anti-HBs Titers Research Articles

Evaluation of hepatitis B virus antibodies in serum in vaccinated children at Tishreen University Hospital in Syria

Background: This study was done to evaluate the level of serum antibody titers in children vaccinated for HBV at Tishreen University Hospital, and to compare the titers of anti-HBs between the different age groups. This study also aimed to evaluate the relation between the infant feeding type and the response to the vaccine. Materials and Methods: A total of 170 children aged 1-12 years including 73 girls and 97 boys were gathered from pediatric department in Tishreen University Hospital. All the children in this study have undergone hepatitis B vaccine program according to the national standards (3 doses at 0, 1, 6 months after birth). The study sample was distributed into three groups according to age as follow: Group1 included children aging [1-4] years, Group2 included children aging [5-8] years, and Group3 included children aging [9-12] years. Plasma anti-HBs titers were measured. In the first age group, it was studied the response rate, and effects of both gender and infant feeding type on immune response to the vaccine. between response due to vaccination and that due to past infection. Results: Children who had a titer higher than 10 miu/mL were considered as responders. Our results revealed that the response rate was (81.1%). No significant difference was observed in antibody concentration between groups 1 and 2 (P=0.14). However, significant statistical difference was observed between groups 2 and 3 (P=0.0009), and between groups 1 and 3 (P=0.01). There was no signifi¬cant difference between girls and boys regarding the response rate (P = 0.65). On the other hand, the statistical analysis showed that there was no relation between the infant feeding type and the response rate. (P=0.96). Conclusion: The response rate to HBV vaccine in our study was 81.1%, which is less than the expected international rate (90-95%). Significant relation was observed between age and waning of antibody titer. However, no statistically significant difference was observed between type of infant feeding and response to HBV vaccine.

The Immune Response after Double Dose Hepatitis B Vaccination in Hemodialysis Patients: Influence of Age and Hepatitis C Virus

Objective: To determine the efficacy of Hepatitis B vaccination among the candidates of maintenance hemodialysis due to chronic kidney disease and to measure the impact of ageing and Hepatitis C infection upon immune seroconversion.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Nephrology Department, Multan Institute of Kidney Diseases (MIKD), Multan Pakistan from Jan to Jun 2020.
 Methodology: Two hundred male and female patients diagnosed with end-stage kidney disease on maintenance dialysis (more than three months) with the range of age, 15 to 70 years, were selected by non-probability consecutive sampling. Already treated patients of HB virus and those with HB virus detectable by ELISA were excluded from the study. Data was accessed through hospital management software records. Three months after the three or four completed doses, antiHBs titer was assessed by ELISA. Cut off the value of anti-Hbs titer was 10U/L to differentiate between responders and non-responders of HBV.
 Results: Among the 117 responders, 109 (93%) cases received four double doses of the vaccine, while only 8 (7%) were those who received three double doses. Among 83 non-responders, 52 (63%) were above age 40 years, while 31 (37%) were of age 40 years or below. In addition, among the non-responders, 63 (76%) were Hep C positive, while 20 (24%) were Hep C negative patients.
 Conclusions: Four double-dose vaccines have been effective for haemodialysis patients with end-stage kidney disease. Vaccine response is inversely correlated with age and Hepatitis C virus.

Post-vaccine immunity against hepatitis B in Moroccan children

Background: Hepatitis B is a major public health issue worldwide. Immunization of infants against this disease has been effective in Morocco since 1999. However, evaluation of post-vaccination response is rarely performed in our setting. The purpose of this study was to evaluate immunity against HBV in fully vaccinated children in the city of Marrakech in Morocco and to investigate the factors influencing the level of post-vaccination immunity. Methods: A descriptive cross-sectional study was conducted on fully vaccinated children who have medical and vaccination records, from three primary healthcare centers in Marrakech. Children with anti-HBs antibody levels between 10 and 100 IU/L were considered moderately immune, and those with antibody levels above 100 IU/L as highly immune, while those with antibody levels below 10 IU/L were considered non-immune. Results: Of the 123 children recruited, 114 (92.7%) had protective anti-HBs antibody titers, of which 37 (30%) were moderately immunized and 77 (62.7%) were highly immunized, and nine (7.3%) were non-immune. Age, birth weight, vaccine type, and time since the previous dose have all been significantly associated with the degree of post-vaccination immunity. Anti-HBs antibody levels were not significantly related to factors potentially linked to post-vaccination non-response, such as chronic disease, immunosuppressive medication and others. Conclusion: Our findings denote that the HBV vaccine used in The Moroccan Expanded Program on Immunization (EPI) is effective against HBV. Nevertheless, in non-responders, corrective actions such as re-vaccination and monitoring of post-vaccination anti-HBs antibody levels should be implemented.

