Doses Of Hepatitis B Virus Vaccine Research Articles

Evaluation of antibody persistence after a four-dose primary hepatitis B vaccination and anamnestic immune response in children under 6 years.

Introduction. Tunisia is an intermediate hepatitis B virus (HBV) endemic country. The vaccination against hepatitis B was introduced in 1995 including four doses with a first dose administrated at birth. Decreasing the level of antibodies against hepatitis B surface antigen (anti-HBs) over time can be alarming. This study was conducted to explore the anti-HBV immune response among children under 6 years old, vaccinated according to the national vaccination schedule, by evaluating the immunological response to primary vaccination and by exploring the anamnestic immune response to a booster dose.Methods. We conducted a cross-sectional prospective study from June 2016 to June 2017 (n=180), based on voluntary participation. Children were recruited from the public pediatric ward sectors in Sahloul University Hospital of Sousse in Central Tunisia. An anti-HB titre was determined based on electro-chemiluminescence micro-particle immunoassay (ECLIA), using Elecsys Anti-HBs II kit, Roche.Results. Mean age at the time of enrollment in the study was 33±14.8 months. The seroprotection rate was 77.2 %. The anti-HB titre differed significantly between the different age groups (P=0.002). The predicting variable for having no seroprotective antibody level was older age. Children with anti-HB levels <10 IU l- 1 were offered an additional dose of HBV vaccine. Anamnestic response 1 month after the challenge dose was observed in 100 % of subjects. The probability of developing a high antibody response, following the booster dose increased in conjunction with an increased pre-booster antibody level.Conclusion. The response to a booster dose suggests the persistence of immune memory in almost all vaccinated individuals. Although a booster dose increases substantially anti-HB titre, the clinical relevance of such an increase remains unknown.

Prevention and care of hepatitis B in the rural region of Fatick in Senegal: a healthcare workers\u2019 perspective using a mixed methods approach

BackgroundIn countries where hepatitis B virus (HBV) is endemic, including Senegal, the World Health Organization recommends systematic HBV screening of pregnant women and vaccination at birth to prevent mother-to-child transmission (MTCT). This study investigated healthcare workers’ (HCW) knowledge and practices regarding HBV prevention and care in the rural region of Fatick in Senegal, as well as challenges they faced in implementing prevention activities related to HBV MTCT.MethodsA mixed-methods survey was conducted between May–July 2017 among 112 HCW working in 15 healthcare facilities in two districts of the Fatick region using face-to-face questionnaires and semi-structured interviews. Descriptive statistics and chi-square/Mann-Whitney tests were used to analyze quantitative data, while qualitative data were analyzed thematically.ResultsThe study population included 87 HCW in the quantitative component (83% women, median age [interquartile range, IQR] = 35 [31–40] years) and 11 in the qualitative component. A knowledge gap was observed in key areas of HBV infection: only 24, 51 and 38%, respectively, correctly reported that early HBV acquisition is associated with a high risk of developing chronic infection, that perinatal transmission is one of the main modes of HBV transmission in Senegal, and that three to four doses of HBV vaccine are required to ensure immunization in children. Despite good acceptability of systematic screening of pregnant women and vaccination at birth, only 48% of HCW mainly involved in prenatal care and 71% of those involved exclusively in vaccination routinely performed these two key interventions. HCW reported several structural barriers that may hinder their implementation: a lack of training in HBV and in counseling, poor availability of rapid diagnostic tests (RDT), high costs of both screening and treatment, a lack of adequate information on treatment options and missed opportunities for vaccination at birth.ConclusionsHCW working in the Fatick region may be insufficiently trained and supported to effectively implement HBV prevention strategies. Our findings suggest an urgent need to strengthen MTCT prevention in this region, by improving HCW knowledge in key areas of HBV infection, providing RDT and antiviral treatment at low cost, and enhancing community-based interventions for the timely vaccination of newborns.

Serological Changes against Hepatitis B Surface Antigen in Children and Adolescents Receiving Chemotherapy for Acute Leukemia.

