|
1
|
Ravanbakhsh N, Rivera Campana A, Chapin C, Jhaveri R. Hepatitis B Virus Treatment in Children: Common Challenges and Management Options in a Case-Based Format. J Pediatric Infect Dis Soc 2024; 13:S142-S147. [PMID: 39171575 DOI: 10.1093/jpids/piae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 08/19/2024] [Indexed: 08/23/2024]
Abstract
The management of hepatitis B virus (HBV) in pediatrics presents many challenges, given the potential sequelae of untreated infection including hepatic fibrosis, cirrhosis, and malignancy, and a lack of clear guidance on the timing of treatment initiation. The goal of this review is to feature common clinical scenarios that occur in the evaluation and treatment of HBV infection in children. Each vignette presents an opportunity to discuss guidelines and evidence-based practices as well as review landmark studies and evolving practices.
Collapse
Affiliation(s)
- Naseem Ravanbakhsh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Andres Rivera Campana
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Catherine Chapin
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ravi Jhaveri
- Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
|
2
|
Sobhani K, Cheng S, Binder RA, Mantis NJ, Crawford JM, Okoye N, Braun JG, Joung S, Wang M, Lozanski G, King CL, Roback JD, Granger DA, Boppana SB, Karger AB. Clinical Utility of SARS-CoV-2 Serological Testing and Defining a Correlate of Protection. Vaccines (Basel) 2023; 11:1644. [PMID: 38005976 PMCID: PMC10674881 DOI: 10.3390/vaccines11111644] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023] Open
Abstract
Herein, we review established clinical use cases for SARS-CoV-2 antibody measures, which include diagnosis of recent prior infection, isolating high titer convalescent plasma, diagnosing multisystem inflammatory syndrome in children (MIS-C), and booster dosing in the immunosuppressed and other populations. We then address whether an antibody correlate of protection (CoP) for SARS-CoV-2 has been successfully defined with the following considerations: Antibody responses in the immunocompetent, vaccine type, variants, use of binding antibody tests vs. neutralization tests, and endpoint measures. In the transition from the COVID-19 pandemic to endemic, there has been much interest in defining an antibody CoP. Due to the high mutability of respiratory viruses and our current knowledge of SARS-CoV-2 variants defining a CoP for prevention of infection is unrealistic. However, a CoP may be defined for prevention of severe disease requiring hospitalization and/or death. Most SARS-CoV-2 CoP research has focused on neutralization measurements. However, there can be significant differences in neutralization test methods, and disparate responses to new variants depending on format. Furthermore, neutralization assays are often impractical for high throughput applications (e.g., assessing humoral immune response in populations or large cohorts). Nevertheless, CoP studies using neutralization measures are reviewed to determine where there is consensus. Alternatively, binding antibody tests could be used to define a CoP. Binding antibody assays tend to be highly automatable, high throughput, and therefore practical for large population applications. Again, we review studies for consensus on binding antibody responses to vaccines, focusing on standardized results. Binding antibodies directed against the S1 receptor binding domain (S1-RBD) of the viral spike protein can provide a practical, indirect measure of neutralization. Initially, a response for S1-RBD antibodies may be selected that reflects the peak response in immunocompetent populations and may serve as a target for booster dosing in the immunocompromised. From existing studies reporting peak S1-RBD responses in standardized units, an approximate range of 1372-2744 BAU/mL for mRNA and recombinant protein vaccines was extracted that could serve as an initial CoP target. This target would need to be confirmed and potentially adjusted for updated vaccines, and almost certainly for other vaccine formats (i.e., viral vector). Alternatively, a threshold or response could be defined based on outcomes over time (i.e., prevention of severe disease). We also discuss the precedent for clinical measurement of antibodies for vaccine-preventable diseases (e.g., hepatitis B). Lastly, cellular immunity is briefly addressed for its importance in the nature and durability of protection.
Collapse
Affiliation(s)
- Kimia Sobhani
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA; (S.C.)
| | - Raquel A. Binder
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Nicholas J. Mantis
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY 12222, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Nkemakonam Okoye
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Jonathan G. Braun
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
- F. Widjaja Inflammatory Bowel Disease Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandy Joung
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA; (S.C.)
| | - Minhao Wang
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA; (S.C.)
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Christopher L. King
- Department of Pathology, Case Western Reserve University and Veterans Affairs Research Service, Cleveland, OH 44106, USA
| | - John D. Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California Irvine, Irvine, CA 92697, USA
| | - Suresh B. Boppana
- Department of Pediatrics and Department of Microbiology, Heersink School of Medicine, UAB, Birmingham, AL 35233, USA
| | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA;
| |
Collapse
|
|
3
|
Abstract
Ongoing sexual transmission presents a significant barrier to viral hepatitis control. Endemic transmission of hepatitis A virus continues through communities of men with male sex partners, despite vaccine availability. Increased incidence of hepatitis B virus from 2014-2018 prompted expanded vaccination guidelines, but uptake and physician awareness remain poor. Hepatitis C virus while strongly associated with injection drug use, is also transmitted by high-risk sexual contact. Despite universal screening recommendations and curative treatment, incidence continues to increase. Even with safe and highly effective vaccinations or treatments, sexual transmission of viral hepatitides must be addressed to achieve disease elimination.
Collapse
Affiliation(s)
- Audrey R Lloyd
- Division of Infectious Diseases, Department of Medicine and Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Children's Harbor Building, 1600 7th Avenue South, Room 308, Birmingham, AL 35223, USA
| | - Ricardo A Franco
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, 1917 Clinic Dewberry, 3220 5th Avenue South, Room 1044A, Birmingham, AL 35222, USA.
| |
Collapse
|
|
4
|
Conners EE, Panagiotakopoulos L, Hofmeister MG, Spradling PR, Hagan LM, Harris AM, Rogers-Brown JS, Wester C, Nelson NP. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations - United States, 2023. MMWR Recomm Rep 2023; 72:1-25. [PMID: 36893044 PMCID: PMC9997714 DOI: 10.15585/mmwr.rr7201a1] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Chronic hepatitis B virus (HBV) infection can lead to substantial morbidity and mortality. Although treatment is not considered curative, antiviral treatment, monitoring, and liver cancer surveillance can reduce morbidity and mortality. Effective vaccines to prevent hepatitis B are available. This report updates and expands CDC's previously published Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection (MMWR Recomm Rep 2008;57[No. RR-8]) regarding screening for HBV infection in the United States. New recommendations include hepatitis B screening using three laboratory tests at least once during a lifetime for adults aged ≥18 years. The report also expands risk-based testing recommendations to include the following populations, activities, exposures, or conditions associated with increased risk for HBV infection: persons incarcerated or formerly incarcerated in a jail, prison, or other detention setting; persons with a history of sexually transmitted infections or multiple sex partners; and persons with a history of hepatitis C virus infection. In addition, to provide increased access to testing, anyone who requests HBV testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.
Collapse
Affiliation(s)
- Erin E. Conners
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | | | - Megan G. Hofmeister
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Philip R. Spradling
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Liesl M. Hagan
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Aaron M. Harris
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Jessica S. Rogers-Brown
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Carolyn Wester
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Noele P. Nelson
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| |
Collapse
|
|
5
|
Castro RS, Cordeiro BS, Rolim MAF, Costa APDM, Santos MDC, Silva MACND, Albuquerque IDC, Fonseca LMB, Pinho JRR, Gouvêa MSG, Silva AAMD, Ferreira ADSP. High prevalence of hepatitis B virus and low vaccine response in children and adolescents in Northeastern Brazil. Rev Inst Med Trop Sao Paulo 2023; 65:e33. [PMID: 37098921 PMCID: PMC10124778 DOI: 10.1590/s1678-9946202365033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/21/2023] [Indexed: 04/27/2023] Open
Abstract
Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson's regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p < 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations.
Collapse
Affiliation(s)
- Rogério Soares Castro
- Universidade Federal do Maranhão, Hospital Universitário, Empresa Brasileira de Serviços Hospitalares, São Luís, Maranhão, Brazil
| | - Bárbara Silva Cordeiro
- Universidade Federal do Maranhão, Hospital Universitário, Empresa Brasileira de Serviços Hospitalares, São Luís, Maranhão, Brazil
| | - Marco Aurélio Ferreira Rolim
- Universidade Federal do Maranhão, Hospital Universitário, Empresa Brasileira de Serviços Hospitalares, São Luís, Maranhão, Brazil
| | - Alessandra Porto de Macedo Costa
- Universidade Federal do Maranhão, Hospital Universitário, Empresa Brasileira de Serviços Hospitalares, São Luís, Maranhão, Brazil
| | - Max Diego Cruz Santos
- Universidade Federal do Maranhão, Hospital Universitário, Empresa Brasileira de Serviços Hospitalares, São Luís, Maranhão, Brazil
| | | | | | | | - João Renato Rebello Pinho
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Gastroenterologia e Hepatologia Tropical (LIM-07), São Paulo, São Paulo, Brazil
| | - Michelle Soares Gomes Gouvêa
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Gastroenterologia e Hepatologia Tropical (LIM-07), São Paulo, São Paulo, Brazil
| | | | - Adalgisa de Souza Paiva Ferreira
- Universidade Federal do Maranhão, Hospital Universitário, Empresa Brasileira de Serviços Hospitalares, São Luís, Maranhão, Brazil
- Universidade Federal do Maranhão, Departamento de Medicina I, São Luís, Maranhão, Brazil
| |
Collapse
|
|
6
|
Romano’ L, Zanetti AR. Hepatitis B Vaccination: A Historical Overview with a Focus on the Italian Achievements. Viruses 2022; 14:1515. [PMID: 35891495 PMCID: PMC9320049 DOI: 10.3390/v14071515] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccination is the most effective way to control and prevent acute and chronic hepatitis B, including cirrhosis and HCC, on a global scale. According to WHO recommendations, 190 countries in the world have introduced hepatitis B vaccination into their national childhood immunization programs with an excellent profile of safety, immunogenicity, and effectiveness. Following vaccination, seroprotection rates are close to 100% in healthy children and over 95% in healthy adults. Persistence of anti-HBs is related to the antibody peak achieved after vaccination. The peak is higher the longer the antibody duration is. Loss of anti-HBs does not necessarily mean loss of immunity since most vaccinated individuals retain immune memory for HBsAg and rapidly develop strong anamnestic responses when boosted. Evidence indicates that the duration of protection can persist for at least 35 years after priming. Hence, booster doses of vaccines are currently not recommended to sustain long-term immunity in healthy vaccinated individuals. In Italy, vaccination against hepatitis B is met with success. In 2020, Italy became one of the first countries in Europe to be validated for achieving the WHO regional hepatitis B control targets.