Hepatitis B Surface Antibody (Anti-HBs) Kinetics during Rituximab Chemotherapy and Performance of Hepatitis B Vaccine before Immunosuppression: Two Prospective Studies.

Rituximab promotes strong immunosuppression leading to a high risk of hepatitis B reactivation (HBV-R) and chronic infection. Current recommendations on HBV-R prevention are expensive and poorly individualized. In resolved hepatitis B patients, previous studies suggest that anti-HBs titers before immunosuppression can predict HBV-R risk. However, guidelines claim that additional data are necessary before recommending spare drug prophylaxis in patients with high anti-HBs titers. On the other hand, in patients with no previous contact with HBV, guidelines recommend vaccine before immunosuppression despite minimal evidence available. To shed light on these knowledge gaps, two prospective studies were conducted to evaluate anti-HBs in hematological cancer patients treated with rituximab. In the first study, anti-HBs-positive patients were referred for following up antibody titers before and during immunosuppression. Patients with anti-HBs ≥ 100 mIU/mL before immunosuppression had no negative seroconversion (anti-HBs loss), in contrast to 18% of those with anti-HBs < 100 mIU/mL. In the second study, patients with no previous contact with HBV were invited to receive HBV vaccine before rituximab chemotherapy. None seroconverted with anti-HBs. In conclusion, both studies reinforce the need to review concepts about HBV prevention during immunosuppression on current guidelines. Narrowing the use of drug prophylaxis and improving vaccine indications are recommended.

Effectiveness of Hepatitis B Vaccination on Various Populations: A Systematic Review

Introduction: Hepatitis B vaccination is important to protect individuals from Hepatitis B virus (HBV) infection. The aim of this study was to conduct a systematic review of the necessity of Hepatitis B vaccination among humans, especially among infants, children, teenagers, adults, risk groups, and health care workers. Methods: Three databases were used in this study, Scopus, Web of Science, and PubMed. We reported the study using PRISMA-P guidelines. The keywords were used in this study (TITLE-ABS-KEY (vaccine) AND TITLE-ABS-KEY (hepatitis AND b) AND TITLE-ABS-KEY (boost)), and we obtained 275 articles. In the web of science, we used ((ALL=(vaccine)) AND ALL= (Hepatitis B)) AND ALL=(Boost), and we obtained 374 articles. In the PubMed, we used ((Vaccine [MeSH Terms]) AND (Hepatitis b [MeSH Terms])) AND (booster immunization [MeSH Terms]), and we obtained 417 articles. Results: There were 60 articles included in this systematic review. The systematic review results showed that infants, children, and teenagers, as well as adult groups who receive the hepatitis B vaccine, can protect for 5-30 years. Meanwhile, risk group and health care workers were suggested to obtain hepatitis B vaccine booster with low anti-HBsAg titer Conclusion: It needs to conduct anti-HBs Ag titer testing to decide whether they need a hepatitis B vaccination booster. Hepatitis B vaccine booster required for the group with anti-HBs Ag titer less than 10 mIU/mL.

The Changes In The AntiHBs Values Following COVID-19 Pneumonia

Background/aim: We aimed to determine if there is a decrease in antiHBS titer below the protective value during Coronavirus-19 disease (COVID-19). Materials and methods: A prospective study was made of 67 patients who had positive antiHbs values checked in the last 1 year. Demographic data and the previous antiHBs values were collected from the patient files and the laboratory findings of new antiHBs titers checked after one months later following COVID-19 infection were compared with the previous ones. Results: In the postcovid evaluation, a statistically significant decrease in the antiHBs levels of COVID-19 patients was determined with respect to previous values before COVID-19 infection (p&amp;lt;0,001). Conclusion: In our study, we found that there was a statistically significant decrease in AntiHBs levels after COVID-19 infection, but none of them were below protective antiHBs levels. As a result, we can say a booster vaccination against hepatitis B is not needed during or after COVID-19 infection, but it would be appropriate to support it with studies with a higher number of patients.

Persistence of hepatitis B surface antibody to hepatitis B vaccine among medical college students in Najran University, Saudi Arabia.