BackgroundVaccination for hepatitis B virus (HBV) after chemotherapy among pediatric patients with acute Leukemia is still a debated issue. We investigated HBV immunity before and after chemotherapy and assessed immune response to re-vaccination after chemotherapy.MethodsWe retrospectively analyzed data of children and adolescents aged <19 years requested for vaccination after chemotherapy for acute leukemia to evaluate hepatitis B surface antibody (HBsAb) status before and after chemotherapy and to identify factors related to HBsAb positivity after chemotherapy.ResultsOf 89 enrolled patients, 61 (68.5%) with acute leukemia were HBsAb positive before chemotherapy. Of these 61 patients, 48 (78.7%) seroconverted to HBsAb negative status after chemotherapy; there were 76 (85.4%) HBsAb negative patients after chemotherapy. HBsAb positive patients when compared to HBsAb negative patients after chemotherapy had a significantly higher HBsAb positive rate (100.0% vs. 63.2%, p=0.008) before chemotherapy. Following HBsAb testing after one dose of the HBV vaccination, 33 (43.4%) of the 76 HBsAb negative patients seroconverted to an HBsAb positive status. HBsAb positive patients after a single dose of HBV vaccination had a significantly higher HBsAb positive rate at the time of diagnosis compared to HBsAb negative patients (84.8% vs. 48.8%, p=0.001).ConclusionsBased on these results, HBV re-vaccination after chemotherapy is recommended for all children and adolescents with acute leukemia. In addition, further investigation is required to improve the immunogenicity of HBV re-vaccination.

The effects of message framing and healthcare provider recommendation on adult hepatitis B vaccination: A randomized controlled trial

Many adults in the U.S. do not receive recommended vaccines, and the research literature remains inconclusive on the best communication strategies for increasing this behavior. This study examined the association of message framing (gained-framed vs. loss-framed vs. control), and healthcare provider (HCP) recommendation (offered vs. recommended) on uptake of adult hepatitis B virus (HBV) vaccination in a high risk population using a 3 × 2 block design randomized controlled trial. Fear of shots, fear of vaccines, and perceived message framing were examined in secondary analyses. Of the 1747 participants, 47.7% (n = 833) received 0 doses of HBV vaccine, 27.8% (n = 485) received 1 dose, 10.4% received 2 doses, and 14.1% received all 3 recommended doses. There was not a significant interaction between message framing and HCP recommendation (p = .59). Mean number of doses received by the gain-framed group (m = 0.96) was not significantly different from the loss-framed group (m = 0.97, RR = 0.99, 95% CI = 0.88–1.12). However, those receiving any framing message received significantly more doses (m = 0.96) than those in the control condition (m = 0.81, RR = 1.17, 95%CI = 1.06–1.31). Participants who received a HCP recommendation received significantly more vaccine doses (m = 0.95) than those in the vaccine-offered condition (mean = 0.82, RR = 1.16, 95%CI = 1.05–1.28). These results suggest there is no difference in vaccine uptake between gain-frame and loss-frame messages, but both are better than a control message. These results also support advising HCP to provide a strong recommendation for vaccinations beyond merely offering it to patients. This study has implications for vaccine uptake beyond HBV, and can inform future research on effective vaccine communication research.Clinicaltrials.gov Identifier: NCT00739752. Registration date: August 20, 2008.

Hepatitis B vaccination in Burkina Faso: prevalence of HBsAg carriage and immune response in children in the western region.

Hepatitis B virus (HBV) infection remains a major health problem in Burkina Faso. To control and prevent HBV infection, Hepatitis B vaccine was introduced in the national expanded program in 2006. In this study, we evaluated the prevalence of HBsAg in children aged under 10 years after one decade of universal hepatitis B vaccination, and the immune response among these children. Between May and October 2015, a cross-sectional study was conducted among children in two primary healthcare centers in the western region of Burkina Faso. Participants were enrolled in Accart-Ville Healthcare Center in Bobo-Dioulasso (urban area) and the Healthcare Center of the village of Djigouera (rural area). Blood samples were collected from all children and analysed for the presence of HBsAg and anti-HBs antibodies (Abs). For HBsAg positive children, blood samples were also taken among their mothers for screening for HBsAg. A total of 265 children were included in this study. The mean age was 4.4 years. HBsAg was found in 3.4% (9/265) of children. Of the 9 HBsAg positive children, 5 had HBsAg positive mothers. From the 265 children tested for quantification of anti-HBs Ab titer, 219 (82.6%) were fully vaccinated and 135 (61.6%) of them had an anti-HBs ≥ 10 mIU/mL. Despite a good vaccination coverage (82.6%), a considerable proportion of vaccinated children remains unprotected from HBV infection. That emphasizes the need for further strengthening of the vaccination program through implementing the birth dose of HBV vaccine as recommended by WHO.

