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Bruce MG, Bruden D, Hurlburt D, Morris J, Bressler S, Thompson G, Lecy D, Rudolph K, Bulkow L, Hennessy T, Simons BC, Weng MK, Nelson N, McMahon BJ. Protection and antibody levels 35 years after primary series with hepatitis B vaccine and response to a booster dose. Hepatology 2022; 76:1180-1189. [PMID: 35320592 PMCID: PMC9790192 DOI: 10.1002/hep.32474] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The duration of protection from hepatitis B vaccination in children and adults is not known. In 1981, we used three doses of plasma-derived hepatitis B vaccine to immunize a cohort of 1578 Alaska Native adults and children from 15 Alaska communities who were ≥6 months old. APPROACH AND RESULTS We tested persons for antibody to hepatitis B surface antigen (anti-HBs) levels 35 years after receiving the primary series. Those with levels <10 mIU/ml received one booster dose of recombinant hepatitis B vaccine 2-4 weeks later and were then evaluated on the basis of anti-HBs measurements 30 days postbooster. Among the 320 recruited, 112 persons had not participated in the 22- or 30-year follow-up study (group 1), and 208 persons had participated but were not given an HBV booster dose (group 2). Among the 112 persons in group 1 who responded to the original primary series, 53 (47.3%) had an anti-HBs level ≥10 mIU/ml. Among group 1, 73.7% (28 of 38) of persons available for a booster dose responded to it with an anti-HBs level ≥10 mIU/ml at 30 days. Initial anti-HBs level after the primary series was correlated with higher anti-HBs levels at 35 years. Among 8 persons who tested positive for antibody to hepatitis B core antigen, none tested positive for HBsAg or HBV DNA. CONCLUSIONS Based on anti-HBs level ≥10 mIU/ml at 35 years and a 73.7% booster dose response, we estimate that 86% of participants had evidence of protection 35 years later. Booster doses are not needed in the general population at this time.
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Affiliation(s)
- Michael G. Bruce
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Dana Bruden
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Debby Hurlburt
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Julie Morris
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Sara Bressler
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Gail Thompson
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Danielle Lecy
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Karen Rudolph
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Lisa Bulkow
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Thomas Hennessy
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Brenna C. Simons
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
| | - Mark K. Weng
- Epidemiology and Surveillance BranchDivision of Viral HepatitisNational Center for HIV/AIDSViral HepatitisSexually Transmitted Disease, and Tuberculosis PreventionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Noele Nelson
- Epidemiology and Surveillance BranchDivision of Viral HepatitisNational Center for HIV/AIDSViral HepatitisSexually Transmitted Disease, and Tuberculosis PreventionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Brian J. McMahon
- Division of Preparedness and Emerging InfectionsNational Center for Emerging and Zoonotic Infectious DiseasesArctic Investigations ProgramCenters for Disease Control and PreventionAnchorageAlaskaUSA
- Liver Disease and Hepatitis ProgramAlaska Native Tribal Health ConsortiumAnchorageAlaskaUSA
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Koc ÖM, Menart C, Theodore J, Kremer C, Hens N, Koek GH, Oude Lashof AML. Ethnicity and response to primary three-dose hepatitis B vaccination in employees in the Netherlands, 1983 through 2017. J Med Virol 2019; 92:309-316. [PMID: 31621084 DOI: 10.1002/jmv.25610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/13/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS Hepatitis B virus (HBV) vaccination is recommended to all employees who have an occupational risk in the Netherlands. This study assessed the determinants of the immune response to primary standard three-dose HBV vaccination (0, 1, 6 months), with the main focus on ethnicity. METHODS Out of 76 239 individuals who received HBV vaccination between April 1983 and December 2017, 11 567 persons with a known country of birth and complete vaccination schedule were included in this study. Weighted multiple logistic regression with Firth's bias adjustment was used to assess the determinants of nonresponse (anti-HBs < 10 mIU/mL) and low response (anti-HBs 10-99 mIU/mL). RESULTS Baseline characteristics of the study population (n = 11 567) were as follows: mean age 27.5 years (95% confidence interval [CI], 27.23-27.72), 99.4% born in the Netherlands and 93.5% of Western European origin. Of all identified subjects, 180 (1.6%) were HBV vaccine nonresponders and 549 (4.8%) were low responders. When compared with individuals aged <40 years, the rate of nonresponse (4.3% vs 0.8%; P < .001) and low response (11.9% vs 2.9%; P < .001) was higher in those aged 40 years or older. The height of anti-HBs levels were lower in those subjects aged >40 years in comparison with those younger than 40 years, P < .001. All nonresponders were born in the Netherlands. Although no significant association was found between nonresponse and individuals of Western European origin (adjusted odds ratio [aOR] = 1.20; 95% CI, 0.66-2.44; P = .163), low response to HBV vaccination was significantly associated with Western European origin (aOR = 2.21; 95% CI, 1.41-3.86; P = .001). Significant determinants for nonresponse were older age at vaccination (aOR = 1.06; 95% CI, 1.06-1.07; P < .001) and male gender (aOR = 2.51; 95% CI, 1.97-3.22; P < .001). CONCLUSIONS The nonresponse rate was low in our study population. Our findings suggest that the vaccines being used for the primary vaccination are probably less immunogenic for older individuals, males, and persons of Western European origin.
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Affiliation(s)
- Özgür M Koc
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Charlotte Menart
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jemimah Theodore
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cécile Kremer
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-Biostat), Hasselt University, Hasselt, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-Biostat), Hasselt University, Hasselt, Belgium.,Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ger H Koek
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Visceral Surgery and Transplantation, University Hospital of the RWTH, Aachen, Germany
| | - Astrid M L Oude Lashof
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
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Koc ÖM, Damoiseaux J, van Loo IHM, Masquillier HIL, Oude Lashof AML. Case report of delayed seroprotection rather than non-response after primary three-dose hepatitis B vaccination. Vaccine 2019; 38:112-114. [PMID: 31648909 DOI: 10.1016/j.vaccine.2019.10.022] [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: 01/10/2019] [Revised: 10/03/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
We describe a delayed hepatitis B seroprotection 12 weeks after the primary vaccination schedule in a 57-year-old male with smoldering multiple myeloma. Based on undetectable anti-HBs antibodies 6 weeks after the third vaccination, the index person was previously considered to be a hepatitis B vaccine non-responder. Because hepatitis B vaccination started in the 1980s, many hepatitis B vaccine non-responders have received a revaccination regimen. If more cases of genuine delayed hepatitis B seroprotection surface in patients with hematologic malignancies, delayed seroprotection should be considered before the commencement of hepatitis B revaccination.
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Affiliation(s)
- Özgür M Koc
- Department of Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Department of Gastro-Enterology and Hepatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - Inge H M van Loo
- Department of Medical Microbiology, School of CAPHRI, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - Heloise I L Masquillier
- Department of Hematology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | - Astrid M L Oude Lashof
- Department of Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
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McKinney WP, Russler SK, Horowitz MM, Battiola RJ, Lee MBF. Duration of Response to Intramuscular Versus Low Dose Intradermal Hepatitis B Booster Immunization. Infect Control Hosp Epidemiol 2016. [DOI: 10.2307/30146996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AbstractObjective:To determine the duration of the immune response to plasma-derived hepatitis B vaccine among healthcare workers responding to booster doses of intradermal (ID) or intramuscular (IM) vaccine in 1986 and those with protective levels of antibody to hepatitis B surface antigen (anti-HBs) in 1986 without booster vaccine. Both groups received a primary hepatitis B vaccine series 24 to 36 months earlier.Design:Cross-sectional follow-up study two years later of an inception cohort defined in 1986.Setting:An academically affiliated metropolitan county hospital.Participants:Group 1: Hospital employees responding to booster doses of hepatitis B vaccine given ID or IM in 1986 due to low anti-HBs levels. Forty-one (82%) of 50 eligible persons were evaluated. Group 2: Persons not receiving booster vaccine in 1986 due to protective levels of anti-HBs. A random sample of 95 persons was drawn from a pool of 152 participants with protective levels in 1986. sixty-five (68%) of 95 contacted persons were restudied.Results:In 1988, 14 (64%) of 22 previous ID responders had anti-HBs levels ≥ 10 milli-international units (mIU)/mL, compared with 17 (89%) of 19 IM responders (p= .055). The 1988 geometric mean titer of IM recipients was 66.4 ±4.5 mIU/mL and of ID recipients was 20.7 ±7.4 (p= .04). None of 65 Group 2 subjects' anti-HBs titers dropped below 10 mIU/mL by 1988.Conclusions: plasma-derived hepatitis B vaccine recipients with anti-HBs levels ≥ 10 mIU/mL at 24 to 36 months after primary immunization are likely to maintain these levels two years later. The diminished durability of the antibody response together with the increased rate of local side effects associated with the ID injection route may limit its applicability as an alternative to using IM booster doses of hepatitis B vaccine.