Around 257 to 291 million people worldwide are infected with the hepatitis B virus (HBV). Immunization is one of the most effective ways to combat HBV infection. Saudi Arabia implemented a mandatory hepatitis B immunization program in 1989. This project investigated the levels of hepatitis B surface antibodies (anti-HBs) among medical students in the college of applied medical science at Najran University in December 2020. Students (n=82) were tested for anti-HBs levels using a chemiluminescent microparticle immunoassay (CMIA). Anti-HBs levels were the main outcome measures. Results showed that about 81.7% of participants had an insufficient amount of Anti-HBs levels (<10 IU/ L) compared to 18.3 % of participants who had protective levels of anti-HBs (≥10 IU/ L). However, 78.5% of the reactive group was at risk of losing immunity with a level between 12 and 42 IU/ L. Our study also showed an association between the age and the level of anti-HBs. Moreover, male students were at more risk than female students. Our results showed a strong relationship between Blood Groups and Anti-HBs antibody levels. The O+ (with 38.8%) and A+ (with 25.4%) blood groups showed the highest percentage amongst participants who had inadequate protection of anti-HBs (<10 IU/ L). Thus, data helps in our understanding and observations on anti-HBV immunity in individuals twenty years after being vaccinated as a child. According to the findings of our study, a large majority of students had a non-protective anti-HBs titer.

Folic acid supplementation in pregnant women with hepatitis B surface antigen improves infant hepatitis B surface antibody mediated by infant IL-4.

Immunoprophylaxis has not completely eliminated hepatitis B virus (HBV) infection due to hyporesponsiveness to hepatitis B vaccine (HepB). We explored the impact of folic acid supplementation (FAS) in pregnant women with positive hepatitis B surface antigen (HBsAg) on their infant hepatitis B surface antibody (anti-HBs) and the mediation effect of infant interleukin-4 (IL-4). We recruited HBsAg-positive mothers and their neonates at baseline. Maternal FAS was obtained via a questionnaire, and neonatal anti-HBs and IL-4 were detected. Follow-up was performed at 11-13 months of age of infants, when anti-HBs and IL-4 were measured. We applied univariate and multivariate analyses. A mediation effect model was performed to explore the mediating role of IL-4. A total of 399 mother-neonate pairs were enrolled and 195 mother-infant pairs were eligible for this analysis. The infant anti-HBs geometric mean concentrations in the maternal FAS group were significnatly higher than those in the no-FAS group (383·8 mIU/ml, 95 % CI: 294·2 mIU/ml to 500·7 mIU/ml v. 217·0 mIU/ml, 95 % CI: 147·0 mIU/ml to 320·4 mIU/ml, z = -3·2, P = 0·001). Infants born to women who took folic acid (FA) within the first trimester were more likely to have high anti-HBs titres (adjusted β-value = 194·1, P = 0·003). The fold change in IL-4 from neonates to infants partially mediated the beneficial influence of maternal FAS on infant anti-HBs (24·7 % mediation effect) after adjusting for confounding factors. FAS during the first trimester to HBsAg-positive mothers could facilitate higher anti-HBs levels in infants aged 11-13 months partly by upregulating IL-4 in infants.

Presumed Protective Role for Anti-Hepatitis B Virus Antibodies Against COVID-19 Severe Cases: A Clinical Study Confirming in silico Hypothesis.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for COVID-19 disease which is known to have a broad clinical spectrum, from asymptomatic to critical presentation leading to death. Many researchers have investigated the factors impacting the course of the disease. Our previous in silico study suggested a possible protective effect of Hepatitis B, Tetanus and Measles vaccines against COVID-19. In continuity, we conducted a cross-sectional clinical study in order to confirm our in silico assumptions regarding the HBs-Ag antibodies.MethodsA representative sex- and age-matched sample of patients with confirmed COVID-19 was selected (n = 340). All clinical presentations were equally represented. Using an ELISA test, each patient benefited of a serology for the detection and measurement of the anti-HBs specific IgG antibodies. The obtained results allowed determining the different correlations between these antibody titers and the disease severity. The R® software and the MedCalc® software served to calculate the Spearman's coefficient of rank correlation (rho) for the obtained titers per severity group as well as the different other calculations and figure representations.ResultsA significant positive correlation was found with the anti-HBs titers (rho = 0.107; p = 0.04). High anti-HBs titers were significantly associated with the mild presentation of COVID-19. A significant difference was found between the obtained titers per severity class (chi-2 test, p = 0.03).Discussion/ConclusionOur findings demonstrated that anti-HBs titers were significantly higher for patients having mild COVID-19 presentations. We presume that being immunized against the HB may play a protective role in the course of the disease. Our study provided more key elements in understanding the disparity of the clinical spectrum among regions.