2486. The Effectiveness of High-Dose Hepatitis B Vaccination in Patients Receiving Immunomodulatory Therapy

BackgroundThe course of hepatitis B virus (HBV) infection is more severe in patients using immunomodulatory drugs (ID) than in the normal population. This study evaluates the results of double-dose administration of HBV vaccine of 40 μg at months 0, 1, 2, and 6.MethodsAnti-HBs negative patients presenting to our polyclinic between January 1 and July 1, 2017 and using ID were administered a double dose of HBV vaccine at months 0, 1, 2, and 6. Patients’ primary diseases and comorbid factors were recorded. Anti-HBs titers above 10 mIU/mL 1 month after completion of vaccination schedules were regarded as response to vaccine.ResultsEighty patients presented during the study. Seventeen patients failing to attend follow-ups were excluded. Twenty-eight (44.4%) of the 63 patients enrolled were men and 35(55.6%) were women. Patients’ ages ranged between 18 and 66, with a mean age of 44.2 (±12.2) and a median value of 46. Comorbid factors were essential hypertension in 5 patients, diabetes mellitus in 4, and hypothyroid in 3. Vaccination was started within 2 weeks before commencement of ID or simultaneously with a biological agent in 29(46%) patients, and anti-HBs titers above 10 mIU/mL were achieved in 24 (82.8%). Thirty-four (54%) patients were started on vaccination while using medication [mean 21.1(±27.7) months], and anti-HBs titers above 10 mIU/mL were achieved in 29. Response was achieved in 53(84.1%) of all the patients in the study, while no response was obtained in 10 (15.9%). No gender difference was observed between the responding and non-responding patients. Response to vaccine was independent of sex, comorbid diseases, immunosuppressive agents, and time of commencement of vaccination (Table 1).ConclusionIn our study, anti-HBs positivity was achieved in 84.1% of patients receiving doses of 40 μg. Although the ideal situation is for patients to start receiving vaccination at least 2 weeks before starting ID, vaccination in the shortest time possible after commencement of treatment is recommended for previously unvaccinated patients. In conclusion, physicians need not be concerned that response to vaccination cannot be achieved in patients started on ID, and seronegative patients must be enrolled in the HBV vaccination program as quickly as possible. Disclosures All authors: No reported disclosures.

Long-term antibody persistence against hepatitis B in adolescents 14–15-years of age vaccinated with 4 doses of hexavalent DTPa-HBV-IPV/Hib vaccine in infancy

ABSTRACTWe evaluated antibody persistence against hepatitis B virus (HBV) in adolescents previously vaccinated with a hexavalent diphtheria-tetanus-acellular pertussis-HBV-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine (DTPa-HBV-IPV/Hib), as part of the national newborn immunization program in Germany. We also assessed the anamnestic response to a challenge dose of a monovalent HBV vaccine. In this phase 4, open-label, non-randomized study (NCT02798952), 302 adolescents aged 14–15 years, primed in their first 2 years of life with 4 DTPa-HBV-IPV/Hib doses, received one challenge dose of monovalent HBV vaccine. Blood samples were taken before and one month post-vaccination and used to determine antibody levels against hepatitis B surface antigen (HBs). Reactogenicity and safety were also assessed post-challenge dose. Pre-challenge dose, 53.7% of 268 participants included in the according-to-protocol cohort for immunogenicity had anti-HBs antibody concentrations ≥10 mIU/mL (seroprotection cut-off) and 16.8% had anti-HBs antibody concentrations ≥100 mIU/mL. One month post-challenge dose, 93.3% of adolescents had anti-HBs antibody concentrations ≥10 mIU/mL and 87.3% had antibody concentrations ≥100 mIU/mL. An anamnestic response was mounted in 92.5% of adolescents. Injection site pain (in 33.6% of participants) and fatigue (30.2%) were the most frequently reported solicited local and general symptoms, respectively. Six of the 55 unsolicited adverse events reported were considered vaccination-related. Two vaccination-unrelated serious adverse events were reported during the study. Long-term antibody persistence against hepatitis B was observed in 14–15 years old adolescents previously primed in infancy with DTPa-HBV-IPV/Hib. A challenge dose of monovalent HBV vaccine induced strong anamnestic response, with no safety concerns.