Collapse
Affiliation(s)
- Luisa Romano’
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi, 20133 Milano, Italy;
| | | |
Collapse
|
|
7
|
Jacobson IM, Brown RS, McMahon BJ, Perrillo RP, Gish R. An Evidence-based Practical Guide to Vaccination for Hepatitis B Virus. J Clin Gastroenterol 2022; 56:478-492. [PMID: 35389923 DOI: 10.1097/mcg.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The hepatitis B virus (HBV) is highly infectious, with over 292 million chronically infected people worldwide and up to 2.4 million in the United States. Following infection, clinically silent liver damage can ensue, but symptoms or signs of advanced disease, including cirrhosis and hepatocellular carcinoma, can take decades to emerge. HBV has the heaviest public health burden of all hepatitis viruses and has now surpassed other major communicable diseases (eg, HIV, diarrheal disease, malaria, tuberculosis) as a leading cause of death globally. Preventing transmission is essential, and efforts are in place to reinforce screening, vaccination, and routine follow-up. Three safe and effective vaccines are available in the United States and other countries for HBV prevention, and the benefits of vaccination in preventing infection and its sequelae have been substantiated. For the first time in over 25 years, a new Food and Drug Administration-approved vaccine is available that offers a high degree of immunogenicity after 2, rather than 3, injections. Persistent challenges include the underutilization of vaccination, choice of vaccine, incomplete vaccinations, varying needs in different populations, management of nonresponders or those with undocumented or incompletely documented vaccination courses, and questions about whether and when booster injections may be needed. A panel of US academic hepatologists with expertise and experience in preventing and managing HBV infection have collaborated to write this practical clinical paper intended to guide clinicians in vaccinating for HBV and address questions that regularly arise in the clinic.
Collapse
Affiliation(s)
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
| | - Brian J McMahon
- University of Washington, Seattle, WA
- University of Alaska
- Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Robert P Perrillo
- Hepatology Division, Baylor Scott and White Medical Center, University of Texas Southwestern, Dallas, TX
| | - Robert Gish
- Loma Linda University, Loma Linda
- UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA
- University of Nevada Las Vegas and Reno Schools of Medicine, Las Vegas, NV
| |
Collapse
|
|
8
|
Tomasik A, Pokorska-Śpiewak M, Marczyńska M. Non-Vertical Exposures to HIV, HBV and HCV Infection in Children and Adolescents-Risk of Infection, Standards of Care and Postexposure Prophylaxis. Pediatr Rep 2021; 13:566-575. [PMID: 34698220 PMCID: PMC8544719 DOI: 10.3390/pediatric13040067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/04/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION in the review, we aimed to present current knowledge about the risk of infection, standards of care, and postexposure prophylaxis (PEP) in pediatric patients after non-vertical exposures to HIV, HBV, and HCV infection. MATERIALS AND METHODS the latest available literature and recommendations of Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), European recommendations for the management of HIV and administration of non-occupational PEP, and Polish AIDS Society were reviewed. RESULTS the majority of cases of non-vertical exposure to blood-borne viruses in the pediatric population consist of sexual exposition and injection with unsterilized sharp objects (usually needlestick injuries). The risk HIV, HBV, and HCV transmission depend on several factors, and each exposure should be evaluated individually with consideration of the patient's medical history. It is crucial to start antiretroviral therapy within 48 h from exposure. Treatment is continued for 28 days, and a 3-drugs regiment is recommended in the majority of cases. Decisions on hepatitis B and tetanus PEP are based on a history of vaccination. There is no PEP for hepatitis C infection, follow-up testing aims for early identification of disease and consideration of treatment options. CONCLUSION all children after the non-vertical exposure to HIV, HBV, and HCV infection should be evaluated by the Infectious Disease specialist as soon as possible after the incident and qualified to post-exposure prophylaxis. Systematic diagnostic and follow-up on children after significant needlestick exposure should be maintained. Children after sexual exposure need a multidisciplinary approach. Response to reported event must be rapid and treatment must be comprehensive.
Collapse
Affiliation(s)
- Anna Tomasik
- Doctoral School, Medical University of Warsaw, Żwirki i Wigury, 02-091 Warsaw, Poland
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 01-201 Warsaw, Poland; (M.P.-Ś.); (M.M.)
- Regional Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 01-201 Warsaw, Poland; (M.P.-Ś.); (M.M.)
- Regional Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Magdalena Marczyńska
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 01-201 Warsaw, Poland; (M.P.-Ś.); (M.M.)
- Regional Hospital of Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| |
Collapse
|
|
9
|
Cornberg M, Sandmann L, Protzer U, Niederau C, Tacke F, Berg T, Glebe D, Jilg W, Wedemeyer H, Wirth S, Höner Zu Siederdissen C, Lynen-Jansen P, van Leeuwen P, Petersen J. S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) zur Prophylaxe, Diagnostik und Therapie der Hepatitis-B-Virusinfektion – (AWMF-Register-Nr. 021-11). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:691-776. [PMID: 34255317 DOI: 10.1055/a-1498-2512] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Markus Cornberg
- Deutsches Zentrum für Infektionsforschung (DZIF), Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover; Centre for individualised infection Medicine (CiiM), Hannover.,Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover
| | - Lisa Sandmann
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover
| | - Ulrike Protzer
- Institut für Virologie, Technische Universität München/Helmholtz Zentrum München, München
| | | | - Frank Tacke
- Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Charité Universitätsmedizin Berlin, Berlin
| | - Thomas Berg
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig
| | - Dieter Glebe
- Institut für Medizinische Virologie, Nationales Referenzzentrum für Hepatitis-B-Viren und Hepatitis-D-Viren, Justus-Liebig-Universität Gießen, Gießen
| | - Wolfgang Jilg
- Institut für Medizinische Mikrobiologie und Hygiene, Universität Regensberg, Regensburg
| | - Heiner Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover
| | - Stefan Wirth
- Zentrum für Kinder- und Jugendmedizin, Helios Universitätsklinikum Wuppertal, Wuppertal
| | | | - Petra Lynen-Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin
| | - Pia van Leeuwen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin
| | - Jörg Petersen
- IFI Institut für Interdisziplinäre Medizin an der Asklepios Klinik St. Georg, Hamburg
| | | |
Collapse
|
|
10
|
Chidambaram V, Jones JM, Lokhandwala PM, Bloch EM, Lanzkron S, Stewart R, Pecker LH. Low rates of transfusion-transmitted infection screening in chronically transfused adults with sickle cell disease. Transfusion 2021; 61:2421-2429. [PMID: 34251034 DOI: 10.1111/trf.16547] [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: 01/08/2021] [Revised: 03/24/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with sickle cell disease (SCD) on chronic transfusion therapy are exposed to a large volume of blood products, thus increasing their risk of transfusion-associated human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV). METHODS We performed a systematic chart review of chronically transfused SCD subjects at the Johns Hopkins Sickle Cell Center for Adults between October 2014 and September 2019 to determine our Center's adherence to the 2014 National Heart, Lung and Blood Institute (NHLBI) SCD guidelines for annual screening for Transfusion Transmitted infections (TTI) and assessed HBV immunity and HBV vaccination rates. RESULTS The study included 85 subjects with a median age of 34 years (23-63); 52% were female. No subject received annual screening; 68 subjects (80%) were screened for HIV, 60 subjects (71%) for HCV and 53 subjects (62%) for HBV infections at least once in the study period. Of those screened, one patient was newly diagnosed with HCV infection, and none with HIV or HBV infection. Among 31 subjects tested for anti-Hepatitis B surface antibody, 16 subjects (52%) tested negative. Nineteen (20%) subjects had HBV vaccination documented. CONCLUSIONS Low adherence to the NHLBI TTI screening guidelines, especially for HBV, highlights the resource intensiveness of this patient population. The low rates of anti-Hepatitis B surface antibody positivity highlight the need to confirm vaccination, provide boosters as indicated, and investigate the adults with SCD's immune response to HBV vaccination.
Collapse
Affiliation(s)
- Vignesh Chidambaram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer M Jones
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Parvez M Lokhandwala
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Biomedical Services, American Red Cross, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rosalyn Stewart
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lydia H Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
|
11
|
Shah NJ, Aloysius MM, Sharma NR, Pallav K. Advances in treatment and prevention of hepatitis B. World J Gastrointest Pharmacol Ther 2021. [DOI: 10.4292/wjg.v12.i4.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
|
12
|
Shah NJ, Aloysius MM, Sharma NR, Pallav K. Advances in treatment and prevention of hepatitis B. World J Gastrointest Pharmacol Ther 2021; 12:56-78. [PMID: 34316384 PMCID: PMC8290928 DOI: 10.4292/wjgpt.v12.i4.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis B (CHB) continues to contribute to worldwide morbidity and mortality significantly. Scientists, clinicians, pharmaceutical companies, and health organizations have dedicated substantial Intellectual and monetary resources to finding a cure, increasing immunization rates, and reducing the global burden of CHB. National and international health-related organizations including the center for disease control, the national institute of health, the American Association for the study of liver disease (AASLD), The European association for the study of the Liver (EASL), The Asia Pacific association for the study of the Liver (APASL) and the world health organization release periodic recommendations for disease prevention and treatment. Our review of the most recent guidelines by EASL, AASLD, APASL, and Taiwan Association for the Study of the Liver revealed that an overwhelming majority of cited studies were published before 2018. We reviewed Hepatitis B-related literature published 2018 onwards to identify recent developments and current barriers that will likely direct future efforts towards eradicating hepatitis B. The breakthrough in our understanding of the hepatitis B virus life cycle and resulting drug development is encouraging with significant room for further progress. Data from high-risk populations, most vulnerable to the devastating effects of hepatitis B infection and reactivation remain sparse. Utilization of systems approach, optimization of experimental models, identification and validation of next-generation biomarkers, and precise modulation of the human immune response will be critical for future innovation. Within the foreseeable future, new treatments will likely complement conventional therapies rather than replace them. Most Importantly, pragmatic management of CHB related population health challenges must be prioritized to produce real-world results.