Immune Response against Hepatitis B Vaccine in Transfusion-Dependent Thalassemic Children Vaccinated in Early Infancy

Background and Objectives: Children with thalassemia are much more vulnerable to being infected by hepatitis B virus (HBV) through transfusion of blood and blood products. Although active immunization against HBV in early infancy is being conducted in Bangladesh by the inclusion of the hepatitis B vaccine (HepB) in the expanded programme on immunization schedule, these children might have altered immune response against HepB due to inevitable iron overload resulting from the disease thalassemia itself as well as repeated transfusion therapy and also from exposure to different allogeneic antigens. The present study was designed to determine the immune response of HepB among transfusion-dependent thalassemic children. Patients and Methods: This cross-sectional study was conducted at a university hospital in Bangladesh. A total of 45 transfusion-dependent thalassemic children were included according to inclusion and exclusion criteria. Data collection was conducted through a structured questionnaire after taking written informed consent from each participant's guardian. Each patient underwent a detailed history taking and antibody to hepatitis B surface antigen (anti-HBs) titer was estimated to see the immune response against HepB. Results: Collected data were analyzed using SPSS version 23. The mean age of the studied children was 9.03 ± 3.78 standard deviation with slight female predominance (51.1% female and 48.9% male). According to the level of anti-HBs titer, the majority (44.4%) had moderate protection, whereas others had no (28.9%) or strong (26.7%) protection. No significant association between the total number of transfusions (approximate), different age groups, and postvaccination interval with anti-HBs titer was observed (P &gt; 0.05). Conclusion: The present study observed an overall poor immune response against HepB as approximately only one-fourth of the study participants got strong protection against HBV. Assessment of anti-HBs titer followed by booster dose or revaccination if necessary is needed to be considered in transfusion-dependent thalassemic children vaccinated in early infancy.

Seroconversion among healthcare workers vaccinated with hepatitis B vaccine of RIMS Hospital, Imphal, Manipur

Hepatitis B, caused by hepatitis B virus (HBV) is a vaccine preventable disease. Health care workers are at high risk of HBV infection due to their exposure to infectious materials. Anti-hepatitis B surface antigen antibody (Anti HBs) titre of 10 IU/mL indicates protection.Aims: To determine the antibody titre among health care workers of RIMS Hospital, Imphal.Settings and Design: Cross-sectional studyMethods and Material: Blood samples were collected from 164 health care workers vaccinated with hepatitis B vaccine and anti HBs titre was estimated by ELISA.Statistical analysis used: Descriptive and inferential statistics. The quantitative variables were expressed as mean and standard deviation while categorical variables were expressed as percentage. Odds ratio was used for calculation of protective antibody titre. Association between antibody titres and time since vaccination was analysed using Pearson correlation.Results: Protective titre seen in 130(79.26%) participants while on-protective titre is seen in 34(20.73%) participants. While only 15.57% of fully vaccinated individuals have non-protective anti HBs titre, 40% of partially vaccinated HCWs do not have protective titre.Conclusions: Completion of a three-dose series of hepatitis B vaccine is important to achieve seroconversion. A second series of vaccine may be recommended for seroconversion failure after the first series of vaccine followed by re-testing of anti Hbs titre. Booster dose is not recommended for seroconverted individuals with low antibody titre.

Acute hepatitis B virus infection despite vaccination in a patient treated by infliximab: a case report

BackgroundDespite an effective vaccine, hepatitis B remains a major global health problem due to its significant morbidity and mortality. Vaccination in immunosuppressed patients such as those treated for an inflammatory bowel disease (IBD) can be less effective. This case describes an uncommon original diagnosis of an acute hepatitis B infection occurring in a vaccinated but immunocompromised IBD patient under long-term infliximab treatment. A low anti-HBs titer and the presence of HBsAg escape mutations are possible hypotheses to explain this unexpected infection.Case presentationA 28-year-old Caucasian male, regularly followed-up for a Crohn’s disease treated by infliximab, was regularly screened for sexually transmissible infections because of at-risk behaviors. Despite a correct immunization scheme against hepatitis B virus (HBV), an active HBV infection was diagnosed during one of those screenings. Retrospective testing of a sample collected 6 months earlier was in favor of an evolution from an acute hepatitis B toward a chronic hepatitis B. The patient has always had a low anti-HBs antibody levels (near the threshold of 10 IU/L) possibly explaining his infection. In addition, HBV sequencing revealed a genotype A2 HBV strain, carrying the sD144A substitution on the S protein, known as a potential immune escape variant. Dual therapy combining tenofovir disoproxil fumarate and emtricitabine, active against HBV but also efficient as an HIV pre-exposure prophylaxis, was initiated. Ten months after treatment initiation, all surrogate biochemical and virological endpoints for HBV functional cure were achieved. Treatment and periodical monitoring are being maintained.ConclusionEmphasis should be placed on HBV screening, vaccination and regular monitoring of patients under long-term immunosuppressive therapy, particularly those with at-risk behaviors.