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Poorolajal J, Hooshmand E, Cochrane Hepato‐Biliary Group. Booster dose vaccination for preventing hepatitis B. Cochrane Database Syst Rev 2016; 2016:CD008256. [PMID: 27271960 PMCID: PMC7154826 DOI: 10.1002/14651858.cd008256.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Antibodies against hepatitis B surface antigen (HBsAg) wane over time following hepatitis B immunisation; hence, it is unclear whether people vaccinated in three-dose or four-dose schedules of the hepatitis B vaccine are still immune when the hepatitis B surface antibody (anti-HBs) level in their body is undetectable, or lower than the level usually considered protective. This question may potentially be answered indirectly by measuring the anamnestic immune response to a booster dose of vaccine. The term 'booster' (or revaccination) refers to an additional dose of hepatitis B vaccine (HBV) given some time post-primary vaccination to induce immune memory and improve protection against hepatitis B virus (HBV) infection. OBJECTIVES To assess the benefits and harms of booster dose hepatitis B vaccination, more than five years after the primary vaccination, for preventing HBV infection in healthy individuals previously vaccinated with the hepatitis B vaccine, and with hepatitis B surface antibody (anti-HBs) levels below 10 mIU/mL. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded, conference databases, and reference lists of articles to January 2016. We also contacted authors of articles. In addition, we searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials (May 2016). SELECTION CRITERIA Randomised clinical trials addressing anamnestic immune response to a booster dose of hepatitis B vaccine, more than five years after the primary vaccination, in apparently healthy participants, vaccinated in a three-dose or four-dose schedule of the hepatitis B vaccine during the primary vaccination, without receiving an additional dose or immunoglobulin. DATA COLLECTION AND ANALYSIS Both review authors decided if the identified studies met the inclusion criteria or not. Primary outcomes included the proportion of participants with anamnestic immune response in non-protected participants and signs of HBV infection. Secondary outcomes were the proportion of participants that developed local and systemic adverse events following a booster dose injection. We planned to report the weighted proportion with 95% confidence intervals (CIs). MAIN RESULTS There were no eligible randomised clinical trials fulfilling the inclusion criteria of this review. AUTHORS' CONCLUSIONS We were unable to include any randomised clinical trials on the topic; only randomised clinical trials will be able to provide an answer as to whether a booster dose vaccination is able to protect against hepatitis B infection.
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Affiliation(s)
- Jalal Poorolajal
- School of Public Health, Hamadan University of Medical SciencesModeling of Noncommunicable Diseases Research Center, Department of EpidemiologyShahid Fahmideh AveHamadanHamadanIran6517838695
| | - Elham Hooshmand
- School of Public Health, Hamadan University of Medical SciencesDepartment of EpidemiologyHamadanIran
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Simons BC, Spradling PR, Bruden DJT, Zanis C, Case S, Choromanski TL, Apodaca M, Brogdon HD, Dwyer G, Snowball M, Negus S, Bruce MG, Morishima C, Knall C, McMahon BJ. A Longitudinal Hepatitis B Vaccine Cohort Demonstrates Long-lasting Hepatitis B Virus (HBV) Cellular Immunity Despite Loss of Antibody Against HBV Surface Antigen. J Infect Dis 2016; 214:273-80. [PMID: 27056956 DOI: 10.1093/infdis/jiw142] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Long-lasting protection resulting from hepatitis B vaccine, despite loss of antibody against hepatitis B virus (HBV) surface antigen (anti-HBs), is undetermined. METHODS We recruited persons from a cohort vaccinated with plasma-derived hepatitis B vaccine in 1981 who have been followed periodically since. We performed serological testing for anti-HBs and microRNA-155 and assessed HBV-specific T-cell responses by enzyme-linked immunospot and cytometric bead array. Study subgroups were defined 32 years after vaccination as having an anti-HBs level of either ≥10 mIU/mL (group 1; n = 13) or <10 mIU/mL (group 2; n = 31). RESULTS All 44 participants, regardless of anti-HBs level, tested positive for tumor necrosis factor α, interleukin 10, or interleukin 6 production by HBV surface antigen-specific T cells. The frequency of natural killer T cells correlated with the level of anti-HBs (P = .008). The proportion of participants who demonstrated T-cell responses to HBV core antigen varied among the cytokines measured, suggesting some natural exposure to HBV in the study group. No participant had evidence of breakthrough HBV infection. CONCLUSIONS Evidence of long-lasting cellular immunity, regardless of anti-HBs level, suggests that protection afforded by primary immunization with plasma-derived hepatitis B vaccine during childhood and adulthood lasts at least 32 years.
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Affiliation(s)
- Brenna C Simons
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC) WWAMI School of Medical Education, College of Health, University of Alaska Anchorage
| | - Philip R Spradling
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia
| | - Dana J T Bruden
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC)
| | - Carolyn Zanis
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC)
| | - Samantha Case
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC)
| | | | - Minjun Apodaca
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Hazel D Brogdon
- WWAMI School of Medical Education, College of Health, University of Alaska Anchorage
| | - Gaelen Dwyer
- WWAMI School of Medical Education, College of Health, University of Alaska Anchorage
| | - Mary Snowball
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium
| | - Susan Negus
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium
| | - Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC)
| | - Chihiro Morishima
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Cindy Knall
- WWAMI School of Medical Education, College of Health, University of Alaska Anchorage
| | - Brian J McMahon
- Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC)
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Chen L, Liu WQ, Lei JH, Guan F, Li MJ, Song WJ, Li YL, Wang T. Chronic Schistosoma japonicum infection reduces immune response to vaccine against hepatitis B in mice. PLoS One 2012; 7:e51512. [PMID: 23272112 PMCID: PMC3522692 DOI: 10.1371/journal.pone.0051512] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 11/01/2012] [Indexed: 02/05/2023] Open
Abstract
Background Hepatitis B and schistosomiasis are most prevalent in Africa and Asia, and co-infections of both are frequent in these areas. The immunomodulation reported to be induced by schistosome infections might restrict immune control of hepatitis B virus (HBV) leading to more severe viral infection. Vaccination is the most effective measure to control and prevent HBV infection, but there is evidence for a reduced immune response to the vaccine in patients with chronic schistosomiasis japonica. Methodology/Principal Findings In this paper, we demonstrate in a mouse model that a chronic Schistosoma japonicum infection can inhibit the immune response to hepatitis B vaccine (HBV vaccine) and lead to lower production of anti-HBs antibodies, interferon-γ (IFN-γ) and interleukin-2 (IL-2). After deworming with Praziquantel (PZQ), the level of anti-HBs antibodies gradually increased and the Th2-biased profile slowly tapered. At 16 weeks after deworming, the levels of anti-HBs antibodies and Th1/Th2 cytokines returned to the normal levels. Conclusions/Significance The results suggest that the preexisting Th2-dominated immune profile in the host infected with the parasite may down–regulate levels of anti-HBs antibodies and Th1 cytokines. To improve the efficacy of HBV vaccination in schistosome infected humans it may be valuable to treat them with praziquantel (PZQ) some time prior to HBV vaccination.
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Affiliation(s)
- Lin Chen
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wuhan Institutes of Biomedical Sciences, Jianghan University, Wuhan, China
| | - Wen-qi Liu
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-hui Lei
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Guan
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man-jun Li
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-jian Song
- Department of Parasitology, Jianghan University, Wuhan, China
| | - Yong-long Li
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Wang
- Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Seroconversion by EMS Personnel Vaccinated with HBV Recombinant DNA. Prehosp Disaster Med 2012. [DOI: 10.1017/s1049023x00039790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To evaluate the seroconversion rate of EMS personnel given the hepatitis B virus (HBV) recombinant deoxyribonucleic acid (DNA) vaccine series.Design:Retrospective review of paramedics and firefighters consecutively completing the HBV recombinant DNA vaccine program.Setting:Urban, non-prof it, private, regional EMS Resource Hospital. The Chicago North EMS System is under contract with the Chicago Fire Department. This contract allows for the voluntary vaccination of EMS personnel with recombinant DNA-HBV vaccine and treatment and follow-up of paramedics and firefighters possibly exposed to HBV.Population:Initial 68 EMS personnel completing HBV recombinant DNA vaccine program (48 primary prophylaxis and 20 post-exposure prophylaxis).Intervention:HBV recombinant DNA vaccine series was administered voluntarily to Chicago EMS System paramedics and firefighters per manufacturers recommendations. Two weeks after completion of the vaccination series, blood samples for HBV antibody titres were drawn to determine reactivity and the need for further immunization.Results:Of the 68 vaccinated individuals, only two had negative titres (3%). These two individuals were given a fourth dose of vaccine with successful seroconversion.Conclusions:Prehospital care personnel are known highrisk, health-care workers for acquiring HBV and should be vaccinated prophylactically. There is a high seroconversion rate (97%) utilizing HBV recombinant DNA vaccine. However, post-vaccination antibody titres must be performed to identify those rare individuals that do not seroconvert.