Hepatitis B Virus Vaccination in HIV: Immunogenicity and Persistence of Seroprotection up to 7 Years Following a Primary Immunization Course.

Vaccination against hepatitis B virus (HBV) is recommended in people living with HIV (PLHIV), although immune response rates are lower than in healthy individuals. We aimed at assessing response rates and predictors as well as persistence of seroprotection in a cohort of PLHIV with no serological evidence of current or previous HBV infection. PLHIV followed at our site were retrospectively included if they started a primary HBV vaccination course (20 mcg three-dose schedule, alone or combined with inactivated hepatitis A virus) between 2007 and 2012. Serological response was defined as hepatitis B surface antibodies (HBsAb) ≥10 IU/liter 4 to 24 weeks after the third vaccine dose. Among 134 patients included, 119 completed the primary HBV vaccination schedule. Of them, 68% developed serological response. HIV viral suppression was associated with HBsAb ≥10 IU/liter [adjustedOR (odds ratio) 0.52, 95% confidence interval (CI) 0.33-0.82, p = .005], whereas CD4-T cell count was not (adjustedOR 1.001, 95% CI 1.001-1.003, p = .1). HBsAb titer declined over time, since 69.3% and 26.9% of vaccinees had HBsAb ≥10 IU/liter 36 and 84 months after the third HBV vaccine dose. Time-updated CD4-T cell count was associated with persistence of seroprotection [adjustedHR (hazard ratio) 1.17, 95% CI 1.06-1.30, p = .003], independently from quantitative HBV surface antigen titer achieved at the end of the primary vaccination schedule (HR 1.02, 95% CI 0.96-1.08, p = .64). The longer the time interval from vaccination, the higher the risk of loss of seroprotection. Repeating HBsAb titer 5 years after a successful HBV vaccination may be used to guide booster vaccination, as the majority of subjects may no longer have seroprotective HbsAb titers.

Public Health Response to Hepatitis B Exposure

In 2015, an estimated 257 million people were living with chronic hepatitis B virus (HBV) globally, with estimates in the United States as high as 2.2 million.1–3 Only 25% of infected individuals in the United States are aware of their HBV infection, and less than 10% are able to access care and tre

Anti-Hepatitis B Antibody status in children with coeliac disease

Objective: This study aimed to compare the antibodies response to hepatitis B virus (HBV) vaccine between Libyan children with coeliac disease (CD) and healthy control. Subjects and Methods: A total of 66 children with CD on a gluten-free diet (GFD) and 31 randomly allocated healthy children who received HBV vaccination according to the standard immunization schedule were included. Hepatitis B virus surface antigen (HBsAg) and the production of specific anti-HBs antibodies were evaluated in all patients and control participants using standard techniques. Patients with &lt;10 IU/L anti-HBs antibodies were considered nonresponses to the vaccination. Results: None of the participants were HBsAg reactive. Forty-one of the 66 patients (62%) were female, and 25 (37.8%) were male. The mean age of the CD patients was 8.2 years (range, 22 months-15 years). Anti-HBs titers were positive in 40 (60.6%) patients and negative in 26 (39.3%) patients, whereas they were positive in 19 (61.2%) of the children in the control group and negative in 12 (38.7%).There was no significant difference in response to vaccine between the two groups (P = 0.83), the study revealed a statistically significant relation between negative anti-HBs titers and duration from the last dose of HBV vaccine (P = 0.004). Conclusion: In the present study, the response rate in Libyan children with CD on GFD was not different from healthy control. However, not all children need booster dose; only nonresponders need an intradermal test-booster dose to reassess the state of their memory cell before considering revaccination.