Longitudinal mapping of hepatitis B vaccine-induced B-cell linear epitopes in healthy individuals.

The elimination of hepatitis B virus (HBV) infection is partially facilitated by the prophylactic HB vaccine. As the loss of seroprotection over time remains a conundrum for long-lasting protection, a comprehensive dynamic analysis of immunogenic targets of the HB vaccine will provide novel insights into the improvement and design of potential targets. In this study, 36 healthy subjects without prior history of hepatitis B infection and negative for hepatitis B surface antibody (anti-HBs) were enrolled. Participants were given a series of three doses of HB vaccine on a 0-, 1-, and 6-month schedule and longitudinally followed up. We systematically mapped 55 overlapping 15-mer peptides covering the small S protein of hepatitis B virus (SHBs) of vaccinees' serum samples at seven time points by performing an ELISA assay. Additionally, the frequencies and function dynamics of adaptive immune response were assessed by flow cytometry. We found that the SHBs peptide coverage presented an overall upward trend along with the vaccination progress, and the individual subpartition recognition was strongly correlated with the anti-HBs titers. Moreover, we identified one dominant epitope (S29) located on "a determinant region" associated with effective vaccine response. Besides, significant correlations between the proportion of plasmablasts and proliferating B cells and levels of anti-HBs were ascertained. Taken together, our data characterized the dynamics of HB vaccine-induced neutralizing antibodies against B-cell linear epitopes on SHBs and adaptive immune response, which will be constructive to develop the next-generation vaccine.

Anti-HBs persistence after primary vaccination with three doses of 5 μg recombinant hepatitis B vaccine among normal and high-responder infants: 10-year of follow-up

Objective: Assess the 10-year Immune persistence and the predictors after primary vaccination hepatitis B vaccine (HepB) among normal and high-responder infants. Methods: A total of 1 838 Infants of 7-12 months old located in Jinan, Weifang, Yantai and Weihai of Shandong Province who were induced normal or high antibody response (anti-HBs titer ≥ 100 mIU/ml) after primary vaccination (three dose with 0-1-6 procedure) with 5 μg recombinant HepB among newborns were included in the study, in 2009. 3 ml of venous blood samples were collected at baseline survey (T0) and antibodies against hepatitis B surface antigen (anti-HBs), antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were detected using chemiluminescence microparticle immunoassay (CMIA) method. A self-designed questionnaire was used to collect information including the infant's age, sex, birth weight, premature birth, birth number, delivery location and mother's HBV infection status. In 2014 (followed up for 5 years) and in 2019 (followed up for 10 years) (T1), 2 ml of venous blood samples were collected. Anti HBS and anti HBC were detected by CMIA method. Those with anti HBS<10 mIU/ml were detected by CMIA method. Multivariate unconditional logistic and linear regression models were used to analyze the influencing factors of anti-HBs positive rate and geometric mean concentration (GMC) at T1. Results: After 10 years follow-up, 73.94% of the subjects (1 359/1 835) finished the follow-up. 51.15% of the subjects, a total of 625 were boys. The positive rate of anti-HBs was 100% at T0 and decreased to 53.44% (95%CI: 50.59%-56.26%) at T1. The average annual decline rate of anti-HBs positive rate from T0 to T1 was 6.07%. The GMC of anti-HBs decreased from 607.89 (95%CI: 579.01-642.62) mIU/ml to 16.44 (95%CI: 15.06-18.00) mIU/ml. The average annual decline rate of anti-HBs GMC in 10-year follow-up was 30.30%. Multivariate logistic analysis showed that the positive rate of anti-HBs at T1 was lower in those who did not vaccinate the first dose in time (OR=0.25, 95%CI:0.07-0.71). Compared with those with GMC<1 000 mIU/ml at T0, those with GMC ≥ 1 000 mIU/ml had a higher positive rate of anti-HBs at T1 (OR=2.29, 95%CI:1.76-2.97). Multivariate regression analysis showed that the GMC of anti-HBs at T1 was lower in those who did not vaccinate the first dose in time (β=-0.50, 95%CI:-1.24-0.24). Compared with those with GMC<1 000 mIU/ml at T0, those with GMC ≥ 1 000 mIU/ml had a higher GMC of anti-HBs at T1 (β=0.81, 95%CI: 0.62-1.05). Conclusion: Anti-HBs GMC decreased in 10 years after primary vaccination of 5 μg recombinant hepatitis B vaccine among normal and high-responders. The anti-HBs persistence was mainly associated with whether the first dose was vaccinated in time and the level of anti-HBs at the end of primary vaccination.