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Poorolajal J, Mahmoodi M, Haghdoost A, Majdzadeh R, Nasseri-Moghaddam S, Ghalichi L, Fotouhi A. Booster dose vaccination for preventing hepatitis B. Cochrane Database Syst Rev 2010:CD008256. [PMID: 21069704 DOI: 10.1002/14651858.cd008256.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Antibodies against hepatitis B surface antigen (HBs) wane over time after vaccination for hepatitis B (HB); hence, the duration of protection provided by the vaccine is still unknown but may be evaluated indirectly by measuring the anamnestic immune response to booster doses of vaccine. OBJECTIVES To assess the benefits and harms of booster dose hepatitis B vaccination for preventing HB infection. SEARCH STRATEGY We searched The Cochrane Hepato-biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 4, 2010) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, conference databases, and reference lists of articles to May 2010. We also contacted authors of articles and manufacturers. SELECTION CRITERIA Randomised clinical trials addressing anamnestic immune response to booster of HB vaccine five years or more after primary vaccination in apparently healthy participants, vaccinated in a 3-dose or 4-dose schedules of HB vaccine without receiving additional dose or immunoglobulin. DATA COLLECTION AND ANALYSIS Two authors made the decisions if the identified publications on studies met the inclusion criteria or not. Primary outcome measures included the proportion with anamnestic immune response in non-protected participants and signs of hepatitis B virus infection. Secondary outcomes were the proportion with local and systemic adverse event events developed following booster dose injection. Weighted proportion were planned to be reported with 95% confidence intervals. MAIN RESULTS There were no eligible randomised clinical trials fulfilling the inclusion criteria of this review. AUTHORS' CONCLUSIONS We were unable to identify randomised clinical trials on the topic. We need randomised clinical trials to formulate future booster policies for preventing hepatitis B infection.
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Affiliation(s)
- Jalal Poorolajal
- Department of Epidemiology and Biostatistics, Research Centre for Health Sciences, Faculty of Health, Hamadan University of Medical Sciences (UMSHA), Shahid Fahmideh Avenue, Hamadan, Hamadan, Iran, 6517838695
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Thompson SC, Oman K. Why should Australia adopt universal infant hepatitis B vaccination? Aust N Z J Public Health 2008. [DOI: 10.1111/j.1467-842x.1996.tb01061.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Moyer LA, Alter MJ, Favero MS. Hemodialysis-Associated Hepatitis B: Revised Recommendations for Serologic Screening. Semin Dial 2007. [DOI: 10.1111/j.1525-139x.1990.tb00045.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Although vaccination against hepatitis B virus (HBV) is highly successful, 5% to 10% of individuals do not experience a response with an adequate antibody level to hepatitis B surface antigen (anti-HBs). Contributing causes for nonresponse to the vaccine are genetic predisposition, immunosuppression, and certain chronic illnesses. The distinction between true nonresponse (after adequate immunization) and waning anti-HBs levels is important. The latter is not uncommon in populations in areas of the world with low endemicity for HBV infection. Data from subjects with waning anti-HBs levels show that immunologic memory may still protect these individuals against acute HBV infection or may prevent chronic infection with HBV for < or =10 years after immunization. Recent reports from Asia and Alaska describe cases of chronic HBV infection 15 years after immunization in subjects who have very low levels of anti-HBs. Thus, nonresponders or those with waning immunity who may be at risk of HBV infection in subsequent years may require a booster dose. Clinical algorithms to reimmunize nonresponders have been described and are discussed in this article. Experimental hepatitis B vaccines have shown some promise in nonresponders but are not commercially available in the United States.
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Affiliation(s)
- Maria H Sjogren
- Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, District of Columbia 20307, USA
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Devito C, Zuber B, Schröder U, Benthin R, Okuda K, Broliden K, Wahren B, Hinkula J. Intranasal HIV-1-gp160-DNA/gp41 peptide prime-boost immunization regimen in mice results in long-term HIV-1 neutralizing humoral mucosal and systemic immunity. THE JOURNAL OF IMMUNOLOGY 2005; 173:7078-89. [PMID: 15557206 DOI: 10.4049/jimmunol.173.11.7078] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An intranasal DNA vaccine prime followed by a gp41 peptide booster immunization was compared with gp41 peptide and control immunizations. Serum HIV-1-specific IgG and IgA as well as IgA in feces and vaginal and lung secretions were detected after immunizations. Long-term humoral immunity was studied for up to 12 mo after the booster immunization by testing the presence of HIV-1 gp41- and CCR5-specific Abs and IgG/IgA-secreting B lymphocytes in spleen and regional lymph nodes in immunized mice. A long-term IgA-specific response in the intestines, vagina, and lungs was obtained in addition to a systemic immune response. Mice immunized only with gp41 peptides and L3 adjuvant developed a long-term gp41-specific serum IgG response systemically, although over a shorter period (1-9 mo), and long-term mucosal gp41-specific IgA immunity. HIV-1-neutralizing serum Abs were induced that were still present 12 mo after booster immunization. HIV-1 SF2-neutralizing fecal and lung IgA was detectable only in the DNA-primed mouse groups. Intranasal DNA prime followed by one peptide/L3 adjuvant booster immunization, but not a peptide prime followed by a DNA booster, was able to induce B cell memory and HIV-1-neutralizing Abs for at least half of a mouse's life span.
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MESH Headings
- AIDS Vaccines/administration & dosage
- AIDS Vaccines/immunology
- Administration, Intranasal
- Amino Acid Sequence
- Animals
- B-Lymphocytes/immunology
- B-Lymphocytes/virology
- Bronchoalveolar Lavage Fluid/immunology
- Bronchoalveolar Lavage Fluid/virology
- Feces/virology
- Female
- HIV Antibodies/biosynthesis
- HIV Envelope Protein gp160/administration & dosage
- HIV Envelope Protein gp160/immunology
- HIV Envelope Protein gp41/administration & dosage
- HIV Envelope Protein gp41/immunology
- HIV-1/immunology
- Immunity, Active
- Immunity, Mucosal
- Immunization, Secondary/methods
- Immunoglobulin A/biosynthesis
- Immunoglobulin G/biosynthesis
- Immunologic Memory
- Intestine, Small/immunology
- Intestine, Small/virology
- Mice
- Mice, Inbred C57BL
- Molecular Sequence Data
- Nasal Mucosa/immunology
- Nasal Mucosa/virology
- Neutralization Tests
- T-Lymphocytes/immunology
- T-Lymphocytes/virology
- Vaccines, DNA/administration & dosage
- Vaccines, DNA/immunology
- Vaccines, Subunit/administration & dosage
- Vaccines, Subunit/immunology
- Vagina/immunology
- Vagina/metabolism
- Vagina/virology
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Affiliation(s)
- Claudia Devito
- Swedish Institute for Infectious Disease Control and Microbiology and Tumorbiology Center, Department of Virology, Karolinska Institute, Solna, Sweden
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15
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Petersen KM, Bulkow LR, McMahon BJ, Zanis C, Getty M, Peters H, Parkinson AJ. Duration of hepatitis B immunity in low risk children receiving hepatitis B vaccinations from birth. Pediatr Infect Dis J 2004; 23:650-5. [PMID: 15247604 DOI: 10.1097/01.inf.0000130952.96259.fd] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The duration of protection after hepatitis B vaccination of infants is unknown. METHODS We determined antibody to hepatitis B surface antigen (anti-HBs) at 4-13 years of age in 363 low risk children who had been vaccinated starting at birth with hepatitis B vaccine. Those with nonprotective titers (<10 mIU/mL) received a booster dose. We similarly followed 16 children of hepatitis B surface antigen (HBsAg)-positive mothers. RESULTS Of low risk infants receiving a plasma-derived vaccine, 41% (42 of 102) of those whose primary response was unknown and 24% (4 of 17) who had initially responded retained protective titers (> or = 10 mIU/mL) of anti-HBs at 9 and 13 years, respectively. Of those who did not have protective antibody titers, 61% (33 of 54) and 67% (8 of 12), respectively, responded to a booster dose. In children of HBsAg-positive mothers, 31% retained protective anti-HBs at 12 years, and 90% (9 of 10) with nonprotective titers responded to a booster. In low risk children initially receiving a recombinant vaccine, 12.5% (26 of 208) and none (0 of 36) retained protective anti-HBs titers at 5 and 7 years of age, respectively. Of those who did not have protective titers, 90% (120 of 134) and 91% (32 of 35), respectively, responded to a booster. CONCLUSIONS Anti-HBs disappeared by 5 years of age in most children who were vaccinated with hepatitis B vaccine from birth. Although most children showed immunologic memory, one-third failed to demonstrate an anamnestic response to a booster dose. Additional long term studies of low risk infants are needed to determine duration of protection and the necessity for or timing of booster doses.