Serological responses to revaccination against HBV in HIV‐positive patients born in the era of nationwide neonatal HBV vaccination

Serological responses to revaccination against hepatitis B virus (HBV) are unclear in HIV-positive adults who had undergone neonatal HBV vaccination and whose antibodies against HBV had waned in the era of combination antiretroviral therapy (cART). Between 2000 and 2017, 666 HIV-positive men who have sex with men (MSM) who were born after 1986, when nationwide neonatal HBV vaccination programme was implemented in Taiwan, were included for analyses. A serological response was defined when a hepatitis B surface antibody (anti-HBs) titre ≥10mIU/mL was measured 4-24weeks after the third dose of HBV vaccination. During the study period, 295 (48.7%) HIV-positive MSM (mean age, 23.2years) who had lost HBV seroprotection were eligible for revaccination; 171 (58.0%) received at least 1 dose (20-μg) of HBV vaccine and 116 (39.3%) completed the 3-dose schedule. The serological response rate to 3 doses of HBV revaccination was 74.0% and the rate of high-titre response (anti-HBs titre ≥100mIU/mL) was 46.0%. The CD4 count before the first dose (per 50-cell/μL increment, adjusted odds ratio, 1.14; 95% confidence interval, 1.01-1.29) was positively associated with the serological response. The incident rate of HBV infection was 9.2 per 1000person-years of follow-up among the patients who were non-responders after revaccination. Despite HBV vaccination in the neonatal period, the serological response rate to HBV revaccination in HIV-positive MSM was modest and could wane rapidly. Regular testing of anti-HBs should be integrated into the HIV care despite cART containing HBV-active agents.

Use of ELISpot assay to study HBs-specific B cell responses in vaccinated and HBV infected humans

Hepatitis B surface antibody (HBsAb) plays a critical role in protecting against infection of hepatitis B virus (HBV) and were extensively studied in literature. At the same time, the status of hepatitis B surface antigen (HBs)-specific B cells in both vaccinated and HBV infected people received limited attention. In the current study, we adopted a highly specific B-cell Enzyme Linked ImmunoSpot (ELISpot) assay to analyze HBs-specific B cells in various clinical settings: healthy individuals with the history of HBV vaccination before and after receiving an extra HBV vaccine boost, people chronically infected with HBV (CHB) in various clinical stages, with or without a particular type anti-viral treatment, or whether receiving a dose of HBV vaccine. In all of these cases, B-cell ELISpot assay was used effectively in enumerating the frequency of HBs-specific B cells. While the focus of the current report was to establish the utility of this assay for HBV research, a number of interesting observations were made in this pilot study based on the profiles and dynamics of HBs-specific B cells in various conditions. Such information is useful to guide the future work in designing novel therapeutic strategies against CHB.

Call to Action: Prevention of Mother-to-Child Transmission of Hepatitis B in Africa.

Hepatitis B virus (HBV) is a significant public health issue that has not been adequately addressed, especially in the high-prevalence region of Africa. Despite the incorporation of HBV vaccines into the Expanded Program on Immunization, children continue to be infected with HBV through maternal-to-child transmission (MTCT). The addition of a birth dose of HBV vaccine would be a cost-effective method to reduce MTCT. Birth-dose HBV vaccine policies have been adopted in the Western Pacific region but not yet in Africa. Even better protection against HBV MTCT can be achieved by treatment of pregnant women with high HBV viral loads with tenofovir. Tenofovir is already widely used in prevention of HIV MTCT (PMTCT) programs. We suggest that existing HIV PMTCT programs could be expanded to deliver care for HBV-infected pregnant women. With appropriate adoption of birth-dose vaccination policies and expansion of PMTCT programs, elimination of HBV MTCT in Africa is achievable.