Collapse
Affiliation(s)
- Niraj James Shah
- Department of Internal Medicine, Digestive Disease, University of Mississippi Medical Center, Jackson, MS 39216, United States
| | - Mark M Aloysius
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, United States
| | - Neil Rohit Sharma
- Department of Internal Medicine, Interventional Oncology and Surgical Endoscopy, Parkview Regional Medical Center, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
| | - Kumar Pallav
- Department of Internal Medicine, Interventional Oncology and Surgical Endoscopy, Parkview Regional Medical Center, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
| |
Collapse
|
|
13
|
Ogega CO, Skinner NE, Blair PW, Park HS, Littlefield K, Ganesan A, Dhakal S, Ladiwala P, Antar AA, Ray SC, Betenbaugh MJ, Pekosz A, Klein SL, Manabe YC, Cox AL, Bailey JR. Durable SARS-CoV-2 B cell immunity after mild or severe disease. J Clin Invest 2021; 131:145516. [PMID: 33571162 DOI: 10.1172/jci145516] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/10/2021] [Indexed: 12/26/2022] Open
Abstract
Multiple studies have shown loss of severe acute respiratory syndrome coronavirus 2-specific (SARS-CoV-2-specific) antibodies over time after infection, raising concern that humoral immunity against the virus is not durable. If immunity wanes quickly, millions of people may be at risk for reinfection after recovery from coronavirus disease 2019 (COVID-19). However, memory B cells (MBCs) could provide durable humoral immunity even if serum neutralizing antibody titers decline. We performed multidimensional flow cytometric analysis of S protein receptor binding domain-specific (S-RBD-specific) MBCs in cohorts of ambulatory patients with COVID-19 with mild disease (n = 7), and hospitalized patients with moderate to severe disease (n = 7), at a median of 54 days (range, 39-104 days) after symptom onset. We detected S-RBD-specific class-switched MBCs in 13 of 14 participants, failing only in the individual with the lowest plasma levels of anti-S-RBD IgG and neutralizing antibodies. Resting MBCs (rMBCs) made up the largest proportion of S-RBD-specific MBCs in both cohorts. FCRL5, a marker of functional memory on rMBCs, was more dramatically upregulated on S-RBD-specific rMBCs after mild infection than after severe infection. These data indicate that most SARS-CoV-2-infected individuals develop S-RBD-specific, class-switched rMBCs that resemble germinal center-derived B cells induced by effective vaccination against other pathogens, providing evidence for durable B cell-mediated immunity against SARS-CoV-2 after mild or severe disease.
Collapse
Affiliation(s)
- Clinton O Ogega
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole E Skinner
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul W Blair
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kirsten Littlefield
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abhinaya Ganesan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Santosh Dhakal
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pranay Ladiwala
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Annukka Ar Antar
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stuart C Ray
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J Betenbaugh
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea L Cox
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Justin R Bailey
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
|
14
|
Cocchio S, Baldo V, Volpin A, Fonzo M, Floreani A, Furlan P, Mason P, Trevisan A, Scapellato ML. Persistence of Anti-Hbs after up to 30 Years in Health Care Workers Vaccinated against Hepatitis B Virus. Vaccines (Basel) 2021; 9:vaccines9040323. [PMID: 33915763 PMCID: PMC8067181 DOI: 10.3390/vaccines9040323] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/20/2022] Open
Abstract
The burden of hepatitis B virus (HBV) infection is a serious public health problem all over the world. Vaccination remains the most effective prevention measure, and safe and effective HBV vaccines have been available since 1982. Health care workers (HCWs) vaccinated against HBV and prospectively followed up for at least 14 years were classified by their antibody titers after primary vaccination as: poor responders (10–99 mIU/mL); moderate responders (100–999 mIU/mL); and good responders (≥1000 mIU/mL). The incidence of antibody loss was calculated for 1000 person-years and the anti-HBs persistence was calculated. The analysis concerned 539 HCWs: 494 good responders (91.7%); 37 moderate responders (6.9%); and eight poor responders (1.5%). The incidence of anti-HBs loss was 52.1 per 1000 person-years for the poor responders, 11.3 per 1000 person-years for the moderate responders, and 1.4 per 1000 person-years for the good responders. The mean persistence of anti-HBs differed significantly between the three groups, being: 19.2 years (95% CI: 15.6–22.8), 25.4 years (95% CI: 23.0–27.9), and 31.0 years (95% CI: 30.5–31.5) for the poor, moderate and good responders, respectively. In conclusion, our findings demonstrate a good persistence of protective anti-HBs titers in HCWs exposed to occupational risk for up to 30 years after a primary vaccination cycle (even without a booster dose) if their titer was initially higher than 100 mIU/mL.
Collapse
Affiliation(s)
- Silvia Cocchio
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Vincenzo Baldo
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
- Correspondence:
| | - Anna Volpin
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Marco Fonzo
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Annarosa Floreani
- Scientific Institute for Research, Hospitalization and Healthcare Negrar, 37024 Negrar, Italy;
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35124 Padova, Italy
| | - Patrizia Furlan
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Paola Mason
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Andrea Trevisan
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| | - Maria Luisa Scapellato
- Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padua, 35100 Padova, Italy; (S.C.); (A.V.); (M.F.); (P.F.); (P.M.); (A.T.); (M.L.S.)
| |
Collapse
|
|
15
|
Ogega CO, Skinner NE, Blair PW, Park HS, Littlefield K, Ganesan A, Ladiwala P, Antar AAR, Ray SC, Betenbaugh MJ, Pekosz A, Klein SL, Manabe YC, Cox AL, Bailey JR. Durable SARS-CoV-2 B cell immunity after mild or severe disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.10.28.20220996. [PMID: 33140070 PMCID: PMC7605583 DOI: 10.1101/2020.10.28.20220996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Multiple studies have shown loss of SARS-CoV-2 specific antibodies over time after infection, raising concern that humoral immunity against the virus is not durable. If immunity wanes quickly, millions of people may be at risk for reinfection after recovery from COVID-19. However, memory B cells (MBC) could provide durable humoral immunity even if serum neutralizing antibody titers decline. We performed multi-dimensional flow cytometric analysis of S protein receptor binding domain (S-RBD)-specific MBC in cohorts of ambulatory COVID-19 patients with mild disease, and hospitalized patients with moderate to severe disease, at a median of 54 (39-104) days after onset of symptoms. We detected S-RBD-specific class-switched MBC in 13 out of 14 participants, including 4 of the 5 participants with lowest plasma levels of anti-S-RBD IgG and neutralizing antibodies. Resting MBC (rMBC) made up the largest proportion of S-RBD-specific class-switched MBC in both cohorts. FCRL5, a marker of functional memory when expressed on rMBC, was dramatically upregulated on S-RBD-specific rMBC. These data indicate that most SARS-CoV-2-infected individuals develop S-RBD-specific, class-switched MBC that phenotypically resemble germinal center-derived B cells induced by effective vaccination against other pathogens, providing evidence for durable B cell-mediated immunity against SARS-CoV-2 after recovery from mild or severe COVID-19 disease.
Collapse
Affiliation(s)
- Clinton O. Ogega
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole E. Skinner
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul W. Blair
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Han-Sol Park
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kirsten Littlefield
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abhinaya Ganesan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Pranay Ladiwala
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Annukka AR Antar
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stuart C. Ray
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J. Betenbaugh
- Advanced Mammalian Biomanufacturing Innovation Center, Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sabra L. Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yukari C. Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea L. Cox
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Justin R. Bailey
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
|
16
|
Documentation of Hepatitis B Immunity in Nursing Students. Nurs Educ Perspect 2020; 43:55-56. [PMID: 32976219 DOI: 10.1097/01.nep.0000000000000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of the risk of occupational exposure, preparation for nursing student clinical placement includes documentation of the hepatitis B immunization series. Requiring a hepatitis B antibody titer is less common. Immunity from the hepatitis B vaccine decreases over time, particularly for those immunized as infants. A record review of one nursing program that required both immunization and an antibody titer found 86 percent of students immunized as infants had low antibody levels, requiring reimmunization following 2013 Centers for Disease Control and Prevention guidelines. Nursing education programs that do not require antibody titers should reevaluate their policies to protect their students.
Collapse
|
|
17
|
Kushner T, Chen Z, Tressler S, Kaufman H, Feinberg J, Terrault NA. Trends in Hepatitis B Infection and Immunity Among Women of Childbearing Age in the United States. Clin Infect Dis 2020; 71:586-592. [PMID: 31504302 PMCID: PMC7384310 DOI: 10.1093/cid/ciz841] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The current opioid injection drug use epidemic has been associated with an increase in hepatitis C virus infections among women of childbearing age in the United States, but changes in hepatitis B virus (HBV) infections have not been studied. METHODS A retrospective analysis of HBV statuses among women of childbearing age nationally and by state was conducted, utilizing the Quest Diagnostics database. Rates of HBV in women born before and after the implementation of universal HBV vaccination recommendations were determined. RESULTS We identified 8 871 965 women tested for HBV from 2011-2017. Nationally, the annual rate of acute HBV infections was stable, but rates increased in Kentucky, Alabama, and Indiana (P < .03). The national prevalence of new, chronic HBV diagnoses decreased significantly, from 0.83% in 2011 to 0.19% in 2017 (P < .0001), but increased in Mississippi, Kentucky, and West Virginia (P ≤ .05). A declining prevalence of HBV seroprotection was evident over time, especially within the birth-dose cohort (which dropped from 48.5% to 38.5%; P < .0001). CONCLUSIONS National rates of newly diagnosed acute and chronic HBV infections declined or were stable overall, but increased significantly in specific Appalachian states. The HBV vaccine is effective in decreasing infections, but seroprotection wanes over time. These trends in new infections may be related to increased injection drug use and highlight potential gaps in HBV vaccine protection.
