HBs Titer Research Articles

Evaluation of Anti-HBsAg Titres among the High-Risk Population of A Tertiary Care Hospital, Tamil Nadu, India

Health care workers (HCW) are a high-risk population for Hepatitis B infection. Hepatitis B vaccine which is 95% effective confers long-term protection and anti-HBs titre is a marker for protective immune response. Our objective was to assess the status of hepatitis B vaccination and to evaluate the anti-HBsAg titres among health care workers in a tertiary care hospital, Tamil Nadu. It was an observational study conducted among 610 Health care workers in a tertiary care teaching hospital from June to December 2018 after obtaining clearance from IEC. Workers were assessed for their HBV vaccination status and for their anti-HBsAg titre after getting informed consent. The antibody titres were measured using CLIA (chemiluminescent Immunoassay) supplied by Abbott diagnostics. The data was entered and analyzed using a Microsoft Excel sheet. In our study, 80.5% were fully vaccinated, 18.5% of them were defaulters which comprised the HCW with 2 doses and 1 dose of vaccine and 0.9% were not vaccinated. In the fully vaccinated group, 37% showed Anti HBs titres of 10-100 mIU/ml, 59.2% showed the titre of > 100 mIU/ml and 3.6% did not show the protective antibody titre (<10 mIU/ml ). The 3.6% who did not show protective antibody titre were given the booster dose of vaccine. Among those who received a booster dose, 61.1% responded with the titre of 10-100 mIU/ml and 22.2% responded with the titre of > 100 mIU/ ml and 16.6% did not respond even with the booster dose. In the defaulters 86.7% had titres < 10 mIU/ml , 9.7% had titres of 10 mIU/ml and 3.6% had titres > 10 mIU/ml. In the non vaccinated group all had titres < 10 mIU/ml. The present study emphasizes the importance of screening of anti-HBsAg titres to be made mandatory for all the health care workers along with HBV Vaccination.

Anti-HBs Antibodies over time in healthcare workers

Background: In developing countries including India only 18 % HCWs are vaccinated against HBV. Inspite of all the recommendations, compliance to vaccination remain poor in majority of health care settings. Aims & Objectives: To estimate serum levels of anti-HBs antibodies in healthcare workers and to correlate the values of Anti-HBs level over time in health care workers. Materials and Methods: This cross-sectional study was conducted on Health care workers of tertiary care hospital. Their demographic details and hepatitis B vaccination history was recorded as per performa. Serum samples of all the subjects were tested for Anti-HBs levels by VIDAS-PC equipment. Results: Out of the 294 HCWs enrolled, 84% (247) were fully vaccinated whereas 16%(47) were partially vaccinated. The vaccination rate was highest among nursing staff (74.9%) followed by doctors (13.8%). 3% of doctors and 12.4% of nurses are still at risk of acquiring HBV infection. On anti -HBs titer estimation, 9.7% of the HCWs had anti-HBs titer < 10 mIU/ml while 90.3% had titre > 10 mIU/ml. Conclusion: This study demonstrated that Hepatitis B immunization must be made compulsory for hospital staff in every health care setting as well as to check their anti HBs titres.

The optimisation of the use of economic resources for hepatitis B vaccination of health care workers

Background/Objectives: Hepatitis B virus (HBV) infection and its sequelae is a significant public health problem. Health-care workers (HCWs) are at high risk of occupational exposure to HBV. Centres for Disease Control and Prevention recommends health-care institutions to administer hepatitis B vaccine (0, 1 and 6 months) to HCWs at risk and to check their post-vaccination titre to ensure seroprotectivity. The main aim of this study was to develop a cost-effective protocol for HBV vaccination of HCWs. Materials and Methods: This descriptive observational study was conducted in the Department of Infection control in a tertiary care hospital from January 2014 to June 2015. Three hundred and ninety-one unvaccinated and 10 remotely vaccinated HCWs were immunised with standard 3 doses (0,1 and 6 months) and a challenge dose of hepatitis B vaccine, respectively, and their anti-hepatitis B surface antibody-titre (HBs titres) were checked 2 months later. Results: Based on the anti-HBs titres , the HCWs were classified as non-responders ( Conclusions: The seoconversion rate to hepatitis B vaccine was high. The anti-HBs titres of remotely vaccinated HCWs were adequate. Booster doses are not necessary. We emphasise all health-care institutions to follow this cost effective approach rather than pre-vaccination screening for infective hepatitis markers.

Anti HBs Levels among Children with Chronic Liver Disease from a Super Speciality Hospital

Background: Hepatitis B Virus (HBV) infection remains a major public health problem worldwide. In present context HBV infection is still not an uncommon problem leading to frequent hospitalization. The anti HBs status of children admitted in this hospital is not known amongst whom HBV vaccination could be advocated. Aim: To evaluate the anti HBs status among children with chronic liver disease attending Gastroenterology Department, Nehru Hospital, PGIMER, Chandigarh. Methods: 88 children (50 Males,38 Females) of chronic liver disease (CLD) admitted between April 2013 and March 2015 were included in the study (exclusion HBV infected patients).Clinical features of patients, diagnostic investigations including abdominal ultrasonography were recorded. Two ml. of blood was collected from each patient and serum was stored at -20 0 C. Tests for detection of HBsAg, anti HCV and quantitative anti HBs levels were uniformly done on all samples by ELISA. Results: Overall 35 children with CLD (39.77%,35/88 pts.) had nil level of anti HBs antibody. 12 children (13.63%,12/88 pts.) had anti HBs level of 150 mIU/ml. All patients were non reactive for anti HCV. Conclusions: 46.59% children with chronic liver disease had sero-protective anti -HBs titer. 39.77% children of chronic liver disease undergoing hospital treatment had undetectable anti-HBs antibody and were susceptible to Hepatitis B virus infection. Prophylactic vaccination against HBV infection should be advised in

Comparing Assay Performance of ELISA and Chemiluminescence Immunoassay in Detecting Antibodies to Hepatitis B Surface Antigen.