Post-vaccination Immunity Against Hepatitis B Among Mongolian Adolescents and Youths

Background: Mongolia introduced vaccination against hepatitis B (HepB) in 1991, leading to a significant decline in the number of infections and mortality associated with the liver disease among this generation. However, the prevalence of hepatitis B virus (HBV) infection and mortality rates among people born before the vaccination program have not declined. Although several studies have been conducted in Mongolia since the introduction of the HepB immunization program, long-term immunity has not been studied at the national level. Objectives: This study aimed to determine the prevalence of HBV infection in adolescents and young adults who received HepB vaccinations at 0, 2, and 8 months after birth and to assess their post-vaccination immunity against hepatitis B. Methods: A population-based cross-sectional study was conducted between December 2016 and December 2018 and included a sample aged 10 to 27 years in Mongolia who had received HepB vaccination according to the national program. A total of 3591 individuals were randomly selected, and data were collected using a structured questionnaire. Blood samples were collected, and serum titers of hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc) were determined by a two-step sandwich chemiluminescent enzyme immunoassay. The age-specific geometric mean of anti-HBs was also estimated. Results: Overall, 98.3% of participants were vaccinated against HepB as infants, according to the interview. The majority had an inadequate anti-HBs titer, while 17.9% had an anti-HBs level of &gt; 10 mIU/mL, of whom 5.7% had immunity induced by HBV infection. Up to 4% of children aged 10 - 19 years and an average of 8% of young adults were serologically positive for HBsAg. The geometric mean anti-HBs titer declined with age, from an average of 40.4 mIU/mL in 10-year-old children to 14.1 IU/mL in 27-year-old adults (P &lt; 0.001). Conclusions: In Mongolia, a small proportion of the population aged 10 - 27 years is immune to HBV, and the geometric mean titer of anti-HBS tended to decrease with age. In order to attain long-term protection against HBV, booster vaccination in adulthood may be necessary.

POS1179 SYSTEMATIC LITERATURE REVIEW ON THE SCREENING AND PROPHYLAXIS OF CHRONIC AND OPPORTUNISTIC INFECTIONS

BackgroundOpportunistic and chronic infections can arise in the context of treatment used for Autoimmune Rheumatic Diseases (ARDs). Although it is recognized that screening procedures and prophylactic measures must be followed, clinical practice is largely heterogeneous, with relevant recommendations not currently developed or disparately located across the literature.ObjectivesTo conduct a systematic literature review (SLR) focusing on the screening and prophylaxis of opportunistic and chronic infections in ARDs. This is preparatory work done by members of the respective EULAR task force (TF).MethodsFollowing the EULAR standardised operating procedures, we conducted an SLR with the following 5 search domains; 1) Infection: infectious agents identifed by a scoping review and expert opinion (TF members), 2) Rheumatic Diseases: all ARDs, 3) Immunosuppression: all immunosuppressives/immunomodulators used in rheumatology, 4) Screening: general and specific (e.g mantoux test) terms, 5) Prophylaxis: general and specific (e.g trimethoprim) terms. Articles were retrieved having the terms from domains 1 AND 2 AND 3, plus terms from domains 4 OR 5. Databases searched: Pubmed, Embase, Cochrane. Exclusion criteria: post-operative infections, pediatric ARDs, not ARDs (e.g septic arthritis), not concerning screening or prophylaxis, Covid-19 studies, articles concerning vaccinations and non-Εnglish literature. Quality of studies included was assessed as follows: Newcastle Ottawa scale for non-randomized controlled trials (RCTs), RoB-Cochrane tool for RCTs, AMSTAR2 for SLRs.Results5641 studies were initially retrieved (Figure 1). After title and abstract screening and removal of duplicates, 568 full-text articles were assessed for eligibility. Finally, 293 articles were included in the SLR. Most studies were of medium quality. Reasons for exclusion are shown in Figure 1. Results categorized as per type of microbe, are as follows: For Tuberculosis; evidence suggests that tuberculin skin test (TST) is affected by treatment with glucocorticoids and conventional synthetic DMARDs (csDMARDs) and its performance is inferior to interferon gamma release assay (IGRA). Agreement between TST and IGRA is moderate to low. Conversion of TST/IGRA occurs in about 10-15% of patients treated with biologic DMARDs (bDMARDs). Various prophylactic schemes have been used for latent TB, including isoniazide for 9 months, rifampicin for 4 months, isoniazide/rifampicin for 3-4 months. For hepatitis B (HBV): there is evidence that risk of reactivation is increased in patients positive for hepatitis B surface antigen. These patients should be referred for HBV treatment. Patients who are positive for anti-HBcore antibodies, are at low risk for reactivation when treated with glucocorticoids, cDMARDs and bDMARDs but should be monitored periodically with liver function tests and HBV-viral load. Patients treated with rituximab display higher risk for HBV reactivation especially when anti-HBs titers are low. Risk for reactivation in hepatitis C RNA positive patients, treated with bDMARDs is low. However, all patients should be referred for antiviral treatment and monitored periodically. For pneumocystis jirovecii: prophylaxis with trimethoprim/sulfamethoxazole (alternatively with atovaquone or pentamidine) should be considered in patients treated with prednisolone: 15-30mg/day for more than 4 weeks. Few data exist for screening and prophylaxis from viruses like EBV, CMV and Varicella Zoster Virus. Expert opinion supports the screening of rare bugs like histoplasma and trypanosoma in patients considered to be at high risk (e.g living in endemic areas).Figure 1.SLR flowchartConclusionThe risk of chronic and opportunistic infections should be considered in all patients prior to treatment with immunosuppressives/immunomodulators. Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics. Collaboration between different disciplines is important.AcknowledgementsWe would like to thank all members of the EULAR Task Force for the screening and prophylaxis of chronic and opportunistic infections in Autoimmune Rheumatic Diseases.Disclosure of InterestsNone declared

