcelona , Spain
| |
Collapse
|
27
|
Grzegorzewska AE. Prophylactic vaccinations in chronic kidney disease: Current status. Hum Vaccin Immunother 2015; 11:2599-605. [PMID: 25911956 PMCID: PMC4685704 DOI: 10.1080/21645515.2015.1034915] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/09/2015] [Accepted: 03/22/2015] [Indexed: 12/17/2022] Open
Abstract
In this review, recent data on results concerning prophylactic vaccinations against hepatitis B virus, influenza viruses, and pneumococci are presented. Effects of active immunization in chronic kidney disease depend on category of glomerular filtration rate (GFR). The lower GFR category the better results of response to vaccination. Abnormalities in toll-like receptors and down-regulation of B-cell activating factor receptor in transitional B cells were recently included into uremia-associated deficits in immunocompetence. Development of novel, more potent vaccines containing toll-like receptor agonists as adjuvants may help to achieve more effective immunization against hepatitis B virus in immunocompromised patients. Experimental studies announce further vaccine adjuvants. A vaccine against hepatitis C virus is not available yet, but promising results were already obtained in the experimental and preliminary clinical studies. Prophylactic vaccinations against influenza viruses and pneumococci become increasingly popular in dialysis facilities due to their proved benefits.
Collapse
Affiliation(s)
- Alicja E Grzegorzewska
- Department of Nephrology, Transplantology, and Internal Diseases; Poznań University of Medical Sciences; Poznań, Poland
| |
Collapse
|
28
|
Gasim GI, Bella A, Adam I. Immune response to hepatitis B vaccine among patients on hemodialysis. World J Hepatol 2015; 7:270-5. [PMID: 25729482 PMCID: PMC4342609 DOI: 10.4254/wjh.v7.i2.270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 11/08/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023] Open
Abstract
Infection with hepatitis B virus (HBV) poses a major health threat worldwide, where the magnitude and overburden of chronic carrier state approaches 150 million chronic carriers. The prevalence of HBV is greater among dialyzed patients compared to the general population owing to their increased vulnerability to blood and its products, along with hazards posed by contaminated hemodialysis tools and devices. An electronic systematic search of the published literature was carried and data on the immunological riposte to hepatitis B vaccination among hemodialysis patients was extracted from relevant studies. End stage renal disease patients on hemodialysis have a lower or an absolutely negative riposte to HBV vaccine. Several means have been tried to improve this response with some success, nevertheless none have been universally adopted. Genetic investigations are foreseen to make a break through concerning HBV vaccination.
Collapse
Affiliation(s)
- Gasim I Gasim
- Gasim I Gasim, Ishag Adam, Qassim College of Medicine, Qassim University, PO Box 15085 Buraydah, Saudi Arabia
| | - Abdelhaleem Bella
- Gasim I Gasim, Ishag Adam, Qassim College of Medicine, Qassim University, PO Box 15085 Buraydah, Saudi Arabia
| | - Ishag Adam
- Gasim I Gasim, Ishag Adam, Qassim College of Medicine, Qassim University, PO Box 15085 Buraydah, Saudi Arabia
| |
Collapse
|
29
|
Grzegorzewska AE. Hepatitis B vaccination in chronic kidney disease patients: a call for novel vaccines. Expert Rev Vaccines 2014; 13:1317-26. [PMID: 25148051 DOI: 10.1586/14760584.2014.944508] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The protective immunization rates in response to hepatitis B vaccination in chronic kidney disease (CKD) patients are lower than response rates in the general population because of genetic and CKD-related factors as well as logistic problems with a proper providing of the recommended vaccination schedules. This review focuses on third-generation vaccines and adjuvanted vaccines commercially introduced in some countries, investigated in clinical trials, especially involving CKD patients or used only in the experimental studies. In order to improve the immunization rate, the use of third-generation vaccines (yeast-derived pre-S2/S HBV vaccines, mammalian cell-derived pre-S2/S HBV vaccines, mammalian cell-derived pre-S1/pre-S2/S HBV vaccines), novel adjuvants (AS04, AS02, phosphorothioate oligodeoxyribonucleotide, hemokinin-1, a polysaccharide based on delta inulin, nano-complex Hep-c, cyclic diguanylate) or immunostimulants for enhancement of immunogenicity of existing recombinant hepatitis B vaccines is tried to improve results of hepatitis B vaccination prior to dialysis commencement or already on renal replacement therapy.
Collapse
Affiliation(s)
- Alicja E Grzegorzewska
- Chair and Department of Nephrology, Transplantology and Internal Diseases Poznań University of Medical Sciences (PUMS), 60-355 Poznań, 49 Przybyszewskiego Blvd Poznań, Poland
| |
Collapse
|
30
|
Rezaee-Zavareh MS, Einollahi B. Hepatitis B vaccination: needs a revision. HEPATITIS MONTHLY 2014; 14:e17461. [PMID: 24734095 PMCID: PMC3984473 DOI: 10.5812/hepatmon.17461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Mohammad Saeid Rezaee-Zavareh
- Students’ Research Committee, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Middle East Liver Disease Center, Tehran, IR Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Behzad Einollahi, Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2181262073, E-mail:
| |
Collapse
|