Collapse
Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhen Chen
- Quest Diagnostics, Secaucus, New Jersey, USA
| | - Stacy Tressler
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | | | - Judith Feinberg
- Departments of Behavioral Medicine & Psychiatry, Neuroscience and Medicine, Division of Infectious Diseases, West Virginia University, Morgantown, USA
| | - Norah A Terrault
- Division of Gastroenterology/Hepatology, University of Southern California, Los Angeles, USA
| |
Collapse
|
|
18
|
Jourdain G, Ngo-Giang-Huong N, Khamduang W. Current progress in the prevention of mother-to-child transmission of hepatitis B and resulting clinical and programmatic implications. Infect Drug Resist 2019; 12:977-987. [PMID: 31118703 PMCID: PMC6499137 DOI: 10.2147/idr.s171695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022] Open
Abstract
There is currently no cure for hepatitis B chronic infections. Because new hepatitis B infections result mainly from perinatal transmission, preventing mother-to-child transmission is essential to reach by 2030 the goal of hepatitis B elimination set by the World Health Organization. The universal administration of hepatitis B vaccine to all infants, regardless of maternal status, starting with the birth dose, is the cornerstone of the strategy for elimination. Additional interventions, such as hepatitis B immune globulin administered to newborns and antiviral prophylaxis administered to hepatitis B infected pregnant women, may contribute to reaching the goal earlier. Hepatitis B immune globulin may remain out for reach of many pregnant women in low- and middle-income countries due to cost and logistic issues, but antivirals are cheap and do not require a cold chain for distribution. However, it has been observed that some viruses harbor mutations associated with escape from vaccine-elicited antibodies following immunization or administration of hepatitis B immune globulin. Also, resistance associated mutations have been described for several drugs used for treatment of hepatitis B infected patients as well as for the prevention of mother-to-child transmission. Whether these mutations have the potential to compromise the prevention of mother-to-child transmission or future treatment of the mother is a question of importance. We propose a review of important recent studies assessing tenofovir disoproxil fumarate for the prevention of mother-to-child transmission, and provides detailed information on the mutations possibly relevant in this setting.
Collapse
Affiliation(s)
- Gonzague Jourdain
- Unit 174-PHPT, Institut de recherche pour le développement (IRD), Marseille, France
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Nicole Ngo-Giang-Huong
- Unit 174-PHPT, Institut de recherche pour le développement (IRD), Marseille, France
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Woottichai Khamduang
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
|
19
|
Bijani B, Allami A, Jafari F, Hajmanoochehri F, Bijani S. Long-term immunogenicity of hepatitis B vaccine and impact of a booster dose on health care. Med J Islam Repub Iran 2019; 33:20. [PMID: 31380310 PMCID: PMC6662535 DOI: 10.34171/mjiri.33.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Accidental exposure to sharp instruments is an important problem for health care students. Thus, the aim of this study was to determine the rate of immunity in health care students 2 decades after national neonatal hepatitis B (HB) vaccination.
Methods: All junior students attending medicine, nursing and midwifery schools were screened for anti-HBs. One dose of hepatitis B vaccine was offered to all participants who did not have antibodies to HB surface antigen (anti-HBs) of > 10 IU/L; then, they were tested for anti-HBs after a month. The participants were classified into 3 groups: postboosting nonimmune, postboosting immune, and preboosting immune. Chi square test and ANOVA were used for data analysis.
Results: In the first step, 65.20% of participants did not show immunity, but after receiving a booster dose, only 6.0% remained nonimmune. The mean age of nonimmune students was significantly higher than that of students who had postboosting immune and preboosting immune status (p=0.001 and 0.002, respectively). Also, the mean injection time from last shot was higher in postboosting immune group compared to preboosting immune group (p<0.001). Also, prebooster anti-HBs level was significantly different among participants with suboptimal response and those who developed anamnestic response, indicating preserved immune memory (p=0.001).
Conclusion: High anamnestic response to HBV booster dose indicates sufficient immunity to HBV in the majority of health care students. However, identifying students who cannot respond to a booster dose of vaccine seems to be necessary at the beginning of health care courses.
Collapse
Affiliation(s)
- Behzad Bijani
- Department of Infectious Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Abbas Allami
- Department of Infectious Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Farzaneh Jafari
- Department of Infectious Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Soroush Bijani
- Department of Pharmaceutical Biotechnology, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
|
20
|
In pursuit of control and elimination: update on hepatitis A and B epidemiology and prevention strategies. Curr Opin Pediatr 2018; 30:689-697. [PMID: 30188873 DOI: 10.1097/mop.0000000000000672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW This review describes the impact of recommendations for routine immunization of infants and children against hepatitis A and hepatitis B, the changing epidemiology of these infections, and the remaining challenges to controlling or eliminating these diseases in the United States. RECENT FINDINGS Rates of hepatitis A and B have significantly declined because of childhood vaccination programs and long-term protection provided by infant immunization. However, hepatitis A immunization rates remain lower than other vaccines, and outbreaks continue to occur in part due to a growing number of susceptible adults. The Advisory Committee on Immunization Practice has updated pre and postexposure prophylaxis and travel recommendations for hepatitis A prevention in young infants, as well as recommendations to reduce ongoing perinatal transmission of hepatitis B. SUMMARY Pediatric healthcare providers should continue to immunize all infants against hepatitis A and B and ensure that no child outgrows the pediatric practice without being vaccinated. To address hepatitis A, providers should be aware of new recommendations for unimmunized travelers, use vaccines to prevent and control outbreaks, and ensure postexposure prophylaxis. Universal vaccination of infants against hepatitis B should begin before hospital discharge. The prevention of perinatal transmission is critical for control and possible eradication of hepatitis B.
Collapse
|
|
21
|
Transcriptome analysis of immune genes in peripheral blood mononuclear cells of young foals and adult horses. PLoS One 2018; 13:e0202646. [PMID: 30183726 PMCID: PMC6124769 DOI: 10.1371/journal.pone.0202646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/07/2018] [Indexed: 12/14/2022] Open
Abstract
During the neonatal period, the ability to generate immune effector and memory responses to vaccines or pathogens is often questioned. This study was undertaken to obtain a global view of the natural differences in the expression of immune genes early in life. Our hypothesis was that transcriptome analyses of peripheral blood mononuclear cells (PBMCs) of foals (on day 1 and day 42 after birth) and adult horses would show differential gene expression profiles that characterize natural immune processes. Gene ontology enrichment analysis provided assessment of biological processes affected by age, and a list of 897 genes with ≥2 fold higher (p<0.01) expression in day 42 when compared to day 1 foal samples. Up-regulated genes included B cell and T cell receptor diversity genes; DNA replication enzymes; natural killer cell receptors; granzyme B and perforin; complement receptors; immunomodulatory receptors; cell adhesion molecules; and cytokines/chemokines and their receptors. The list of 1,383 genes that had higher (p<0.01) expression on day 1 when compared to day 42 foal samples was populated by genes with roles in innate immunity such as antimicrobial proteins; pathogen recognition receptors; cytokines/chemokines and their receptors; cell adhesion molecules; co-stimulatory molecules; and T cell receptor delta chain. Within the 742 genes with increased expression between day 42 foal and adult samples, B cell immunity was the main biological process (p = 2.4E-04). Novel data on markedly low (p<0.0001) TLR3 gene expression, and high (p≤0.01) expression of IL27, IL13RA1, IREM-1, SIRL-1, and SIRPα on day 1 compared to day 42 foal samples point out potential mechanisms of increased susceptibility to pathogens in early life. The results portray a progression from innate immune gene expression predominance early in life to adaptive immune gene expression increasing with age with a putative overlay of immune suppressing genes in the neonatal phase. These results provide insight to the unique attributes of the equine neonatal and young immune system, and offer many avenues of future investigation.
Collapse
|
|
22
|
Mahmood S, Shah KU, Khan TM. Immune Persistence After Infant Hepatitis-B Vaccination: A Systematic Review and Meta-Analysis. Sci Rep 2018; 8:12550. [PMID: 30135554 PMCID: PMC6105718 DOI: 10.1038/s41598-018-30512-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/27/2018] [Indexed: 01/10/2023] Open
Abstract
A systematic review was performed to estimate the duration of protection of Hepatitis-B vaccine after primary vaccination during infancy. The number of seropositive participants with anti-HBs antibody titer ≥ 10 mIU/ml and seronegative participants who had anti-HBs antibody titer ≤ 10 mIU/ml after booster dose was the main outcome criteria to find out the protection time of Hepatitis-B vaccine. Twelve studies were selected for systematic review. Overall, results from the meta-analysis have revealed that the risk of Anti-HBs Titer ≤ 10 mIU/ml reduced by 50%. Upon performing the sub-group analysis it was revealed that the overall risk of having Anti-HBs Titre ≤ 10 mIU/ml was reduced up to 62% among the subjects age 21–30 years (0.38 [0.34, 0.44]; I2 = 0.0%, p = 0.938). Furthermore, it was observed that the risk of having titre level less than 10 mIU/ml for plasma derived vaccines were to be 56% [0.44, CI 0.33–0.57, I2 90.9%, p = <0.001]. Vaccination in early infancy does not ensure protection against Hepatitis-B infection. There is a strong correlation between the duration of protection and time elapsed after primary immunization during infancy.
Collapse
Affiliation(s)
- Sajid Mahmood
- Faculty of Pharmacy, Quaid-e-Azam University, Islamabad, 45320, Pakistan
| | - Kifayat Ullah Shah
- Faculty of Pharmacy, Quaid-e-Azam University, Islamabad, 45320, Pakistan
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Bandar Sunway, 45700, Selangor, Malaysia. .,The Institute of Pharmaceutical Sciences (IPS), University of Veterinary & Animal Sciences (UVAS), Outfall road, Lahore, Pakistan.
| |
Collapse
|
|
23
|
Dionne-Odom J, Njei B, Tita ATN. Elimination of Vertical Transmission of Hepatitis B in Africa: A Review of Available Tools and New Opportunities. Clin Ther 2018; 40:1255-1267. [PMID: 29983265 PMCID: PMC6123260 DOI: 10.1016/j.clinthera.2018.05.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE This review article focuses on preventing vertical transmission of hepatitis B virus (HBV) among pregnant women living in sub-Saharan Africa (SSA), where disease is endemic and the estimated maternal HBV seroprevalence is >8%. Available interventions that have been studied in low- and middle-income countries are compared in terms of efficacy and effectiveness in clinical practice. Global disease-elimination targets, barriers to HBV-prevention efforts, and critical research gaps are discussed. METHODS A PubMed literature search in February 2018 identified relevant studies of interventions to reduce or prevent the transmission of HBV during pregnancy or in the peripartum period. Studies that focused on interventions that are currently available or could be made available in SSA were included. Trials conducted in SSA and other low-income countries were prioritized, although studies of interventions in middle- and high-income countries were included. FINDINGS Among 127 studies and reports included in the review, 60 included data from SSA. The most cost-effective intervention to reduce HBV infection rates in SSA is timely birth-dose vaccination followed by completion of the 3-dose infant-vaccination series. The identification and treatment of pregnant women with elevated HBV viral load to further reduce the risk for vertical transmission in SSA show promise, but efficacy and tolerability trials in Africa are lacking. IMPLICATIONS Scale-up of currently available tools is required to reach HBV disease-elimination goals in SSA. Many countries in SSA are in the process of rolling out national birth-dose vaccination campaigns; this roll out provides an opportunity to evaluate and improve processes in order to expand coverage. Early antenatal care, promotion of facility deliveries, and increased awareness of HBV prevention are also key components of prevention success. Future studies in SSA should identity an HBV-prevention package that is effective, well tolerated, and feasible and can be administered in the antenatal clinic and tailored to vertical-transmission risk.