Evaluation of a personalized, dose-sparing revaccination strategy in hepatitis B vaccine non-responders

ObjectivesThe detection of low levels of antibodies against HBsAg (anti-HBs) below 10 IU/L in non-responders after a primary hepatitis B vaccination, is associated with seroconversion after revaccination. We compared the diagnostic performance of four anti-HBs assays in non-responders in their ability to differentiate between absence or presence of low levels of anti-HBs and propose a revaccination strategy guided by anti-HBs titres. MethodsNon-responders were revaccinated with Fendrix 20 μg at 0, 1 and 2 months. Anti-HBs titres were determined by Abbott Architect, Diasorin Liaison, Roche Cobas and Siemens ADVIA Centaur. Inter-assay agreement was evaluated with Cohen’s Kappa (k) in baseline samples between zero-responders without detectable antibodies and poor-responders with detectable antibodies < 10 IU/L. Seroconversion rates and geometric mean titres were analysed at 0, 1 and 3 months. A titre-based strategy (one revaccination dose and anti-HBs measurement followed by two more revaccination doses if required) was compared with the standard revaccination series of 3 doses. Results57 participants were included in the analysis. k was ≥ 0.65 for all assays except ADVIA (k ≤ 0.41). After one revaccination dose all assays detected a mean seroconversion rate in zero-responders of 42.9%, compared to 85.1% in poor-responders. The difference between zero- and poor-responders in seroconversion rate per assay was significant (p < 0.05). After three revaccination doses the mean seroconversion rate was 88.2% in zero-responders and 98.5% in poor-responders (p > 0.286 per assay). A titre-based strategy reduced the amount of revaccinations by 17% compared with the standard. ConclusionsAll assays demonstrated a comparable difference in seroconversion rate between zero- and poor-responders after one revaccination dose. The revaccination strategy could be optimised by differentiation between zero- and poor-responders followed by a titre-guided schedule.

Seroprotection of Hepatitis B Vaccine in Dental Students Two Decades after Infant Immunization and the Possible Need for Revaccination.

This study aimed to assess hepatitis B surface antibody (anti-HBs) persistence among dental students two decades after infant vaccination and immune response after revaccination or booster dose in nonimmune groups. A cross-sectional study was performed using laboratory reports for anti-HBs performed to dental students at the Umm al-Qura University from 2016 to 2020. Reports were classified according to baseline antibody titer into group I (titer <10 mIU/mL), group II (titer 10 to <100 mIU/mL), and group III (titer ≥100 mIU/mL). The basal antibody titer of each group was correlated to student's gender and birth year and compared with postrevaccination or booster dose titer in groups I and II. Data of baseline and postrevaccination anti-HBs antibody titers were analyzed using Statistical Package for Social Science (SPSS). One-way ANOVA was used to compare between different means for antibody titers of students as well as baseline and postrevaccination antibody levels for nonimmune students with nonprotective antibody titers. Pairwise multiple comparison of the difference between baseline and postrevaccination anti-HBs antibody titers were done by post hoc Tukey's honestly significant difference (HSD) test. Chi-squared test was used for comparing between the frequencies. A p-Value of ≤0.05 was considered significant and p < 0.01 was considered highly significant. A significant percentage (73.6%) of students had antibody titer <10 mIU/mL, while only 4.8% had antibody titer ≥100 mIU/mL with nonsignificant difference between both genders (χ 2 =3.784, p = 0.151). A statistically nonsignificant difference was also found between the three categories of anti-HBs antibody titers among students with different birth dates (χ 2 = 13.817, p = 0.182). After revaccination of nonimmune students, 100% of them showed strongly protective antibody titers with mean of 842.88 to 844.58 mIU/mL. A highly significant difference was observed between the mean baseline and postrevaccination antibody titers in both genders, with a higher mean of post revaccination (p = 0.000). Two decades after infant immunization, a significant percentage of dental students failed to maintain the anti-HBs seroprotective titer. So titer measurement should be made compulsory before they begin their clinical training and revaccination or booster dose should be given to nonimmune students to maintain a high protection level.