Vaccine Therapy in Chronic Hepatitis B Carriers: A Randomised Double-Blind Controlled Trial

Introduction: Chronic carriers of Hepatitis B Virus (HBV) are persistent sources of the virus and may transmit HBV to healthy individuals. Aim: This study was conducted to assess therapeutic effects of HBV vaccine on Chronic HBV Carriers (CHC). Methods and Materials: This clinical trial was conducted on CHCs aged 20-65 years, randomly allocated into four groups. Group 1 (control) did not receive vaccine. Group 2, 3 and 4 (vaccine groups) received different doses of HBV vaccine. HBV viral load (IU/mL) was assessed at baseline and two months after the last dose of HBV vaccine. Reduction or elimination of HBV viral load was considered as positive response. Absolute Response Rates (ARR) was calculated for each group. Subgroup analysis was done on subjects with baseline viral load of <100,000 and negative HBeAb. Relative Response Rates (RRR) was defined as ARR in vaccine group divided by that of control. RRRs were calculated for total participants (overall RRR) and the above-mentioned subgroup of subjects (subgroup RRR). Results: In total, 97 CHCs were recruited. No adverse reaction was reported. There was no significant difference in ARRs between study groups (p-value=0.09). An overall RRR of 0.78 and a subgroup RRR of 1.18 has been reported. A 50 increase was found in the RRR in subgroups of subjects with baseline viral load of <100,000 and negative HBeAb compared to the overall RRR. Conclusion: It may be worth future studies to assess the therapeutic effects of HBV vaccine. © 2018, Journal of Clinical and Diagnostic Research. All rights reserved.

The Impact of Hepatitis B Vaccine Failure on Long-term Natural Course of Chronic Hepatitis B Virus Infection in Hepatitis B e Antigen-Seropositive Children.

Vaccine failure with chronic hepatitis B virus (HBV) infection still develops in children after universal hepatitis B immunization. This study aimed to investigate the natural course of chronic HBV infection in children with vaccine failure and compare it with that of nonvaccinated children. Three hundred fifty-six hepatitis B e antigen (HBeAg)-seropositive, hepatitis B surface antigen (HBsAg) carrier children, who were followed for at least 1 year without antiviral therapy, were enrolled. These comprised 105 vaccine failure subjects who received 3 doses of HBV vaccine in infancy and 251 nonvaccinated subjects. The clinical, serologic, and virologic features were compared between the 2 groups. The cumulative HBeAg seroconversion rate was significantly lower in the vaccine failure group than in the nonvaccinated group (30.5% vs 77.7%, P < .0001). Genotype C HBV infection was more frequent in the vaccine failure group (33.7% vs 13.4%, P < .0001), and the maternal HBsAg-positive rate was higher (97.1% vs 66.4%, P < .0001). In a multivariate analysis, vaccine failure, genotype C infection, and maternal HBsAg positivity were significantly associated with delayed HBeAg seroconversion. HBeAg-seropositive vaccine failure HBV-carrier children were associated with delayed HBeAg seroconversion during long-term follow-up, and more HBV genotype C infection and maternal HBsAg seropositivity.

Possible Impact of 190G > A CCR2 and Δ32 CCR5 Mutations on Decrease of the HBV Vaccine Immunogenicity-A Preliminary Report.

Background: Chemokine genetic variations are involved in infectious diseases such as hepatitis B virus (HBV). Several allelic variants might, in theory, affect the outcome of vaccination. Objectives: This study was carried out to examine the associations of Δ32 CCR5 and 190G > A CCR2 polymorphisms with a response to a primary course of three HBV vaccinations. Methods: Between December 2014 and December 2016, patients from three randomly selected primary care clinics in the West Pomeranian region (Poland), 1 month after receiving the third dose of HBV vaccine, were enrolled. Enzyme-linked immunosorbent assay (ELISA) system version 3.0 was used to detect anti-HBs and anti-HBc totals. The identification of polymorphisms were performed by a polymerase chain reaction technique using a single primer extension assay. Genotype distributions of responders versus non-responders to HBV vaccination were compared on the basis of anti-HBs level. Results: In 149 patients (mean age 60 years) the mean anti-HBs level was 652.2 ± 425.9 mIU/mL (range: 0–1111.0 mIU/mL). There were 14.1% (n = 21) non-responders to the HBV vaccine (anti-HBs < 10.0 mIU/mL). The wild type/Δ32 genotype of CCR5 gene was found in 18.1% participants, and 1.3% were Δ32/Δ32 homozygotes. The frequency of allele A of the CCR2 gene was 11.1%. Lower anti-HBs levels in Δ32/Δ32 homozygotes were observed (Me = 61 mIU/mL vs. Me = 660.2 mIU/mL; p = 0.048). As age was found to be a correlate to the anti-HBs titer (r = −0.218, p = 0.0075; 95% CI: −0.366–−0.059)—an analysis of a co-variance was performed which found a statistically significant (p = 0.04) difference in anti-HBs titres between Δ32/Δ32 homozygotes and other CCR5 genotypes. The association between anti-HBs titres and CCR2 genotypes was not statistically significant. Conclusions: Our study—which is a preliminary report that suggest this topic deserves further observation with larger sample sizes, different ethnicities, and other single nucleotide poly-morphisms (SNPs)—suggests the possible involvement of CCR5 polymorphism in impairing the immunologic response to HBV vaccination, predominantly in relation to the passage of time.

