Abstract
In order to determine the frequency and timing of the loss of detectable antibody response to hepatitis B in children with hemophilia A and B following 1° immunization with hepatitis B vaccine, we conducted a retrospective study of patients with hemophilia followed regularly at Children's Hospital of Michigan comprehensive hemophilia center. Of 98 patients (pts) with hemophilia A (69 pts) and hemophilia B (29 pts), 16 pts (16%) acquired their antibody against hepatitis Bs antigen (HBsAg) following a natural infection. The remaining 82 pts (84%) received a complete 1° immunization series against hepatitis B with either the plasma derived or the recombinant vaccines. 80 of 82 became immunized following the 1° immunization series. 70 of 80 pts(87.5%) who became immune maintained detectable levels of antibody against HBV 1-14 years (median 5 yrs) following the complete 1° immunization series. 10/80 pts (12%) lost detectable antibody response to HBsAg 2-8 yrs (median 4 yrs), after having established humoral immune response. 2/82 pts (2.4%) never acquired detectable antibody against HBsAg following a complete 1° immunization series. All vaccines were administered into the anterolateral thigh muscle. Therefore, 12/82 pts (15%) either lost their acquired detectable antibody response or never seroconverted after the completion of the 1° immunization series as recommended by the Centers for Disease Control and Prevention (CDC). Of these 12 pts, only 1 pt is HIV positive and 6 pts are seropositive for hepatitis C antibody. 10/12 pts have been re-immunized and 6 of the 10 have shown positive antibody response to the booster vaccines. All pts who seroconverted following a natural infection maintained a detectable antibody response to HBsAg. Since HBs antibody levels fall over a period of time following immunization, sometimes to undetectable levels in pts with hemophilia, and since pts with hemophilia still remain at increased risk of acquiring hepatitis B infection, periodic screening of antibody titer against HBsAg should be part of the routine laboratory follow-up of pts with hemophilia, even after completion of 1° immunization series. Booster doses should then be given when appropriate.
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