Age-specific seroprotection after Hepatitis B virus vaccination among Korean American pediatric population in Queens, New York

ABSTRACT Hepatitis B Virus (HBV) infection is a major health issue among Asian Americans. The prevalence of chronic Hepatitis B infection in New York City is estimated to be 2.7% compared with .3% in the overall United States. The efficacy and long-term immunity of HBV vaccination in the Korean American pediatric population in Queens, NY, are not well explored. This study aimed to 1) determine the age-specific prevalence of anti-HBs seropositivity in the Korean American pediatric population and 2) assess biologic/demographic factors influencing immunologic response to HBV vaccine. We performed a retrospective chart review of patients registered to a pediatric health clinic located in Queens, NY, from October 2014 to October 2020. Out of 604 medical records of patients aged ≤18 years who received a completed series of HBV vaccines during infancy, we analyzed 91 medical records where HBV serology test (HBsAg and anti-HBs) results were available. Three out of 91 subjects were born to HBsAg-positive mothers. Eight out of 91 subjects were born in South Korea. Overall, 54.9% of subjects were anti-HBs-seropositive. The seropositive rate in the 15 to 18-years-old-age group (14.3%) was significantly lower than that in other age groups: < 1 year (100%) (p = .015), 1–4 years (52.6%) (p = .033), 5–9 years (63.3%) (p = .0034), and 10–14 years (64%) (p = .0063). The mean duration since vaccination in seropositive subjects was 96.5 ± 53.9 months, and that in seronegative subjects was 121.7 ± 64.2 months (p < .047). Gender, BMI, and foreign birth were not significant risk factors affecting the nonseroprotective status. The role of routine screening of anti-HB titers and booster vaccination in this endemic community needs to be further explored.

Retrospective Analysis of Hepatitis B and Hepatitis C Viruses and HIV Infections in Patients Presenting to the General Surgery Clinic and Evaluated Preoperatively

Aim: Hepatitis B(HBV), Hepatitis C(HCV) and HIV infections are important parenterally transmitted infections. The aim of this study is to determine the seroprevalence of HBsAg, anti-HBs, anti-HCV and anti-HIV in patients with preoperative preparation.&#x0D; Materials and MethodS: Anti-HBs, HBsAg, anti-HCV, anti-HIV tests with chemiluminescent enzyme immune-assay method in a total of 900 patients applied to the General Surgery Clinic and were evaluated preoperatively by Abbott Architect i1000 immunoassay analyzer (Abbott Diagnostics, Illinois, USA) operated according to the manufacturer's instructions. Anti-HBs titer above 10 IU/mL, serum optical density/”cut-off” control optical density (S/Co) ≥1 in HBsAg, anti HCV and anti-HIV tests were accepted as positive. HBV-DNA and HCV RNA tests were performed with real-time PCR method.&#x0D; Results: Anti-HBs test was found to be reactive in 34.11% and nonreactive in 65.89%. HBsAg positivity was 1.0% (9/900), and anti-HCV positivity was 0.33% (3/900). Anti-HIV positivity and HBsAg-anti-HCV association were not detected. Six patients with HBsAg positivity and one patient with anti-HCV positivity were found incidentally during preoperative examinations.&#x0D; Conclusion:As a result of these data, it can be concluded that cost-effective serological tests for HBV and HCV infections performed in the preoperative period are extremely important in the detection of asymptomatic patients. Preoperative screening is important in terms of early diagnosis of patients before complications such as cirrhosis and HCC develop, enabling treatment, as well as enabling healthcare professionals to increase infection control measures while intervening with infected patients, to be more careful in terms of percutaneous injuries, and to reduce the risk of transmission.