Occurrence of Needlestick and Injuries among Health-care Workers of a Tertiary Care Teaching Hospital in North India.

Introduction:Occupational hazards such as accidental exposure to sharp, cuts, and splashes are common among health-care workers (HCWs).Aims and Objectives:To determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. The second aim was to know the baseline antibody levels against hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) immediately after these accidents.Methods:An observational prospective study was done in the HCWs of a tertiary care academic health organization of North India from January 2011 to December 2013. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline HBV, HCV, and HIV serum markers. The exposed HCWs were followed up and repeat testing was done after 3–4 weeks for seroconversion up to 6 months.Results:A total of 476 injuries were reported. Needlestick injury of fingers was the most common. Doctors were found to have the highest exposure rate (73.7%) distantly followed by nurses (19.1%). A significant number of the HCWs (125, 26.3%) vaccinated in past had hepatitis B surface antibody (anti-HBs) titers <10 mIU/mL (protection defined as anti-HBs level ≥10 mIU/ml). Only 44 sources were found to be seropositive (11 for HIV, 9 for HCV, and 24 for HBV). No seroconversion was seen in any of the exposed HCWs after 6 months.Conclusions:The incidence of needlestick and sharp injuries is most often encountered in emergency wards. Anti-HBs titers were suboptimal in many of the HCWs requiring a booster dose of HBV vaccination.

Effects of Interleukin-4 and Interleukin-12b Gene Polymorphisms on Hepatitis B Virus Vaccination

Approximately 10% of individuals do not respond to hepatitis B virus (HBV) vaccination, i.e. non-responders (NRs). We aimed to investigate the association of interleukin (IL)-4 and IL-12B gene polymorphisms with responsiveness to the HBV vaccine in Korean infants. Among 300 healthy infants (9-12 month), SNPs for the IL-4 gene (rs2243250, rs2070874, and rs2227284) and for the IL-12B gene (rs3213094 and rs17860508) were compared between subgroups in terms of the response to HBV vaccination. The percentages of NRs (< 10 mIU/mL), low-titer responders (LRs, 10-100 mIU/mL), and high-titer responders (HRs, ≥ 100 mIU/mL) were 20.3%, 37.7% and 42.0%, respectively. No SNPs differed in frequency between NRs and responders or between LRs and HRs. We divided the subjects into two groups according to the time interval from the 3rd dose of HBV vaccination to Ab quantification: > 6 months from the 3rd dose (n = 87) and ≤ 6 months from the 3rd dose (n = 213). In the ≤ 6 month subjects, rs2243250C and rs2227284G were significantly frequent in the lower-titer individuals (NRs + LR) than HRs (40.1 vs. 25.9%, p = 0.014 and 45.1 vs. 33.0%, p = 0.018, respectively), and the rs2243250C and rs2227284G frequencies were significantly different among the three subgroups (13.2 vs. 26.9 vs. 25.9%, p = 0.040 and 15.5 vs. 29.6 vs. 33.0%, p = 0.038, respectively). In conclusion, those results suggest that IL-4 gene polymorphisms may play a role in the response to the HBV vaccine in Korean infants.