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Affiliation(s)
- Kenneth M Petersen
- Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA
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16
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Abstract
Immunization is the most effective way to prevent transmission of HBV and, hence, the development of acute or chronic hepatitis B. The national strategy to eliminate transmission of the virus in the United States includes vaccination of all newborn infants, children, adolescents, and high-risk adults. Postexposure prophylaxis is also advocated, depending on the vaccination and anti-HBs status of the exposed person. Seroprotection after vaccination, defined as anti-HBs > or = 10 mIU/mL, is achieved in over 95% of all vaccinees. The hepatitis B vaccines are very well tolerated with usually minimal adverse effects. Predictors of non-response include increasing age, male gender, obesity, tobacco smoking, and immunocompromising chronic disease. For those who remain nonresponders after the second series of vaccination, adjuvants such as GM-CSF may be considered, but their results are variable.
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Affiliation(s)
- Andy S Yu
- Liver Transplant Program, Stanford University Medical Center, 750 Welch Road, Suite 210, Stanford, CA 94305, USA
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17
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Charest AF, Grand'Maison A, McDougall J, Goldstein MB. Evolution of naturally acquired hepatitis B immunity in the long-term hemodialysis population. Am J Kidney Dis 2003; 42:1193-9. [PMID: 14655191 DOI: 10.1053/j.ajkd.2003.08.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the natural history of vaccination-induced hepatitis B virus (HBV) antibodies (Abs) is becoming clearer, little is known about naturally acquired immunity. Some assume that these patients never lose their Abs. METHODS To document the natural history of HBV immunity, we prospectively followed up all naturally immune patients initiating hemodialysis (HD) therapy at St Michael's Hospital (Toronto, Canada). Patients presenting with Ab to hepatitis B surface antigen (HBsAb) who had no history of vaccination had a core Ab level measured to confirm natural immunity. When HBsAb titer decreased to less than 10 IU/L, patients were administered a single dose of 40 microg of Engerix B vaccine (Smith Kline Beecham Pharma Inc, Oakville, Ontario, Canada) intramuscularly as a booster dose. RESULTS We identified 29 patients beginning HD therapy with natural immunity. Nine patients (30%) subsequently lost immunity (defined as Ab titer decreasing to < 10 IU/L) during follow-up. They were older and had a lower Ab titer at initiation of HD therapy. Four of 5 patients with a low response to the booster dose were 75 years or older. Two patients with a low peak Ab titer after the booster dose again had their Ab titer decrease to less than 10 IU/L after 6 and 10 months. Both patients were switched to intradermal vaccination. All other patients were still immune after a median of 26 months. CONCLUSION Individuals who are naturally immune against HBV may experience a decrease in Ab titer. Their responses to booster vaccinations varied widely. It is possible that elderly patients with natural immunity require closer surveillance. We provide recommendations for surveillance in these patients.
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18
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Edstam JS, Dulmaa N, Nymadawa P, Rinchin A, Khulan J, Kimball AM. Comparison of hepatitis B vaccine coverage and effectiveness among urban and rural Mongolian 2-year-olds. Prev Med 2002; 34:207-14. [PMID: 11817916 DOI: 10.1006/pmed.2001.0972] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The prevalence of hepatitis B (HBV) carriage in Mongolia is reported to be 14%. Universal HBV immunization of newborns has been shown to decrease carriage in Asian populations. Mongolia began universal newborn vaccination in 1991. This evaluation of vaccine coverage and effectiveness compares the success of the program between urban and nomadic rural populations. METHODS Using random cluster sampling, 148 Mongolian 2-year-olds from seminomadic rural families were compared with 127 2-year-olds from Ulaanbaatar, the capital city. RESULTS More than 95% of all subjects received hepatitis B vaccine although rural subjects were less likely to complete the series than were urban subjects. Adequate vaccine response differed significantly: 94.2% of urban subjects versus only 70.2% of rural subjects had protective anti-HBs levels (P < 0.001). Overall the proportion of hepatitis B infection in both samples was lower than the historical Mongolian prevalence. However, unexpectedly 40% of subjects in rural Bayanhongor Aimag (Province) were found to be HBsAg positive. CONCLUSION The Mongolian infant vaccination program for hepatitis B is successfully reducing the rate of chronic carriage in the immunized generation. However, vaccine response among rural subjects is less than that among urban. There appears to be a pocket of high disease prevalence in Bayanhongor that requires further study.
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Affiliation(s)
- James S Edstam
- School of Public Health and Community Medicine, University of Washington, Box 357660, Seattle, WA 98195, USA.
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19
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Charest AF, McDougall J, Goldstein MB. A randomized comparison of intradermal and intramuscular vaccination against hepatitis B virus in incident chronic hemodialysis patients. Am J Kidney Dis 2000; 36:976-82. [PMID: 11054354 DOI: 10.1053/ajkd.2000.19099] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hepatitis B virus (HBV) remains a threat to hemodialysis patients. Nevertheless, the vaccination rate against this virus is low, perhaps because of the low conversion rate. Although intradermal (ID) vaccination has been proven to be effective (even in patients nonresponsive to intramuscular [IM] vaccination), the duration of immunity was short. The impact of vaccination route and a greater peak antibody (Ab) titer on conversion rate and duration of immunity after ID or IM vaccination was compared in incident hemodialysis patients. Forty-nine patients were randomly assigned to treatment with 5 microgram of recombinant hepatitis B vaccine (Engerix B; Smith Kline Beecham Pharma Inc, Oakville, ON, Canada) ID every 2 weeks up to either a peak Ab titer of 1,000 IU/L or greater or 52 doses, whereas 48 patients were administered 40 microgram IM at 0, 1, 2, and 6 months. Group demographics were similar. Conversion was achieved in 97.6% of the ID group and 90.5% of the IM group (P: = 0.16). There was no difference between ID and IM groups in time required to convert, peak Ab titer reached, and proportion of patients with a peak Ab titer of 1,000 IU/L or greater. Overall, the duration of immunity was not different after ID or IM vaccination (P = 0.683), and patients in the IM group with a peak Ab titer of 1,000 IU/L or greater had a longer duration of immunity (P = 0.001). In conclusion, a high conversion rate and long duration of immunity against HBV can be achieved cost-effectively in the end-stage renal disease population using the ID or IM route and aiming for an Ab titer exceeding 1,000 IU/L. Based on these data, we provide recommendations for vaccination and surveillance in this population.
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Affiliation(s)
- A F Charest
- Nephrology Division, St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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20
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Abstract
The challenge of viral hepatitis has been acknowledged and confronted in the last decade. Significant progress in prevention of infection with HAV and HBV may eradicate these serious infections from the United States and other parts of the world in the coming decades. Application of prophylactic strategies to children will be a major mechanism in accomplishing this task. The quest for potent antiviral medications continues. The next critically important development will be ways to prevent new HCV infections and to treat the millions of already infected individuals at risk for the serious consequences of this disease. For pediatricians, realizing these goals requires a greater understanding of perinatal HCV transmission, use of vaccines for prevention of viral hepatitis, and identification of HCV-infected children who are likely to benefit from new therapeutic strategies as they become available.
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MESH Headings
- Antiviral Agents/therapeutic use
- Child
- Child, Preschool
- Hepatitis A/diagnosis
- Hepatitis A/drug therapy
- Hepatitis A/prevention & control
- Hepatitis A/virology
- Hepatitis B/diagnosis
- Hepatitis B/drug therapy
- Hepatitis B/prevention & control
- Hepatitis B/virology
- Hepatitis C/diagnosis
- Hepatitis C/drug therapy
- Hepatitis C/prevention & control
- Hepatitis C/virology
- Hepatitis, Viral, Human/diagnosis
- Hepatitis, Viral, Human/drug therapy
- Hepatitis, Viral, Human/prevention & control
- Hepatitis, Viral, Human/virology
- Humans
- Immunization Schedule
- Infant
- Infant, Newborn
- Viral Hepatitis Vaccines/therapeutic use
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Affiliation(s)
- M M Jonas
- Department of Pediatrics, Harvard Medical School, and the Division of Gastroenterology, Children's Hospital, Boston, Massachusetts, USA.