Collapse
Affiliation(s)
- Jodie Dionne-Odom
- Department of Medicine, Division of Infectious Diseases, University of Alabama, Birmingham, Alabama.
| | - Basile Njei
- Department of Medicine, Section of Digestive Disease, Yale University, New Haven, Connecticut
| | - Alan T N Tita
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Center for Women's Reproductive Health, University of Alabama, Birmingham, Alabama
| |
Collapse
|
|
24
|
Wu W, Lv J, Liu J, Yan B, Feng Y, Xu A, Zhang L. Persistence of immune memory among adults with normal and high antibody response to primary hepatitis B vaccination: Results from a five-year follow-up study in China. Hum Vaccin Immunother 2018; 14:2485-2490. [PMID: 29993330 DOI: 10.1080/21645515.2018.1477911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Immune memory after hepatitis B vaccination among adults is still under investigation. In this study, adults who had normal and high antibody response to the primary series of hepatitis B vaccination (HepB) were followed up at 5 years after the primary immunization. A booster dose was given to those who had low hepatitis B surface antibody (anti-HBs) titers, defined as anti-HBs levels < 10 mIU/mL. Blood samples were collected at two weeks after the booster and anti-HBs levels were measured. We assumed those with ant-HBs levels > = 10 mIU/mL after the booster had anamnestic response. In total, 242 persons completed the booster and the anti-HBs test. The anamnestic response rate was 99.59% (241/242) and geometric mean concentration (GMC) of anti-HBs after the booster was 2989 mIU/mL (95% CI: 255, 35085). Anti-HBs titer after the booster dose had a positive correlation with anti-HBs titers measured right after the primary immunization as well as anti-HBs titers 5 years later just before the booster. After the booster, no significant difference was found in anti-HBs titers between participants who were immunized with the 10μg HepB vaccine and those with the 20μg vaccine. Multivariable analysis showed that 1) vaccine brand used for the primary vaccination, 2) anti-HBs titers after primary vaccination and 3) anti-HBs titers before the booster dose were independently associated with the anti-HBs titers after the booster 1) β = -0.21, 95% CI: -0.33, -0.09, P = 0.001; 2) β = 0.07, 95% CI: 0.05, 0.09, P < 0.001; 3) β = 0.04, 95% CI: 0.02, 0.07, P < 0.001). In summary, anamnestic response exists among almost all adults at five years after HepB primary immunization. Vaccine brand used for primary vaccination, initial anti-HBs titers after primary immunization and anti-HBs titers before the booster were the independent predictive factors of HepB anamnestic response titers.
Collapse
Affiliation(s)
- Wenlong Wu
- a School of Public Health, Shandong University , Jinan , China.,b Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention; Shandong Provincial Center for Disease Control and Prevention , Jinan , China
| | - Jingjing Lv
- a School of Public Health, Shandong University , Jinan , China.,b Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention; Shandong Provincial Center for Disease Control and Prevention , Jinan , China
| | - Jiaye Liu
- a School of Public Health, Shandong University , Jinan , China.,b Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention; Shandong Provincial Center for Disease Control and Prevention , Jinan , China
| | - Bingyu Yan
- a School of Public Health, Shandong University , Jinan , China.,b Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention; Shandong Provincial Center for Disease Control and Prevention , Jinan , China
| | - Yi Feng
- a School of Public Health, Shandong University , Jinan , China.,b Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention; Shandong Provincial Center for Disease Control and Prevention , Jinan , China
| | - Aiqiang Xu
- a School of Public Health, Shandong University , Jinan , China.,b Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention; Shandong Provincial Center for Disease Control and Prevention , Jinan , China
| | - Li Zhang
- a School of Public Health, Shandong University , Jinan , China.,b Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention; Shandong Provincial Center for Disease Control and Prevention , Jinan , China
| |
Collapse
|
|
25
|
Osiowy C. From infancy and beyond… ensuring a lifetime of hepatitis B virus (HBV) vaccine-induced immunity. Hum Vaccin Immunother 2018; 14:2093-2097. [PMID: 29641290 PMCID: PMC6150009 DOI: 10.1080/21645515.2018.1462428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite the long-term efficacy and immune persistence observed following HBV vaccination of infants, the need for a booster dose following infant immunization continues to be deliberated. Evidence from HBV booster dose response studies and long-term immunization program reviews are the basis for the recommendation that a vaccine booster is not necessary. However, further studies continue to emerge and highlight the need for standardization among observational studies in order to appropriately compare outcomes. There is an assumption that neonatal and infant (within 12 months of age) vaccine immune responses are equivalent; however, evidence exists for distinct vaccine responses within the first year of life. HBV vaccine programs have evolved over time, particularly regarding the type and dosage of vaccine used. Several universal neonatal immunization programs initially incorporated a 2.5 μg dosage (Recombivax-HB, Merck). This dosage has been shown in multiple long-term studies and meta-analyses to be associated with a lower primary response, decreased antibody persistence over time, and a reduced booster response 10 to 20 years following immunization. Ongoing surveillance of this and other HBV neonatally-vaccinated populations, particularly in low endemic regions, is necessary to understand the impact on long-term protection in order to ensure lifelong protection against hepatitis B infection.
Collapse
Affiliation(s)
- Carla Osiowy
- a National Microbiology Laboratory , Public Health Agency of Canada , Winnipeg , Manitoba , Canada
| |
Collapse
|
|
26
|
Weinberger B, Haks MC, de Paus RA, Ottenhoff THM, Bauer T, Grubeck-Loebenstein B. Impaired Immune Response to Primary but Not to Booster Vaccination Against Hepatitis B in Older Adults. Front Immunol 2018; 9:1035. [PMID: 29868000 PMCID: PMC5962691 DOI: 10.3389/fimmu.2018.01035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/25/2018] [Indexed: 12/12/2022] Open
Abstract
Many current vaccines are less immunogenic and less effective in elderly compared to younger adults due to age-related changes of the immune system. Most vaccines utilized in the elderly contain antigens, which the target population has had previous contact with due to previous vaccination or infection. Therefore, most studies investigating vaccine-induced immune responses in the elderly do not analyze responses to neo-antigens but rather booster responses. However, age-related differences in the immune response could differentially affect primary versus recall responses. We therefore investigated the impact of age on primary and recall antibody responses following hepatitis B vaccination in young and older adults. Focused gene expression profiling was performed before and 1 day after the vaccination in order to identify gene signatures predicting antibody responses. Young (20-40 years; n = 24) and elderly (>60 years; n = 17) healthy volunteers received either a primary series (no prior vaccination) or a single booster shot (documented primary vaccination more than 10 years ago). Antibody titers were determined at days 0, 7, and 28, as well as 6 months after the vaccination. After primary vaccination, antibody responses were lower and delayed in the elderly compared to young adults. Non-responders after the three-dose primary series were only observed in the elderly group. Maximum antibody concentrations after booster vaccination were similar in both age groups. Focused gene expression profiling identified 29 transcripts that correlated with age at baseline and clustered in a network centered around type I interferons and pro-inflammatory cytokines. In addition, smaller 8- and 6-gene signatures were identified at baseline that associated with vaccine responsiveness during primary and booster vaccination, respectively. When evaluating the kinetic changes in gene expression profiles before and after primary vaccination, a 33-gene signature, dominated by IFN-signaling, pro-inflammatory cytokines, inflammasome components, and immune cell subset markers, was uncovered that was associated with vaccine responsiveness. By contrast, no such transcripts were identified during booster vaccination. Our results document that primary differs from booster vaccination in old age, in regard to antibody responses as well as at the level of gene signatures. Clinical Trial Registration www.clinicaltrialsregister.eu, this trial was registered at the EU Clinical Trial Register (EU-CTR) with the EUDRACT-Nr. 2013-002589-38.
Collapse
Affiliation(s)
- Birgit Weinberger
- Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
| | - Mariëlle C Haks
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Roelof A de Paus
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Tanja Bauer
- Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich, Germany
| | | |
Collapse
|
|
27
|
Kosalaraksa P, Chokephaibulkit K, Benjaponpitak S, Pancharoen C, Chuenkitmongkol S, B'Chir S, Da Costa X, Vidor E. Persistence of hepatitis B immune memory until 9-10 years of age following hepatitis B vaccination at birth and DTaP-IPV-HB-PRP∼T vaccination at 2, 4 and 6 months. Hum Vaccin Immunother 2018; 14:1257-1265. [PMID: 29333947 PMCID: PMC5989896 DOI: 10.1080/21645515.2018.1426418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/21/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the long-term persistence of anti-hepatitis B surface (HBs) antibodies and the response to a HB challenge re-vaccination in children who had received a primary series of DTaP-IPV-HB-PRP∼T (Hexaxim™) or DTaP-IPV-HB/PRP∼T (Infanrix hexa™). METHODS Two cohorts of participants who had previously received HB vaccine at birth followed by either DTaP-IPV-HB-PRP∼T or DTaP-IPV-HB/PRP∼T co-administered with PCV7 at 2, 4, 6 months of age in a randomized, Phase III, observer-blind study in Thailand, were followed up for anti-HBs antibodies (geometric mean concentrations [GMCs] and seroprotection [SP] rate [% of participants with a titer ≥10 mIU/mL]) at 12-18 months of age and 9-10 years of age. A monovalent HB challenge re-vaccination was administered at 9-10 years of age and the anamnestic response was evaluated. RESULTS Anti-HBs GMCs and SP rates in the DTaP-IPV-HB-PRP∼T and DTaP-IPV-HB/PRP∼T groups were high and similar post-primary vaccination series (2477 mIU/mL and 99.5% and 2442 mIU/mL and 99.5%, respectively) and declined to a similar extent in each group at 12-18 months (154.5 mIU/mL and 90.8% and 162.3 mIU/mL and 96.5%, respectively). Antibody levels further declined at 9-10 years of age (13.3 mIU/mL and 49.3% and 8.0 mIU/mL and 42.9%) and a strong anamnestic response occurred in each group post-HB challenge re-vaccination (92.8% and 98.7%, respectively). CONCLUSION The kinetics of long-term anti-HBs antibody persistence were similar following a primary series of DTaP-IPV-HB-PRP∼T or DTaP-IPV-HB/PRP∼T. The response to a subsequent HB challenge re-vaccination was strong and similar in each group, demonstrating persisting immune memory.