Efficacy of Hepatitis B Virus Vaccination and Antibody Response to Reactivation Dose Among Adult Non-Responders to Primary Hepatitis B Vaccination in Chronic Hepatitis C Egyptian Patients

BACKGROUND AND AIMS: Acute HBV infection in patients with chronic HCV-related liver disease is associated with a severe and often fulminant course of the disease. Additionally, HCV patients may be at a higher than an average risk of acquiring hepatitis B because of the similar routes of transmission of both viruses. HBV infection can be prevented by the administration of a safe and immunogenic vaccine. Insufficient immune response to hepatitis B virus (HBV) vaccine in patients with chronic hepatitis C virus is frequently encountered and anti-HBs levels may persist for a shorter time than among immune competent persons. The purpose of present study was to determine long-term persistence of anti-HBs among Egyptian patients with chronic hepatitis C infection. It also assesses the need and response to a subsequent challenge with vaccine booster doses. METHODS: 200 individuals were enrolled; (GI) 100 patients suffered from chronic HCV infection and 100 healthy individuals as a control (GII). Both groups were matched in regard to age and sex. Each individual received a standard 3-dose series of HBV vaccine; 20µg recombinant DNA vaccine of HBV(Euvax-B LG Life science, Korea) administered by IM injection into deltoid muscle at 0, 1, 6 months interval. HBs antibody titer was measured after 4 weeks. Suboptimal or Non-responders (anti-HBs titer < 10 IU/L) received a booster dose and reevaluated after 4 weeks; Suboptimal response of group I (42 patients) divided into 2 subgroups: GIa (21 patients), which received 40 µg(double dose) recombinant HBV vaccine and GIb (21 patients), received standard adult dose 20 µg HBV vaccine. 11 individuals with suboptimal response of G II received standard adult dose 20 µg HBV vaccine too. CONCLUSION: Chronic HCV patients showed lower response rate for standard doses of HBV vaccine especially with advancing age, diabetes and hypoalbuminemia. A double booster dose (40 μg) vaccine would be recommended for them which are better than revaccination with the standard 3 doses recombinant HBV vaccine.

Persistence of protective anti-HBs antibody levels and anamnestic response to HBV booster vaccination: A cross-sectional study among healthcare students 20 years following the universal immunization campaign in Italy

ABSTRACTVaccination against Hepatitis B Virus (HBV) became mandatory in Italy for all newborns and 12 years-old individuals in the 1991. The immunogenicity of HBV vaccine and the effectiveness of the universal immunization strategy have been widely demonstrated. However the need to assess the antibody concentrations above the well known serological correlate of protection for HBV infection (≥10 mIU/mL), established in individuals immunized with a 3 doses vaccination course, is still recommended in subjects exposed to occupational risks in different settings, particularly the healthcare services. This practice has to be performed during the preventive medical examination, before the worker's exposure to biological hazards, as a fundamental part of Occupational Health Surveillance Programs in several Countries, including Italy: the goal is to assure individual protection, also providing booster doses when needed, after many years following the primary vaccination. During the 2011–2013 period, an observational study was performed in Healthcare students (HCSs) trained at a regional university acute-care hospital in North-Western Italy, properly immunized against HBV during infancy or adolescence, in order to evaluate the persistence of seroprotection and to assess the anamnestic response to booster vaccination. Data from 717 subjects undergoing HbsAg Ab and HBc Ab testing during the preventive medical examination, and receiving a booster dose of HBV vaccine when resulting with a non-protective titer (<10 mIU/mL), were collected and analyzed. Most of the HCSs (74.6%) included in the survey, mean age 24.8 y ( ± 4.6 SD), had received the primary vaccination course during the first year of life (3–5–11 months). Globally, 507 (70.7%) HCSs showed protective antibody titres, and an anamnestic response was observed in more than 95% subjects receiving the booster dose. Our study demonstrated the long-term persistence of protection of HBV vaccine, more than 20 y following the primary immunization, in HCSs who are exposed to occupational health risk. The anamnestic response observed in non-seroprotected subjects who received the booster further confirms the capability of the HBV vaccine to create a strong immunological memory.