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21
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Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and management of blood-borne infections in health care workers. Clin Microbiol Rev 2000; 13:385-407. [PMID: 10885983 PMCID: PMC88939 DOI: 10.1128/cmr.13.3.385] [Citation(s) in RCA: 160] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Exposure to blood-borne pathogens poses a serious risk to health care workers (HCWs). We review the risk and management of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections in HCWs and also discuss current methods for preventing exposures and recommendations for postexposure prophylaxis. In the health care setting, blood-borne pathogen transmission occurs predominantly by percutaneous or mucosal exposure of workers to the blood or body fluids of infected patients. Prospective studies of HCWs have estimated that the average risk for HIV transmission after a percutaneous exposure is approximately 0.3%, the risk of HBV transmission is 6 to 30%, and the risk of HCV transmission is approximately 1.8%. To minimize the risk of blood-borne pathogen transmission from HCWs to patients, all HCWs should adhere to standard precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. Employers should have in place a system that includes written protocols for prompt reporting, evaluation, counseling, treatment, and follow-up of occupational exposures that may place a worker at risk of blood-borne pathogen infection. A sustained commitment to the occupational health of all HCWs will ensure maximum protection for HCWs and patients and the availability of optimal medical care for all who need it.
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Affiliation(s)
- E M Beltrami
- HIV Infections Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia 30333, USA.
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22
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Böcher WO, Galun E, Marcus H, Daudi N, Terkieltaub D, Shouval D, Löhr HF, Reisner Y. Reduced hepatitis B virus surface antigen-specific Th1 helper cell frequency of chronic HBV carriers is associated with a failure to produce antigen-specific antibodies in the trimera mouse. Hepatology 2000; 31:480-7. [PMID: 10655274 DOI: 10.1002/hep.510310231] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In chronic hepatitis B virus (HBV) infection weak antiviral immune responses are associated with viral persistence. We studied possible immune deficits underlying the lack of serum antibodies of such patients against the HBV surface antigen (HBsAg) in a novel human/mouse chimeric model. A hepatitis B surface antigen (HBs) vaccination of Balb/c mice engrafted with peripheral blood mononuclear cells (PBMC) of naturally HBV-immunized donors induced high frequencies of human HBsAg-specific B and T helper 1 (Th1) cells. These responses were associated with high serum anti-HBs antibody levels of the subclasses immunoglobulin G1 (IgG1) and IgG2 that are driven by interleukin-2 (IL-2) and interferon-gamma (IFN-gamma). In contrast, PBMC of chronic HBV carriers transplanted into the chimera failed to produce anti-HBs antibodies after vaccination with HBsAg and exhibited a deficit of antigen-specific Th1 cells. A possible influence of HBsAg or viremia was excluded by the lack of viral replication in such chimera. The observed T-cell defect was specific for HBsAg, as the B- and T-cell responses to tetanus toxoid (TT) were fully retained. Thus, our study shows that viral persistence in chronic HBV carriers is associated with an HBsAg-specific Th1 cell defect, which likely is responsible for the insufficient neutralizing anti-HBs-antibody response and is not reversed by HBs vaccination. Alternative approaches to induce HBs-specific Th1 cell responses might represent a future therapeutic option.
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Affiliation(s)
- W O Böcher
- Department of Immunology, The Weizmann Institute of Science, Rehovot, Israel
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23
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Böcher WO, Herzog-Hauff S, Schlaak J, Meyer zum Büschenfeld KH, Löhr HF. Kinetics of hepatitis B surface antigen-specific immune responses in acute and chronic hepatitis B or after HBs vaccination: stimulation of the in vitro antibody response by interferon gamma. Hepatology 1999; 29:238-44. [PMID: 9862872 DOI: 10.1002/hep.510290120] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Because cellular and humoral immune responses against the hepatitis B virus (HBV) surface antigen (HBs) might be crucial to overcome HBV infection, HBs-specific B- and T-cell responses of HBV patients and HBs vaccine recipients were analyzed quantitatively and functionally. In patients with acute hepatitis B (AHB), transient high anti-HBs-secreting B-cell frequencies were observed early after clinical onset, whereas 1 patient who probably developed chronic infection and chronic HBV carriers had absent or weak B- and T-cell responses. In HBs vaccine recipients, maximal HBs-specific B- and T-cell responses were detected after the first injection that decreased gradually before anti-HBs antibodies appeared in serum. Years after vaccination, anti-HBs-secreting B cells were enriched in the bone marrow. After in vitro stimulation with HBsAg, peripheral blood mononuclear cells (PBMC) of only 1 of 5 acute and 1 of 6 chronic HBV patients, but of all 6 vaccine recipients, secreted varying amounts of interferon gamma (IFN-gamma), but no interleukin-4 (IL-4) or IL-5. Furthermore, the addition of IFN-gamma, but not of IL-2, -4, -12, or IFN-alpha, resulted in strong increases of anti-HBs-secreting B cells in vaccine recipients and chronic carriers. In conclusion, circulating anti-HBs-secreting B cells were significantly higher in early acute hepatitis B or early after HBs vaccination than in chronic hepatitis B and decreased in the follow-up as a result of compartmentalization to lymphoid tissues. Release of IFN-gamma by antigen-stimulated T cells might be critical for anti-HBs formation.
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Affiliation(s)
- W O Böcher
- First Department of Internal Medicine, Johannes-Gutenberg University, Mainz, Germany
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24
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Li H, Li RC, Liao SS, Yang JY, Zeng XJ, Wang SS. Persistence of hepatitis B vaccine immune protection and response to hepatitis B booster immunization. World J Gastroenterol 1998; 4:493-496. [PMID: 11819352 PMCID: PMC4723436 DOI: 10.3748/wjg.v4.i6.493] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the persistence of immune protection of China-made, plasma-derived hepatitis B vaccine after infancy immunization and the time table of booster immunization.
METHODS: A cross-sectional follow-up study and an experimental study on booster were used for the evaluation of the serological effect 7 years after vaccination and the antibody anamnestic response. Radioimmunoassay was used for the detection of hepatitis B virus markers.
RESULTS: The protective anti-HBs positive rates of 1018 children, who were vaccinated according to the regimen of three doses of 10 μg hepatitis B vaccine in their infancy, declined from 75.0% during the first two years to 48.2% in the 7th year after the first dosage, however, the positive rates for HBsAg and anti-HBc always fluctuated at a low frequency. A total of 144 subjects aged 6 or 7 years, who were negative for both HBsAg and anti-HBc before booster, were selected from 1018 children of the follow-up study, and boosted with 1 μg intradermally or 2 μg hypodermically hepatitis B vaccines. Their anti-HBs GMT and anti-HBs positive rates were 190.6 mIU/mL and 89.6% in the first month after booster, significantly higher than 14.7 mIU/mL and 54.9% before booster (P < 0.01), and declined back to 25.3 mIU/mL and 75.5% in the 12th month; among 65 children with the anti-HBs negative before booster, 40 had a level of anti-HBS ≥ 100 mIU/mL one month after booster, suggesting retention of immune memory in most of them.
CONCLUSION: No need for revaccination against hepatitis B in the 7th year after the initial immunization due to better persistence of immune protection of the vaccine and retention of immune memory to hepatitis B virus in the vast majority of the vaccinees.
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25
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Abstract
OBJECTIVE To review two main issues concerning the hepatitis B vaccine: (1) the management of unresponsive subjects and (2) the need for routine booster doses. DATA SOURCES Pertinent literature identified via MEDLINE (1980-1996) search as well as references cited in published articles. DATA SYNTHESIS The optimal procedure for management of subjects unresponsive to hepatitis B vaccine has not been well established. Most unresponsive subjects are not absolute nonresponders, since most of them can develop protective concentrations of antibodies to hepatitis B surface antigen (anti-HBsAg) after hepatitis B revaccination, consisting of a fourth or a fifth dose or a new complete course of immunization. In subjects who do not respond to the hepatitis B vaccine after four or more injections, the benefits of the combination of cytokines (e.g., interferon-alfa, interleukin-2 [aldesleukin]) and vaccine have not been clearly shown. There are two main opinions regarding the need for routine booster doses. Experts from the US, claiming long-term protection from immunologic memory, suggest delaying booster doses for at least a decade after vaccination in subjects with normal immune status. Furthermore, postvaccination antibody testing should be restricted only to high-risk subjects. Once a vaccinated subject has responded satisfactorily, further antibody tests are unnecessary. Only hemodialysis patients should be tested annually for adequate antibody concentrations and the booster dose administered when concentrations decline to less than 10 IU/L. Experts from Europe suggest that vaccine-induced antibody responses should be assessed in all subjects and booster doses administered at intervals, with the theory being that protection correlates with the presence of antibody. However, indications about appropriate timing for booster doses and target titers of anti-HBsAg remain controversial. CONCLUSIONS It is possible to obtain seroconversion in nonresponders by using variations in vaccination strategies (i.e., > 3 doses, double amounts of HBsAg). Adjuvants such as interferon-alfa or aldesleukin are of limited use. The opinions of American experts regarding routine booster doses, as expressed by the statement of the Immunization Practices Advisory Committee, seem to be well defined and helpful to clinicians trying to resolve controversies for individual patients. The opinions of the European experts are not unanimous and are sometimes impractical. A consensus conference is needed.