Collapse
|
|
28
|
|
|
29
|
Saffar H, Khalilian AR, Saffar MJ, Ajami A. Long-term Protection Against the Hepatitis B Virus Detected Through an Early Response to a Booster Dose Injection. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Objective
To determine the duration of protection conferred by the hepatitis B (HB) vaccination and the necessity of a booster dose.
Methods
Immediately after the initial blood sampling, 252 youths (aged 18.8-20.5 years, 52% females) with a history of neonatal HB vaccination with one dose of the HB vaccine received a booster. Serum concentrations of antibodies against the HB surface antigen were assessed in samples collected before and 10-14 days after the booster. Seroconversion from concentrations <10 to ≥10 IU/L were defined as a positive immune response.
Results
Of the 252 participants, 131 were serosusceptible and 114 responded.
Conclusions
Nearly 90% of young people preserved their long-term protection; the results of this study do not support the use of an HB booster vaccination.
Collapse
|
|
30
|
Stevens CE, Toy P, Kamili S, Taylor PE, Tong MJ, Xia GL, Vyas GN. Eradicating hepatitis B virus: The critical role of preventing perinatal transmission. Biologicals 2017; 50:3-19. [DOI: 10.1016/j.biologicals.2017.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022] Open
|
|
31
|
Anderson CL, Remschmidt C, Drobnitzky FP, Falkenhorst G, Zimmermann R, Wichmann O, Harder T. Hepatitis B immune status in adolescents vaccinated during infancy: A retrospective cohort study from a pediatric practice in Germany. Hum Vaccin Immunother 2017; 12:779-84. [PMID: 26633195 DOI: 10.1080/21645515.2015.1105414] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In Germany, vaccination of infants against hepatitis B is recommended since 1995. However, data on long-term immunity is sparse and the necessity of a booster dose remains uncertain. Aims of this study were to assess the long-term persistence of antibodies to the hepatitis B surface antigen (anti-HBs) after immunization during infancy and the effect of a subsequent hepatitis B booster vaccination during adolescence on anti-HBs levels. Patients from a private pediatric practice who had received a full vaccination course of hepatitis B as infants and who were quantitatively tested for anti-HBs during adolescence (pre-booster levels) were included. In those participants who received a hepatitis B booster, post-booster anti-HBs levels were measured. Univariate analyses were conducted to determine factors associated with pre- and post-booster anti-HBs levels, respectively. 106 participants (53% male) were included in the study. At an average of 13.7 y after primary vaccination, 14% of participants had an anti-HBs level of ≥100 IU/l, while 46% were at 10-99 IU/l and 40% had anti-HBs levels of <10 IU/l. In total, 34 received a booster vaccination. Of those, 97% (33/34) had post-booster anti-HBs levels ≥ 100 IU/l, which were independent from pre-booster levels. No other patient characteristics were associated with pre-booster or post-booster anti-HBs≥ 100 IU/l. Although almost half of study participants showed low anti-HBs levels at follow-up, robust responses to booster vaccination suggest that adolescents who received the full vaccination course during infancy are still protected against hepatitis B infection.
Collapse
Affiliation(s)
- Carrie L Anderson
- a Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin , Berlin , Germany.,b Robert Koch Institute, Immunization Unit , Berlin , Germany
| | | | | | | | - Ruth Zimmermann
- d Robert Koch Institute, Unit for HIV/AIDS, STI and Blood-borne infections , Berlin , Germany
| | - Ole Wichmann
- b Robert Koch Institute, Immunization Unit , Berlin , Germany
| | - Thomas Harder
- b Robert Koch Institute, Immunization Unit , Berlin , Germany
| |
Collapse
|
|
32
|
Prevalence of anti-hepatitis B surface antibodies among children and adolescents vaccinated in infancy and effect of booster dose administered within a pilot study. Epidemiol Infect 2017; 145:2890-2895. [PMID: 28903797 DOI: 10.1017/s0950268817002126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We determined the prevalence of anti-hepatitis B surface antibodies (anti-HBs) among children and adolescents vaccinated for hepatitis B virus in infancy as part of the routine vaccination programme. A representative serum sample of the Israeli population age 0-19 was tested. In a separate pilot study, a booster dose of hepatitis B vaccine was administered to 31 candidates for national service, who were fully vaccinated in infancy and tested negative for hepatitis B surface antibodies at age 17-19 years and anti-HBs antibodies were assessed 8 weeks later. Of the 1273 samples tested, 631 (49·6%) were positive to anti-HBs antibodies. Seropositivity rates were 89·5% among infants aged 6-12 months and declined significantly with age to 20·7% at age 19 years. No differences in seropositivity rates were observed between Jews and Arabs, males and females and those born in Israel and in other countries. Seroconversion rate among the 31 individuals who received a booster dose was 90·3% (95% CI: 75·1-96·6%). We recommend a booster dose for healthcare personnel before starting to work at the health care facility.
Collapse
|
|
33
|
Persistence of Hepatitis B Immunity Following 3-dose Infant Primary Series in HIV-infected Thai Adolescents and Immunologic Response to Revaccination. Pediatr Infect Dis J 2017; 36:863-868. [PMID: 28419007 DOI: 10.1097/inf.0000000000001613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND HIV infection may alter immunologic response and the establishment of immune memory to infant hepatitis B virus (HBV) vaccination. This study aimed to determine the need to revaccinate perinatally HIV-infected Thai adolescents. METHODS Cross-sectional serologic tests for HBV, including hepatitis B surface antigen, anti-hepatitis B surface antibody (anti-HBs) and anti-hepatitis B core antibody (anti-HBc), were performed in perinatally HIV-infected adolescents. Adolescents having anti-HBs <100 mIU/mL with negative anti-HBc and immune reconstitution from highly active antiretroviral therapy (HAART) were revaccinated using regular (10 μg) 3-dose schedule given intramuscularly at 0-, 2- and 6-month intervals. RESULTS Of 193 adolescents who received 3-dose infant HBV vaccination, 6 were receiving HAART during vaccination, median (interquartile range) current age 14.5 (11.7-16.2) years, 7 (3.6%) had positive anti-HBc (indicating breakthrough infection), of which 4 (2%) had positive hepatitis B surface antigen (indicating chronic infection). Twenty-two (11.4%) adolescents had protective anti-HBs concentration >10 mIU/mL. Of 164 revaccinated adolescents, 142 (86.6%) had HIV viral load <40 copies/mL. Anti-HBs seroconversion rates >10 mIU/mL were 58.0% (94/162) after the first dose and 97.5% (158/162) after the third dose of revaccination. Forty-five (28%) subjects responded to the first dose with anti-HBs antibody ≥100 mIU/mL had a shorter median duration with CD4 count <15% than their counterparts (6.2 vs. 11.1 months; P = 0.049). CONCLUSIONS Only half of perinatally HIV-infected adolescents were able to elicit anti-HBs response with a single-dose HBV vaccine. Revaccination with 3-dose schedule is required in perinatally HIV-infected adolescents who did not initiate HAART at the time of infant vaccination.
Collapse
|
|
34
|
Lee KH, Shim KS, Lim IS, Chae SA, Yun SW, Lee NM, Choi YB, Yi DY. Changes in hepatitis B virus antibody titers over time among children: a single center study from 2012 to 2015 in an urban of South Korea. BMC Pediatr 2017; 17:164. [PMID: 28705230 PMCID: PMC5512724 DOI: 10.1186/s12887-017-0924-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/05/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is the most common cause of liver disease in endemic areas such as South Korea. After HBV vaccination, hepatitis B surface antibody (HBsAb) titers gradually decrease. Trends in HBsAb titers have not been evaluated among children in South Korea over the past decade. METHODS We screened 6155 patients (aged 7 months to 17 years) who underwent HBV antigen/antibody testing at Chung-Ang University Hospital from May 2012 to April 2015. Titer criteria were defined as follows: positive, titer ≥100 IU/L; weakly positive, titer 10-99 IU/L; and negative, titer <10 IU/L. We also compared titers before and 1 month after a single booster vaccination. RESULTS Of the 5655 patients included, 3016 were male and 5 (0.09%) tested positive for HBV surface antigen. A marked reduction in antibody titer was observed until 4 years of age. Thereafter, the titers showed fluctuating decreases. HBsAb titers reached their lowest levels by 14 years of age. After 7 years of age, 50% of patients tested negative for HBsAb. Simple linear analysis showed that the titer reached levels of <10 IU/L and zero at 12.9 and 13.4 years of age, respectively. 1 month after a single booster vaccination was administered to those who were HBsAb-negative (n = 72), 69 children (96%) had developed antibodies while 3 (4%) remained HBsAb-negative. CONCLUSIONS In conclusion, the continuous reduction in HBsAb titers over time and in each age group was confirmed. The titer level was shown significant decline until age 4. More than half of the sample had negative titers after age 7 years. After booster vaccination, most of child significantly increase titer level.
Collapse
Affiliation(s)
- Kyeong Hun Lee
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Kyu Seok Shim
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - In Seok Lim
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
- College of Medicine, Chung-Ang University, Seoul, Korea
| | - Soo Ahn Chae
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
- College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sin Weon Yun
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
- College of Medicine, Chung-Ang University, Seoul, Korea
| | - Na Mi Lee
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Young Bae Choi
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.
