Hepatitis A and B Seroimmunity in Vaccinated Children With Cirrhosis: Presidential Poster Award

Abstract

Introduction: Superinfection with vaccine-preventable virus like hepatitis A virus (HAV) or hepatitis B virus (HBV) in patients with cirrhosis may induce rapid decompensation. Cirrhotic patients achieve lower response to HBV vaccination compared to healthy adults. HAV antibody titer is lower in patients with decompensated cirrhosis versus compensated cirrhosis. Our study aims to assess the incidence of hepatitis B surface antibody (HBV S Ab) titer (Ab QN) < 10 IU/l and non-reactive hepatitis A antibody (HAV Ab) titer (Ab QL) in vaccinated children with cirrhosis. Methods: All children, between ages 6 months and 17 years, with biopsy proven cirrhosis or clinically evident portal hypertension (CEPH) as defined by Childhood Liver Disease Research Network, who have confirmed completion of 3 dose HBV vaccination series and/or 2 dose HAV vaccination series were prospectively enrolled in our study. Children with past or present medical history of HAV or HBV infection and children with non-cirrhotic causes of portal hypertension were excluded. Once enrolled, we reviewed their basic demographics, physical exam findings, endoscopic findings, and lab results including HAV Ab QL and HBV S Ab QN from EMR. Results: So far, we have enrolled 12 patients, 4 boys and 8 girls with a mean age of 9.33 years. Ten patients have underlying diagnosis of biliary atresia. Half of these patients have biopsy proven cirrhosis. Onethird of our patients have platelet level < 150 k/cumm and half of our patients have splenomegaly on physical exam. In our preliminary data, the incidence of HBV S Ab < 10 IU/l is 41.7% and the incidence of non-reactive HAV Ab is 16.7%. All children with HBV S Ab < 10 IU/l and non-reactive HAV Ab are older than 5 years of age. The incidence of HBV S Ab < 10 IU/l and non-reactive HAV Ab in children older than 5 years of age is 62.5% and 25% respectively. All children found to have non-reactive HAV Ab are African American. Low HBV S Ab were present in 50% of children with documented splenomegaly compared to 33% without splenomegaly. Similarly, 60% of children with thrombocytopenia had HBV S Ab < 10 IU/l. Conclusion: There is a high incidence of low immune reactivity to HBV and HAV vaccination in children with cirrhosis. This reactivity seems to be lost with increasing age of the patients. Low HBV S Ab and non-reactive HAV Ab are associated with age > 5 years and African American race.1052 Figure 1 No Caption available.