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26
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Da Villa G, Pelliccia MG, Peluso F, Ricciardi E, Sepe A. Anti-HBs responses in children vaccinated with different schedules of either plasma-derived or HBV DNA recombinant vaccine. RESEARCH IN VIROLOGY 1997; 148:109-14. [PMID: 9108609 DOI: 10.1016/s0923-2516(97)89893-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study evaluated the immunogenic and protective effects of plasma-derived and DNA recombinant anti-hepatitis B virus vaccines administered to infants at various ages and with different vaccination schedules: 3 monthly doses in the first 3 months of life, 3 doses (at 3, 5 and 11 months) or 2 doses (at 1 and 3 months) or 2 doses (at 3 and 5 months). Anti-HBs (hepatitis B surface) and anti-HBc (hepatitis B core) markers were investigated twice: one month and ten years after vaccination in 261 children immunized with plasma-derived vaccine, and one month and five years after vaccination in 449 children immunized with DNA recombinant vaccine. In all groups, the appearance of anti-HBs protective levels one month after vaccination and their persistence in the following years were found in a larger number of subjects when the vaccine doses had been administered after the third month of life rather than in the first three months. Moreover, our results show that the reappearance of surface antibodies a week after the booster, in vaccinated children who became anti-HBs- in the years following vaccination, occurred in a larger number of subjects when the primary vaccination with 3 doses had been performed in the first quarter or with 2 or 3 doses in the second quarter. In contrast, protective levels of anti-HBs were found in a small number of children belonging to the group vaccinated with 2 doses in the first three months, and among them the majority seroconverted only one month after the booster. Anti-HBc was found 10 years after vaccination in only one child immunized with 2 doses of plasma-derived vaccine, and 5 years after vaccination in two children immunized with 2 doses of DNA recombinant vaccine. All these children were found to lose anti-HBs, and none of them had signs of disease or became a carrier. Based on these results, the disappearance, in some children, of protective levels of anti-HBs in the years following vaccination does not mean the loss of anti-HBV protection. In fact, the trial showed that they reacted immediately to booster stimulation, demonstrating a solid immunologic memory. Therefore, there may be no reason for giving booster injections when the vaccination of infants is carried out correctly.
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Affiliation(s)
- G Da Villa
- Italian Institute for Prevention of Liver Diseases, Naples, Italy
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27
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Abstract
Hepatitis is a diagnosis that can easily be missed by the physician. The morbidity of this disease is significant when one takes into account all the cases that either do not have a typical presentation or are misdiagnosed. The emergency physician bears substantial responsibility in the diagnosis and intervention of patients with hepatitis, and needs to develop a systematic way of approaching the patient with a viral syndrome or other vague complaints that will allow appropriate consideration of this diagnosis.
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Affiliation(s)
- J D Bondesson
- Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia, USA
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28
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Bennett RG, Powers DC, Remsburg RE, Scheve A, Clements ML. Hepatitis B virus vaccination for older adults. J Am Geriatr Soc 1996; 44:699-703. [PMID: 8642163 DOI: 10.1111/j.1532-5415.1996.tb01835.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare in adults more than 50 years old the tolerability and immunogenicity of vaccination with recombinant hepatitis B surface antigen (HBs) compared with vaccination with recombinant hepatitis B protein PreS2 + S, and to investigate the safety and immunogenicity of a fourth vaccine dose in poor and non-responders. DESIGN Randomized, double-blind prospective study. SETTING General clinical research center for outpatient evaluation and vaccination. SUBJECTS Adults older than age 50 who were in general good health and with no known risk factors for acquiring or serologic evidence of hepatitis B virus infection. INTERVENTION Subjects were randomized to receive 10 mcg HBs (Recombivax, Merck, Sharp and Dohme), 12 mcg PreS2 + S, or 24 mcg PreS2 + S vaccine at 0, 1, and 6 months. Poor and non-responders (anti-Hbs < 10 mIU/mL at month 9 and/or 12) were encouraged to receive a fourth vaccine injection. MEASUREMENTS Diary records of temperature and local and systemic reactions following each vaccination were maintained by all subjects. Anti-HBs levels were measured by radioimmunoassay before the first injection, at 1, 2, 3, 6, 7, 9, and 12 months after for all subjects, and 1 month after the fourth injection for the group of poor and non-responders. MAIN RESULTS Twenty men and nine women (mean age +/- SD, 66 +/- 8.0 years) were enrolled. Ten subjects received HBs vaccine, nine received 12 mcg PreS2 + S vaccine, and 10 received 24 mcg PreS2 + S vaccine. One subject in the HBs group dropped out, and data were analyzed for the remaining 28 subjects. There were no differences in rates of side effects reported by each of the three groups. Overall, minor local adverse reactions occurred in 12 (40%) after at least one of the first three vaccinations. Systemic side effects occurred in five (17%) after the first vaccination, in one after the second, but in none after the third. The 24-mcg PreS2 + S vaccine was not more immunogenic than the HBs vaccine, and the 12-mcg PreS2 + S vaccine was judged inadequate. Nineteen of 22 (86%) poor and non-responders received a fourth vaccination. Minor local adverse reactions were reported by six (32%), and none reported a systemic side effect. For the 12 subjects receiving a fourth injection of HBs or 24 mcg PreS2 + S vaccine, the proportion of responders 1 month following the fourth injection was greater than for 1 month following the third injection (11 of 12 [92%] versus 12 of 19 [63%], respectively, P < .05). CONCLUSION For adults more than 50 years of age who have low anti-HBs levels after three vaccine injections, a fourth injection is well tolerated and results in improved immunogenic response.
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Affiliation(s)
- R G Bennett
- Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA
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Affiliation(s)
- R B Wainwright
- Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Anchorage, Alaska, USA
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Abstract
Recent discovery of the two major agents responsible for non-A, non-B hepatitis has led to rapid progress in the diagnosis and prevention of viral hepatitis. Newly implemented vaccine strategies against hepatitis A and hepatitis B are protecting children from infection, and new immunomodulatory therapy with interferon-alpha is being used to eradicate disease in patients chronically infected with hepatitis virus B or C.
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Affiliation(s)
- L N Fishman
- Center for Childhood Liver Disease, Children's Hospital, Boston, Massachusetts, USA
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Abstract
In the United States, the reported rate of hepatitis B has declined by over 50% since 1987, probably as a result of vaccination programmes, behavioural changes, refinements in blood screening procedures, and the availability of virus inactivated blood components. The majority of new hepatitis B infections occur in 20-39 year olds, and perinatal transmission is uncommon except in certain at risk groups. Initial efforts to control hepatitis B in the US were targeted at high risk groups, including health care personnel. Then, in 1988, the Centers for Disease Control and Prevention (CDC) recommended screening of all pregnant females for hepatitis B surface antigen and full immunisation of infants born to those testing positive. A recommendation for universal immunisation of infants was endorsed in 1991. Compliance has been slow but progressive. The CDC also has recommended 'catch up' immunisation of adolescents and high risk children and adults. Demonstration projects suggest that these can be successful, given the provision of free or low cost vaccine and appropriate support. Hepatitis B vaccination has been shown to be cost effective and should be integrated into the routine childhood immunisation schedule. Responses to hepatitis B vaccine have largely been shown to be durable, although at least one booster dose after five to 10 years seems prudent, especially if a low dose, yeast derived vaccine has been used.