- College of Medicine, Chung-Ang University, Seoul, Korea.
| |
Collapse
|
|
35
|
Zanetti A, Desole MG, Romanò L, d'Alessandro A, Conversano M, Ferrera G, Panico MG, Tomasi A, Zoppi G, Zuliani M, Thomas S, Soubeyrand B, Eymin C, Lockhart S. Safety and immune response to a challenge dose of hepatitis B vaccine in healthy children primed 10years earlier with hexavalent vaccines in a 3, 5, 11-month schedule: An open-label, controlled, multicentre trial in Italy. Vaccine 2017. [PMID: 28624307 DOI: 10.1016/j.vaccine.2017.05.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS The strategy of vaccinating infants to prevent hepatitis B virus infection in adolescence or adulthood requires durable immunity. This study investigated responses to a challenge dose of monovalent hepatitis B vaccine in children primed with three doses of either Hexavac® or Infanrix hexa® 10years earlier during infancy. METHODS This open-label, controlled, multicentre study conducted in Italy, enrolled 751 healthy pre-adolescents (aged 11-13years) who were given either Hexavac (n=409) or Infanrix hexa (n=342) at 3, 5 and 11months of life. All participants received a challenge dose of a monovalent hepatitis B vaccine (HBVaxPro® 5µg). The concentrations of antibodies to hepatitis B surface antigen (anti-HBs) were measured before and 1month after the challenge dose. The analysis was descriptive and no formal hypothesis was tested. RESULTS One month post-challenge, 331 participants in the Hexavac cohort [83.6%, 95% CI: 79.6; 87.1] and 324 in the Infanrix hexa cohort [96.4%, 95% CI: 93.8; 98.1] had anti-HBs concentrations ≥10mIU/mL. Before the challenge dose, an anti-HBs concentration of ≥10mIU/mL was found in 94 children in the Hexavac cohort [23.9%, 95% CI: 19.7; 28.4] and in 232 children in the Infanrix hexa cohort [69%, 95% CI: 63.8; 74.0]. Among children with a pre-challenge anti-HBs concentration of <10mIU/mL, 236 [78.7%, 95% CI: 73.6; 83.2] in the Hexavac cohort and 92 [88.5%, 95% CI: 80.7; 93.9] in the Infanrix hexa cohort achieved protective anti-HBs antibody concentrations. No evidence of active hepatitis B disease was observed in either group, and the HBVaxPro challenge dose was well tolerated. CONCLUSIONS These data confirm that immune memory persists in a high percentage of children (>80%) at least 10years after a two-dose primary and booster vaccination schedule with a hexavalent vaccine (Hexavac or Infanrix hexa). TRIAL REGISTRATION EudraCT Number: 2013-001602-28; clinicaltrials.gov: NCT02012998.
Collapse
Affiliation(s)
- Alessandro Zanetti
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy.
| | | | - Luisa Romanò
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133 Milano, Italy.
| | - Antonio d'Alessandro
- ASL Salerno, Dipartimento di Prevenzione Servizio Epidemiologia e Prevenzione, Via Bruno Grimaldi 60, 84014 Nocera Inferiore, Salerno, Italy.
| | - Michele Conversano
- ASL 1 Taranto, Servizio di Igiene Pubblica, Ospedale Civile Pagliari, Viale Magna Grecia, 74016 Massafra, Taranto, Italy.
| | - Giuseppe Ferrera
- ASP 7 Ragusa, Servizio di Epidemiologia e Prevenzione, Via Aldo Licitra, 11, 97100 Ragusa, Italy.
| | - Maria Grazia Panico
- Servizio di Epidemiologia ASL Salerno, Via Settimio Mobilio, 52, 84100 Salerno, Italy.
| | - Alberto Tomasi
- ASL 2 Lucca, U.O. Igiene e Sanità Pubblica, Dipartimento della Prevenzione, Piazza Aldo Moro, 5, 55012 Capannori, Lucca, Italy.
| | - Giorgio Zoppi
- ASL n. 4 Chiavarese, Dipartimento di Prevenzione, Struttura Complessa Igiene e Sanità Pubblica, Corso Dante, 16043 Chiavari, Genova, Italy.
| | - Massimo Zuliani
- ASS n. 5 "Bassa Friulana", Dipartimento di Prevenzione Servizio di Igiene e Sanità Pubblica c/o Ospedale di Latisana, Via Sabbionera 45, 33053 Latisana, Udine, Italy.
| | - Stéphane Thomas
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367 Lyon Cedex 07, France.
| | - Benoît Soubeyrand
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367 Lyon Cedex 07, France.
| | - Cécile Eymin
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367 Lyon Cedex 07, France.
| | - Stephen Lockhart
- Sanofi Pasteur MSD, 162 avenue Jean Jaurès, CS 50712, 69367 Lyon Cedex 07, France.
| |
Collapse
|
|
36
|
Melhem NM, Mahfouz RA, Kreidieh K, Abdul-Khalik R, El-Khatib R, Talhouk R, Musharrafieh U, Hamadeh G. Potential role of killer immunoglobulin receptor genes among individuals vaccinated against hepatitis B virus in Lebanon. World J Hepatol 2016; 8:1212-1221. [PMID: 27803766 PMCID: PMC5067441 DOI: 10.4254/wjh.v8.i29.1212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/13/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the role of killer immunoglobulin receptor (KIR) genes in responsiveness or non-responsiveness to vaccination against hepatitis B virus.
METHODS We recruited 101 voluntary participants between March 2010 and December 2011. Sera samples from vaccinated and non-vaccinated participants were tested for the presence of anti-HBs antibodies as a measure of protection against hepatitis B, hepatitis B surface antigen and hepatitis B core antibody as indicators of infection by enzyme-linked immunosorbent assay. KIR gene frequencies were determined by polymerase chain reaction.
RESULTS Sera samples from 99 participants were tested for the levels of anti-HBs as an indicator of protection (≥ 10 mIU/mL) following vaccination as defined by the World Health Organization international reference standard. Among the vaccinated participants, 47% (35/74) had anti-HBs titers above 100 mIU/mL, 22% (16/74) had anti-HBs ranging between 10-100 mIU/mL, and 20% (15/74) had values of less than 10 mIU/mL. We report the lack of significant association between the number of vaccine dosages and the titer of antibodies among our vaccinated participants. The inhibitory KIR2DL1, KIR2DL4, KIR3DL1, KIR3DL2, and KIR3DL were detected in more than 95%, whereas KIR2DL2, KIR2DL3, KIR2DL5 (KR2DL5A and KIR2DL5B) were expressed in 56%, 84% and 42% (25% and 29%) of participants, respectively. The observed frequency of the activating KIR genes ranged between 35% and 55% except for KIR2DS4, detected in 95% of the study participants (40.6% 2DS4*001/002; 82.2% 2DS4*003/007). KIR2DP1 pseudogene was detected in 99% of our participants, whereas KIR3DP*001/02/04 and KIR3DP1*003 had frequencies of 17% and 100%, respectively. No association between the frequency of KIR genes and anti-HBs antibodies was detected. When we compared the frequency of KIR genes between vaccinated individuals with protective antibodies titers and those who lost their protective antibody levels, we did not detect a significant difference. KIR2DL5B was significantly different among different groups of vaccinated participants (group I > 100 mIU/mL, group II 10-100 mIU/mL, group III < 10 mIU/mL and group IV with undetectable levels of protective antibodies).
CONCLUSION To our knowledge, this is the first study screening for the possible role of KIR genes among individuals vaccinated against hepatitis B virus (HBV). Our results can be used to design larger studies to better understand the role of KIR genes in protection against or susceptibility to HBV post vaccination.
Collapse
|
|
37
|
Posuwan N, Wanlapakorn N, Sa-nguanmoo P, Wasitthankasem R, Vichaiwattana P, Klinfueng S, Vuthitanachot V, Sae-lao S, Foonoi M, Fakthongyoo A, Makaroon J, Srisingh K, Asawarachun D, Owatanapanich S, Wutthiratkowit N, Tohtubtiang K, Yoocharoen P, Vongpunsawad S, Poovorawan Y. The Success of a Universal Hepatitis B Immunization Program as Part of Thailand's EPI after 22 Years' Implementation. PLoS One 2016; 11:e0150499. [PMID: 26938736 PMCID: PMC4777547 DOI: 10.1371/journal.pone.0150499] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/16/2016] [Indexed: 12/19/2022] Open
Abstract
Hepatitis B vaccination for newborns was introduced in two provinces in 1988 as part of Thailand's Expanded Program on Immunization (EPI), and extended to the whole country in 1992. Our previous studies showed that children and adolescents who were born after the implementation of this program had a carrier rate of less than 1%, compared with 5-6% before implementation. In 2014 we performed hepatitis B serosurveys among 5964 subjects in the different geographic regions of the country to evaluate the long-term immunogenicity and impact of universal hepatitis B vaccination in newborns as part of the 22-year EPI program, by assessing HBsAg, anti-HBc and anti-HBs seropositivity status. The number of HB virus (HBV) carriers, both children and young adults, who were born after universal HB vaccination was markedly reduced. The carrier rates among the age groups 6 months to 5 years, 5-10, 11-20, 21-30, 31-40, 41-50 and >50 years were respectively 0.1, 0.29, 0.69, 3.12, 3.78, 4.67 and 5.99%. The seropositivity rate for HBsAg in the post-EPI group was 0.6%, whereas in the pre-EPI group it was as high as 4.5% (p<0.001). HBV infection by means of detectable anti-HBc had also drastically declined in the population born after the HB vaccine was integrated into the EPI program. We estimated that the total number of HBV carriers amounted to 2.22 million, or 3.48% of the total population, most of whom are adults. The HB vaccine is the first vaccine shown to be effective in preventing the occurrence of chronic liver disease and hepatocellular carcinoma. Universal vaccination campaign will contribute to the eventual eradication of HBV-associated disease.
Collapse
Affiliation(s)
- Nawarat Posuwan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Pattaratida Sa-nguanmoo
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Rujipat Wasitthankasem
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Preeyaporn Vichaiwattana
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Sirapa Klinfueng
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | | | | | | | | | | | | | | | | | | | | | - Pornsak Yoocharoen
- Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Mueang, Nonthaburi, Thailand
| | - Sompong Vongpunsawad
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| |
Collapse
|
|
38
|
Roberts H, Kruszon-Moran D, Ly KN, Hughes E, Iqbal K, Jiles RB, Holmberg SD. Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988-2012. Hepatology 2016; 63:388-97. [PMID: 26251317 DOI: 10.1002/hep.28109] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 07/31/2015] [Indexed: 12/16/2022]
Abstract
UNLABELLED The number of persons with chronic hepatitis B virus (HBV) infection in the United States is affected by diminishing numbers of young persons who are susceptible because of universal infant vaccination since 1991, offset by numbers of HBV-infected persons migrating to the United States from endemic countries. The prevalence of HBV infection was determined by serological testing and analysis among noninstitutionalized persons age 6 years and older for: antibody to hepatitis B core antigen (anti-HBc), indicative of previous HBV infection; hepatitis B surface antigen (HBsAg), indicative of chronic (current) infection; and antibody to hepatitis B surface antigen (anti-HBs), indicative of immunity from vaccination. These prevalence estimates were analyzed in three periods of the National Health and Nutrition Examination Survey (NHANES): 1988-1994 (21,260 persons); 1999-2008 (29,828); and 2007-2012 (22,358). In 2011-2012, for the first time, non-Hispanic Asians were oversampled in NHANES. For the most recent period (2007-2012), 3.9% had anti-HBc, indicating approximately 10.8 (95% confidence interval [CI]: 9.4-12.2) million noninstitutionalized U.S. residents having ever been infected with HBV. The overall prevalence of chronic HBV infection has remained constant since 1999: 0.3% (95% CI: 0.2-0.4), and since 1999, prevalence of chronic HBV infection among non-Hispanic blacks has been 2- to 3-fold greater than the general population. An estimated 3.1% (1.8%-5.2%) of non-Hispanic Asians were chronically infected with HBV during 2011-2012, which reflects a 10-fold greater prevalence than the general population. Adjusted prevalence of vaccine-induced immunity increased 16% since 1999, and the number of persons (mainly young) with serological evidence of vaccine protection from HBV infection rose from 57.8 (95% CI: 55.4-60.1) million to 68.5 (95% CI: 65.4-71.2) million. CONCLUSION Despite increasing immune protection in young persons vaccinated in infancy, an analysis of chronic hepatitis B prevalence in racial and ethnic populations indicates that during 2011-2012, there were 847,000 HBV infections (which included ~400,000 non-Hispanic Asians) in the noninstitutionalized U.S. POPULATION.
