Abstract
BackgroundVaccination is the best way to protect children under 5 years from death or disability. Children with biliary atresia (BA), which is the most common pediatric cholestatic end-stage liver disease (PELD), are more vulnerable to infectious diseases. However, the vaccination coverage and factors modulating vaccine responses in children with BA are largely unknown.MethodsIn this study, 288 children (median age: 7 months) diagnosed with BA before liver transplantation were enrolled for the evaluation of vaccination status and the factors affecting the immune response to the hepatitis B (HBV) vaccine. Moreover, 49 BA children (median age: 4 months) were enrolled for flow cytometric analysis of CD4+ T cells and CD19+ B cell subsets and correlations with serum bile acid levels.ResultsGenerally, these children had very low routine vaccination rates for the meningococcal serogroup AC (Men AC) (41.2%), measles-mumps-rubella (MMR) (31.3%), poliomyelitis (Polio) (25.3%), hepatitis A (HAV) (25.0%), Japanese encephalitis (JE) (15.0%), diphtheria-tetanus-pertussis (DTP) (14.2%), meningococcal serogroup A (Men A) (13.5%) and varicella (VAR) (10.8%) vaccines, but not for the HBV (96.2%) and bacillus Calmette-Guérin (BCG) (84.7%) vaccines. Remarkably, 19.8% (57/288) of the patients had HBV infection. Out of 220 patients vaccinated for HBV, 113 (51.4%), 85 (38.6%) and 22 (10%) had one, two or three doses of the HBV vaccine, respectively. Furthermore, logistic regression analysis revealed that the bile acid level was an independent factor associated with poor HBV vaccine response (p = 0.03; OR = 0.394; 95% CI = 0.170-0.969). Immunophenotyping showed that bile acids were only negatively correlated with the CD19+CD27+IgG+ post-class-switched memory B cell ratio (p = 0.01).ConclusionThis study reveals the overall vaccination rates of routine vaccines in Chinese BA children are very low and the poor HBV vaccine responses are associated with bile acids, possibly via the inhibition of CD19+CD27+IgG+ post-class-switched memory B cell response.Clinical Trial Registration http://www.chictr.org.cn, identifier ChiCTR1800019165.
Highlights
Immunization is the most effective and economic way to prevent infection and disability and saves millions of children from death yearly [1, 2]
Logistic regression analysis revealed that the bile acid level was an independent factor associated with poor hepatitis B virus (HBV) vaccine response (p = 0.03; OR = 0.394; 95% CI = 0.170-0.969)
This study reveals the overall vaccination rates of routine vaccines in Chinese biliary atresia (BA) children are very low and the poor HBV vaccine responses are associated with bile acids, possibly via the inhibition of CD19+CD27+IgG+ post-class-switched memory B cell response
Summary
Immunization is the most effective and economic way to prevent infection and disability and saves millions of children from death yearly [1, 2]. It provides infants and young children protection against life-threatening infectious diseases such as influenza, polio, measles, meningitis and some cancers that may occur in adulthood [3,4,5,6,7,8]. Vaccination is the best protection against HBV infection in young children in China (≤5 years old) [14]. The vaccination coverage and factors modulating vaccine responses in children with BA are largely unknown
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