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Abstract
This article reviews the epidemiology of hepatitis B in the United States, previous vaccination strategy, and reasons for its failure and issues leading to the recommendation to vaccinate all adolescents. A review of specific hepatitis B virus risk behaviors of adolescents and barriers to vaccinating adolescents is covered. Strategies that favor successful completion of the immunization series are also examined. Hepatitis B infection is an important public health concern for adolescents. The previous vaccine strategy to immunize only individuals though to be at high risk was unsuccessful, especially because providers of care could not identify these individuals. Furthermore, many individuals thought not to be at high risk for infection were exposed through contacts which could not be identified. Challenges to immunization of adolescents include logistical issues, patient education, cost of the vaccine, and patient compliance. Several of these issues can be addressed by a school-based hepatitis B immunization program. The body of evidence and national policy is rapidly changing to support the recommendation that all adolescents receive the hepatitis B immunization series. The series would be most effective if administered during the middle-school years. A universal adolescent hepatitis B vaccination program would result in the most immediate health benefits and acceleration toward the eradication of hepatitis B in the United States.
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Affiliation(s)
- M H Lawrence
- Yale University School of Medicine, New Haven, CT, USA
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Levitz RE, Cooper BW, Regan HC. Immunization with high-dose intradermal recombinant hepatitis B vaccine in healthcare workers who failed to respond to intramuscular vaccination. Infect Control Hosp Epidemiol 1995. [PMID: 7759824 DOI: 10.2307/30140948] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To achieve immunity to hepatitis B in healthcare workers who failed to respond to intramuscular vaccination and boosters. DESIGN An open prospective study of intradermal vaccination with recombinant hepatitis B vaccine. SETTING A large community hospital in Connecticut. PARTICIPANTS Healthcare workers including physicians, nurses, and laboratory workers. RESULTS Immunization with high-dose intradermal recombinant hepatitis B vaccine, given in up to four doses, achieved immunity in 88% of healthcare workers who had previously been nonimmune. CONCLUSIONS We conclude that intradermal vaccination is efficacious in the majority of healthcare workers who failed to respond to intramuscular vaccine. Further studies, including randomized comparisons with intramuscular vaccine as well as studies of cell-mediated immunity, appear warranted.
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Affiliation(s)
- R E Levitz
- Division of Infectious Diseases, Hartford Hospital, CT 06102, USA
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Affiliation(s)
- A J Tilzey
- Department of Virology, St Thomas' Hospital, London, UK
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35
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Li Volti S, Giammanco-Bilancia G, Giammanco G, Mollica F. Duration of hepatitis B antibody response in children immunised with hepatitis B and compulsory vaccines. Eur J Epidemiol 1995; 11:217-9. [PMID: 7672079 DOI: 10.1007/bf01719491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty four subjects were simultaneously administered DT toxoids, OPV and HBV vaccines at the age of 3, 4-5 and 11 months and then followed up for 2 and 4 years in order to evaluate the duration of the immune response and the need and the timing of HBV revaccination. A fall in anti-HBs titre below 10 mIU/ml was observed at the follow up in 4/24 (16.7%) of the subjects. In other 5 children (20.8%) anti-HBs titre was found to be just above 10 mIU/ml. This would suggest that a revaccination is indicated and it could be performed at the age of 5-6 years when children enter school. This schedule is simple, effective and money saving since it reduces the cost/benefit ratio and the number of visits for immunisations, and it is expected to improve the compliance for the vaccination.
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Affiliation(s)
- S Li Volti
- Institute of Pediatrics, University of Catania, Italy
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36
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Gindler J, Hadler SC, Strebel PM, Watson JC. Recommended childhood immunization schedule. United States--1995. Clin Pediatr (Phila) 1995; 34:66-72. [PMID: 7729109 DOI: 10.1177/000992289503400201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J Gindler
- Child Vaccine Preventable Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Trivello R, Chiaramonte M, Ngatchu T, Baldo V, Majori S, Moschen ME, Simoncello I, Renzulli G, Naccarato R. Persistence of anti-HBs antibodies in health care personnel vaccinated with plasma-derived hepatitis B vaccine and response to recombinant DNA HB booster vaccine. Vaccine 1995; 13:139-41. [PMID: 7625106 DOI: 10.1016/0264-410x(95)93126-t] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Long-term persistence of specific antibodies after primary immunization against HBV infection has been reported. In this study, we evaluated the persistence of anti-HBs in vaccinees 6 years after primary immunization and the response to a booster dose using a recombinant DNA yeast-derived HB vaccine. An 85.4% seroprotection rate was observed after 6 years with a significantly higher seroprotective rate in those subjects who received four doses of vaccine primary immunization as compared with those who received three doses (93.9% versus 67.2%, p < 0.001). One month after receiving the booster dose, 98.6% of the subjects had an anamnestic type of response. The GMTs were found to decrease progressively with increasing age. The antibody levels after booster dose were higher than those attained at the end of primary immunization and reflected the trend seen before the administration of the booster. These results are consistent with the existence of an effective immunological memory in HB vaccine responders. Subjects who received four doses during primary immunization were better seroprotected and had a higher seroprotection rate after the booster dose.
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Affiliation(s)
- R Trivello
- Institute of Hygiene, University of Padua, Italy
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38
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Struve J, Aronsson B, Frenning B, Forsgren M, Weiland O. Response to a booster dose 18 months after a low anti-HBs response (10-99 IU/l) to three doses of intradermally or intramuscularly administered recombinant hepatitis B vaccine. Infection 1995; 23:42-5. [PMID: 7744490 DOI: 10.1007/bf01710057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The response to a booster dose, given by the same route 18 months after the completion of the primary vaccination scheme, was studied in hospital staff members who responded with anti-HBs levels in the range of 10-99 IU/l after three intradermal (i.d., n = 51) or intramuscular (i.m., n = 11) doses of recombinant hepatitis B virus (HBV) vaccine administered at 0, 1 and 6 months. At the time of boostering the anti-HBs levels had declined to < 10 IU/l in 44/51 (86%) of the i.d. and 10/11 of the i.m. vaccines. All i.m. and 90% of i.d. vaccinees responded to the booster dose with anti-HBs level > or = 10 IU/l, and with geonmetric mean titres 1,074 IU/l and 121 IU/l, respectively. It was concluded that all i.m. and 90% of i.d. vaccinees with an initial anti-HBs response of 10-99 IU/l after three doses of HBV vaccine (among whom the anti-HBs levels in the majority had declined < 10 IU/l) mounted an anti-HBs level > or = 10 IU/l after a booster dose. The anti-HBs concentrations were generally higher after i.m. than i.d. booster doses in accordance with the response to primary vaccination.
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Affiliation(s)
- J Struve
- Division of Infectious Diseases, Karolinska Institute, Huddinge Hospital, Sweden
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Cleveland JL, Siew C, Lockwood SA, Gruninger SE, Chang SB, Neidle EA, Russell CM. Factors associated with hepatitis B vaccine response among dentists. J Dent Res 1994; 73:1029-35. [PMID: 8006228 DOI: 10.1177/00220345940730050301] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The objective of this study was to evaluate personal and immunization factors associated with serologic evidence of hepatitis B virus (HBV) vaccine response. A study was conducted using data from United States dentists participating from 1987 to 1991 in the Health Screening Program of the American Dental Association's annual session. This study included dentists (n = 507) who (1) received their most recent dose of HBV vaccine within the previous 10 months, (2) completed a core questionnaire, and (3) were tested for HBV markers (HBsAg, anti-HBs, and anti-HBc) and were found not to have evidence of past or present infection. Non-responders were defined as dentists testing negative for all three markers (n = 100). Responders were defined as dentists having serological evidence of anti-HBs alone (n = 407). Logistic regression models were used to assess the relationship of vaccine response to the variables sex, age, number of vaccine doses, site of vaccination, type of vaccine, and history of hepatitis. Vaccine response was most strongly associated with sex, age, and number of doses. Factors unrelated to vaccine response included type of vaccine and history of hepatitis. Adherence to the recommended number of doses and early vaccination are critical to adequate protection against hepatitis B infection of dentists, who are often exposed to blood and other body fluids.