Collapse
Affiliation(s)
- Henry Roberts
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deanna Kruszon-Moran
- Division of Health Nutrition Examination Surveys, National Center for Health Statistics, Rockville, MD
| | - Kathleen N Ly
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth Hughes
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kashif Iqbal
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ruth B Jiles
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| | - Scott D Holmberg
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
|
39
|
Brunskole Hummel I, Zitzmann A, Erl M, Wenzel JJ, Jilg W. Characteristics of immune memory 10-15 years after primary hepatitis B vaccination. Vaccine 2015; 34:636-642. [PMID: 26718687 DOI: 10.1016/j.vaccine.2015.12.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/08/2015] [Accepted: 12/11/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS The definition of immune memory after hepatitis B vaccination is still under debate. Therefore, we analysed hepatitis B surface antigen (HBsAg)-specific memory in more detail by investigating the kinetics of humoral and cellular responses after hepatitis B booster vaccination. METHODS The anti-HBs kinetics of 23 individuals with anti-HBs titres below 10 IU/l, who had been vaccinated 10-15 years ago, was monitored at day 0, 3, 7, 14 and 28 after booster vaccination. HBsAg-specific IFNγ- and IL5-secreting cells in enriched CD4(+) fraction were measured at day 0, 7 and 28 post-booster by enzyme-linked immunospot assay (ELISpot). RESULTS 22 of 23 subjects showed similar anti-HBs kinetic curves, including 3 of 4 subjects who did not reach anti-HBs titres of 10 IU/l. The steep anti-HBs increase started between day 3 and 7 and peaked around day 14. A plateau or only minimal changes were visible between day 14 and 28. 17.4% of subjects showed pre-booster cellular responses, and this rate had increased to 47.8% and 56.5% after 7 and 28 days, respectively. The kinetic patterns of T cell responses differed considerably among subjects. A dominance of Th2 responses (IL5 secretion) over Th1 responses (IFNγ secretion) could be observed. CONCLUSIONS The presence of B cell memory could be shown by a typical anamnestic anti-HBs response curve after a booster dose in all but one individual. In contrast, T cell responses to booster vaccination, which occurred in approximately 50% of participants, were rather heterogeneous.
Collapse
Affiliation(s)
- Irena Brunskole Hummel
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
| | - Anita Zitzmann
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
| | - Monika Erl
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
| | - Jürgen J Wenzel
- Institute of Clinical Microbiology and Hygiene, University Medical Centre Regensburg, 93053 Regensburg, Germany.
| | - Wolfgang Jilg
- Institute of Medical Microbiology and Hygiene, University of Regensburg, 93053 Regensburg, Germany.
| |
Collapse
|
|
40
|
Hartal M, Yavnai N, Galor I, Avramovich E, Sela T, Kayouf R, Tzurel-Ferber A, Greenberg LJ, Halperin T, Levine H. Seroprevalence of anti-HBs antibodies at young adulthood, before and after a booster vaccine dose, among medical personnel vaccinated in infancy. Vaccine 2015; 33:4878-85. [DOI: 10.1016/j.vaccine.2015.07.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/20/2015] [Accepted: 07/20/2015] [Indexed: 11/30/2022]
|
|
41
|
Response to challenge dose among young adults vaccinated for hepatitis B as infants: importance of detectable residual antibody to hepatitis B surface antigen. Infect Control Hosp Epidemiol 2015; 36:529-33. [PMID: 25643863 DOI: 10.1017/ice.2015.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine whether a difference in antibody to hepatitis B surface antigen (anti-HBs) response to a hepatitis B vaccine challenge dose existed among persons with a baseline anti-HBs level of 0 mIU/mL (group 1) and those with "non-zero" levels of 0.1-4.9 (group 2) and 5.0-9.9 (group 3) mIU/mL, according to the VITROS ECi anti-HBs assay. DESIGN Subanalysis of randomized clinical trial. Response was defined as a postchallenge anti-HBs level of at least 10 mIU/mL and 4-fold rise in anti-HBs level 2 weeks after a single challenge dose of 10 vs 20 µg Engerix-B. Baseline was defined as the anti-HBs level immediately before administration of the challenge dose. SETTING Pediatric integrated healthcare system near Houston, Texas. PARTICIPANTS Three hundred nineteen US-born 16-19-year-olds who completed the hepatitis B vaccine series during the first year of life. RESULTS One hundred seventy-eight persons had zero (group 1) and 141 (114 group 2 and 27 group 3) had non-zero anti-HBs levels at baseline. Response to the challenge dose was significantly higher among those with non-zero vs zero anti-HBs levels, irrespective of challenge dosage; only 1 person with a non-zero anti-HBs level failed to respond to the challenge dose (group 3, 27/27 [100%] vs group 2, 113/114 [99%] vs group 1, 145/178 [82%]; P<.0001). CONCLUSIONS Among participants with residual anti-HBs levels less than 10 mIU/mL 16-19 years after primary hepatitis B vaccination during infancy, non-zero anti-HBs levels, with rare exception, indicated persistence of immune memory to HBsAg. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01341275
Collapse
|
|
42
|
Arístegui Fernández J, Díez-Domingo J, Marés Bermúdez J, Martinón Torres F. [Vaccination against hepatitis B. Impact of vaccination programmes after 20 years of use in Spain. Is it time for a change?]. Enferm Infecc Microbiol Clin 2015; 33:113-8. [PMID: 25620127 DOI: 10.1016/j.eimc.2014.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 12/11/2022]
Abstract
The highest incidence rate of hepatitis B (HB) in Spain is detected in adults between 20 and 54 years old, whereas the incidence in children under 1 year old is almost nil. The low prevalence of HB in children under 1 year is mainly due to the success of gestational screening strategies for the detection of HBsAg(+) in pregnant women, and vaccination campaigns during childhood. Currently, in Spain, the last dose of the HB included in the national childhood immunization program is administered at 6 months of age, although some studies show that delaying the age of the administration of the last dose of HB vaccine and increasing the time between doses, may improve immune memory by offering greater protection against this virus in the adulthood. In this article, the impact of HB vaccination in Spain is reviewed, and other potential vaccination strategies in our environment are discussed, such as extending the interval between doses, and administering the last dose in the second year of life, adapting the valid strategy in Spain to the current epidemiological context in order to reduce the prevalence of HB in adulthood.
Collapse
Affiliation(s)
- Javier Arístegui Fernández
- Departamento de Pediatría, Hospital Universitario Basurto. Universidad del País Vasco (UPV/EHU), Bilbao, España.
| | - Javier Díez-Domingo
- Director Científico de FISABIO-Salud Pública, Conselleria de Sanitat de Valencia, Valencia, España
| | | | - Federico Martinón Torres
- Servicio de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| |
Collapse
|
|
43
|
Chang YC, Wang JH, Chen YS, Lin JS, Cheng CF, Chu CH. Hepatitis B virus vaccination booster does not provide additional protection in adolescents: a cross-sectional school-based study. BMC Public Health 2014; 14:991. [PMID: 25248369 PMCID: PMC4246462 DOI: 10.1186/1471-2458-14-991] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 09/18/2014] [Indexed: 01/05/2023] Open
Abstract
Background Current consensus does not support the use of a universal booster of hepatitis B virus (HBV) vaccine because there is an anamnestic response in almost all children 15 years after universal infant HBV vaccination. We aimed to provide a booster strategy among adolescents as a result of their changes in lifestyle and sexual activity. Methods This study comprised a series of cross-sectional serological surveys of HBV markers in four age groups between 2004 and 2012. The seropositivity rates of hepatitis B surface antigen (HBsAg) and its reciprocal antibody (anti-HBs) for each age group were collected. There were two parts to this study; age-specific HBV seroepidemiology and subgroup analysis, including effects of different vaccine types, booster response for immunogenicity at 15 years of age, and longitudinal follow-up to identify possible additional protection by HBV booster. Results Within the study period, data on serum anti-HBs and HBsAg in a total of 6950 students from four age groups were collected. The overall anti-HBs and HBsAg seropositivity rates were 44.3% and 1.2%, respectively. The anti-HBs seropositivity rate in the plasma-derived subgroup was significantly higher in both 15- and 18-year age groups. Overall response rate in the double-seronegative recipients at 15 years of age was 92.5% at 6 weeks following one recombinant HBV booster dose. Among the 24 recipients showing anti-HBs seroconversion at 6 weeks after booster, seven subjects (29.2%) had lost their anti-HBs seropositivity again within 3 years. Increased seropositivity rates and titers of anti-HBs did not provide additional protective effects among subjects comprehensively vaccinated against HBV in infancy. Conclusions HBV booster strategy at 15 years of age was the main contributor to the unique age-related phenomenon of anti-HBs seropositivity rate and titer. No increase in HBsAg seropositivity rates within different age groups was observed. Vaccination with plasma-derived HBV vaccines in infancy provided higher anti-HBs seropositivity at 15–18 years of age. Overall booster response rate was 92.5% and indicated that intact immunogenicity persisted at least 15 years after primary HBV vaccination in infancy. Booster vaccination of HBV did not confer additional protection against HBsAg carriage in our study.
Collapse
Affiliation(s)
| | | | | | | | | | - Chia-Hsiang Chu
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
| |
Collapse
|