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Affiliation(s)
- J L Cleveland
- Centers for Disease Control & Prevention, Division of Oral Health, Atlanta, Georgia 30333
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Corona R, Gandolfi C, Ferrigno L, Sagliocca L, Ciaralli F, Martelli A, Galanti C, Moiraghi A, Palumbo F, Novaco F. Hepatitis B in children in Italy: incidence and risk factors: SEIEVA Collaborating Group. Sistema Epidemiologico Integrato dell'Epatite virale Acuta. Eur J Epidemiol 1994; 10:219-22. [PMID: 7813702 DOI: 10.1007/bf01730374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The objectives of the present report were to give a baseline picture of hepatitis B notification incidence rates in children before the campaign of mass vaccination for newborns and adolescents (12-13 years old), and to study the role of different risk factors. Data from a specific national surveillance system of acute viral hepatitis (SEIEVA, Sistema Epidemiologico Integrato dell'Epatite Virale Acuta) were used and acute hepatitis B cases were compared to acute hepatitis A patients with the case-control study method to estimate the associations with the considered risk factors. Since the system began, one hundred and sixty-three local health departments have joined SEIEVA covering 30% of the Italian population. The incidence of acute hepatitis B notifications among 0-14 aged children was 9 per 100,000 in 1985 and 1 per 100,000 in 1990. Such decline in incidence was observed in both the North and the South of Italy. Surgical interventions, dental therapy and household contacts with a HBsAg chronic carrier were found to be associated with acute hepatitis B. The point estimate of the odds ratio was 10 for the latter risk factor. Other preventive measures in addition to vaccination are needed to control the risk of hepatitis B infection and other parenteral diseases due to surgical intervention and dental therapy.
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Affiliation(s)
- R Corona
- Istituto Superiore di Sanità, Rome, Italy
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Abstract
The practice of dermatology has always carried with it the risk of patient-acquired infection. This review covers health risks associated with the care of HIV-infected patients and patients who are chronic carriers of hepatitis B or C virus, protection options to reduce exposure, and protocols should exposure occur. Hepatitis B continues to be a major risk to health care workers, killing approximately 200 per year. In contrast, as of 1990, only 327 total health care personnel had acquired HIV, with no deaths reported. Data are lacking regarding hepatitis C, but it appears to be an increasing concern. Needlesticks are the most common form of occupational transmission, with an infectivity rate of 30% for hepatitis B, 3% for hepatitis C, and 0.3% for HIV. Universal precautions are the cornerstones of safety. Hepatitis B vaccination, zidovudine prophylaxis, and hepatitis C therapy are discussed as postexposure recommendations are reviewed.
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Affiliation(s)
- K Kiene
- Division of Dermatology, University of California, Los Angeles
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43
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Hall AJ. Hepatitis B vaccination: protection for how long and against what? BMJ (CLINICAL RESEARCH ED.) 1993; 307:276-7. [PMID: 8374369 PMCID: PMC1678572 DOI: 10.1136/bmj.307.6899.276] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Tabor E, Cairns J, Gerety RJ, Bayley AC. Nine-year follow-up study of a plasma-derived hepatitis B vaccine in a rural African setting. J Med Virol 1993; 40:204-9. [PMID: 8355018 DOI: 10.1002/jmv.1890400307] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
One hundred and one of 255 recipients of a plasma-derived hepatitis B vaccine were evaluated in 1990, 9 years after the first vaccine dose in a study in Zambia to evaluate the efficacy of one, two, or three doses. In 1983, 2 years after the first vaccine dose, antibody to the hepatitis B surface antigen (anti-HBs) had been detectable in 90 of these 101 participants (89%). In 1990, anti-HBs was still detectable in 72 of 101 (71%), and was present at a protective level (> or = 10 mIU/mL) in 68 of 101 (67%). Although the original vaccine study elicited a protective level of antibody in a greater percentage of children and adolescents than in adults, there were no significant differences among the three groups at 9 years. (In 1990, anti-HBs was still detectable in 52 of 70 [74%] who had had no serologic markers of the hepatitis B virus in 1981, and a protective level was detected in 47 of 70 [67%].) A protective level of anti-HBs was detected in 1990 in 26 of 36 (72%) recipients of three doses and in 23 of 31 (74%) recipients of two doses; the slightly lower prevalence among recipients of one dose (19 of 34 [56%]) was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E Tabor
- National Cancer Institute, National Institutes of Health, Bethesda, MD 20892
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45
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Abstract
The record of disease prevention in children is an impressive testament to our universal immunization program. However, these successes are being threatened by rates of vaccination in some areas of the country that are substantially less than those seen in the developing world. Unless the pediatric immunization rates are improved, epidemics of other vaccine-preventable diseases will recur, as evidenced by the measles outbreaks. Although the tools needed for disease prevention are available, the means for their delivery are lacking. It is the obligation of us all to immunize the nation's children.
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46
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Ginsberg GM, Shouval D. Cost-benefit analysis of a nationwide neonatal inoculation programme against hepatitis B in an area of intermediate endemicity. J Epidemiol Community Health 1992; 46:587-94. [PMID: 1494073 PMCID: PMC1059674 DOI: 10.1136/jech.46.6.587] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE The aim was to estimate the costs and benefits of a nationwide neonatal vaccination campaign against hepatitis B in Israel for the 1990-2034 period. DESIGN Using morbidity, mortality, utilisation, and cost data from Israeli and international sources, a spreadsheet model was constructed to carry out the cost-benefit analysis. SETTING The entire State of Israel, an area of intermediate endemicity. PARTICIPANTS The population of Israel from 1990-2034. MAIN RESULTS A policy of immunising all Israeli neonates would, for a cost of $13.8 million, reduce the number of cases of hepatitis B during the 1990-2035 period in the cohort from 359,000 to 166,000 and save the nation around $21.5 million in health resources alone, $16.6 million in averted work absences, and a further $0.6 million in averted premature mortality costs. Even when the savings to the health services ($0.6 million) arising from the reduction in hepatocellular carcinoma are excluded, the direct benefit to cost ratio is 1.51/1, still in excess of unity. CONCLUSIONS The decision to adopt a nationwide neonatal inoculation policy, starting in January 1992, appears to be not only medically but also economically justifiable.
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Affiliation(s)
- G M Ginsberg
- Department of Data Analysis, Ministry of Health, Jerusalem, Israel
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McMahon BJ, Parkinson AJ, Helminiak C, Wainwright RB, Bulkow L, Kellerman-Douglas A, Schoenberg S, Ritter D. Response to hepatitis B vaccine of persons positive for antibody to hepatitis B core antigen. Gastroenterology 1992; 103:590-4. [PMID: 1386048 DOI: 10.1016/0016-5085(92)90851-o] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The significance of antibody to hepatitis B core antigen (anti-HBc) present in a person's serum without hepatitis B surface antigen (HBsAg) or its antibody (anti-HBs) is unknown. Serum specimens from 281 persons initially positive only for anti-HBc by enzyme immunoassay (EIA) were retested by radioimmunoassay (RIA), and of these, 177 (63%) remained positive for anti-HBc by both assays. Of these 177 persons, 3 were positive for HBsAg, and 72 possessed low levels of anti-HBs [less than 10 sample ratio units; (SRU's)]. When persons positive for anti-HBc by EIA and RIA were given one 20-micrograms dose of plasma-derived hepatitis B vaccine and tested for anti-HBs 1 month later, a booster response was observed in 14 of 41 (34%) persons with low level anti-HBs and 3 of 50 (6%) persons negative for anti-HBs. Of those positive only for anti-HBc by EIA but negative by RIA, only 3 of 37 (8.1%) showed a booster response. Of those who completed the three-dose immunization series and did not show a booster response, 63 of 80 (78.8%) developed anti-HBs levels greater than 10 standard ratio unit. The majority of persons with isolated anti-HBc will have a primary rather than a booster response to hepatitis B vaccine.
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Affiliation(s)
- B J McMahon
- Alaska Native Medical Center, Indian Health Service, Anchorage
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48
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Struve J, Aronsson B, Frenning B, Granath F, von Sydow M, Weiland O. Intramuscular versus intradermal administration of a recombinant hepatitis B vaccine: a comparison of response rates and analysis of factors influencing the antibody response. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1992; 24:423-9. [PMID: 1411307 DOI: 10.3109/00365549209052627] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In an open controlled study 286 health care workers in Stockholm, Sweden, received 20 micrograms of a recombinant hepatitis B vaccine (Engerix B) by the intramuscular route, and 383 2 micrograms by the intradermal route. Seroconversion to protective anti-HBs levels (anti-HBs titre greater than or equal to 10 IU/l) was achieved in 94% of the i.m. and 89% of the i.d. vaccinees. Female sex, intramuscular vaccination, young age, and being a non-smoker were associated with a higher response rate and a higher geometric mean anti-HBs titre than male sex, intradermal vaccination, old age and being a smoker. If an acceptable response rate to protective anti-HBs levels of 85% is chosen, intradermal vaccination can be used as a cost reducing strategy for all women and for non-smoking men less than 30 years of age, as estimated in a logistic regression model. Due to the variable antibody response in different individuals, post vaccination testing for anti-HBs titres is recommended in health care workers, regardless of vaccination route.
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Affiliation(s)
- J Struve
- Department of Infectious Diseases, Karolinska Institute, Huddinge Hospital, Sweden
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