Antibodies to Hepatitis B surface Antigen (Anti-HBs) levels are measured as markers for immune response to vaccination and in decision making for post-exposure prophylaxis against Hepatitis-B. Several immunoassay formats are used to measure Anti-HBs, thus carrying the possibility of variation in measured levels between different assays. This study compares the performance of Chemiluminescence Immunoassay (CLIA) against Enzyme-linked Immunosorbent Assay (ELISA) in measuring Anti-HBs titer by looking into concordance between the two test reports. To compare the agreement between ELISA and CLIA in measurement of Anti-HBs antibody titers. This prospective comparative study conducted at Kasturba Medical College, Manipal measured consecutive serum samples (69) sent for anti-HBs levels during May-June 2016 using both CLIA (Abbott Architect) and ELISA (Bio-Rad). Anti-HBs values of ≤10mIU/ml was considered as non-protective and >10mIU/ml as protective. The agreement between the tests in classifying the antibody titers as non-protective or protective was computed using Kappa coefficient, and the difference in individual titer values between the tests compared using Bland-Altman plot on SPSS (v.15). Out of the 69 samples analysed, 18 samples (26.1%) were of health-care personnel and remaining of patients. Agreement between ELISA and CLIA in identifying the antibody titers as protective and non-protective were 96.5% and 90.9% respectively, resulting in an agreement of 0.84. The coefficient-of-variation of ELISA and CLIA were 74.5% and 113.1%, respectively. Three value based discordant results were noted; two samples deemed protective by ELISA were reported as non-protective by CLIA. One non-protective titer by ELISA was reported as protective by CLIA. Analytical agreement is good between the two immunoassays. However there are some discrepancies in quantitative measurement. This may have been due the variation in the standard calibrators used in each assay. Though CLIA showed more variation in the values, it has the advantage of being automated test with low turn around time. Therefore, both the test methodologies can be reliably used in place of each other for detection of Anti- HBs titer.

Screening of protective anti HBS titres among health care professionals and students at a tertiary care centre

Screening of protective anti HBS titres among health care professionals and students at a tertiary care centre

Anti HBs titers in health care professionals and students at university hospital

Anti HBs titers in health care professionals and students at university hospital

HEPATITIS B VIRAL MARKERS AND VACCINATION STATUS AMONG HEALTH CARE PROVIDERS IN MENOUFIA GOVERNORATE

Objectives: this study aimed at determinination of HBV viral markers, vaccination status of physicians and nurses acting in high risk departments and to estimate anti- HBs titer in vaccinated persons. Subjects and methods: A cross sectional study was done for doctors and nurses in high-risk departments in a district hospital in Menoufiya Governorate selected by simple random sampling. One hundred health care workers (HCWs) voluntarily participated in the study. A structured questionnaire was used to collect demographic data, HBV vaccination history and occupational risk factors. ELISA was used to test sera for HBsAg, Anti-HBs and total anti-HBc. Results: among the 100 participants, none of them tested positive for HBsAg, 49% had Anti-HBs, and 26% had Anti-HBc. Only 29% of the HCWs were immune after vaccination although 34% reported complete three doses HBV vaccine. Forty five of HCWs (45%) never vaccinated and were susceptible to HBV infection. The prevalence of life time exposure to HBV was 26%. All who reported complete vaccination had HBsAb, pyears (149.48± 43.67 vs. 97.47±29.25), in those who are free from chronic diseases (144.77± 45.70 vs. 102.08±31.01), and among those who had last dose of vaccine exposure factor. There is a need to vaccinate all HCWs as a matter of policy.

Immunological response to two hepatitis B vaccines administered in two different schedules

To evaluate the antibody response to a plasma derived hepatitis B vaccine containing pre-S and S antigens and a recombinant vaccine containing only S antigen and compare the two vaccines in 0, 1, 2 and 0, 1, 6, schedules One hundred fifty nine healthy infants were randomized to receive the vaccines in two different schedules. Anti HBs titers were estimated prior to the vaccination and then one-month following the second and third doses. Both the vaccines produced a high rate of seroconversion and seroprotection. The antibody response was similar with both the vaccines and the 0, 1, 6, schedule induced a significantly higher antibody level than the 0, 1, 2, schedule. 0, 1, 6 schedule produces a higher antibody level than 0, 1, 2 schedule though both the schedules have good seroconversion and seroprotection rates with both the vaccines.

GRANULOCYTE MACROPHAGE COLONY STIMULATING FACTOR IMPROVES IMMUNOGENECITY OF HEPATITIS B VACCINE IN HEMODIALYSIS PATIENTS

Only 20-50% of hemodialysis patients, develop protective antibodies following double dose Hepatitis B vaccination. Early reports suggest augmented response with concomitant use of Granulocyte macrophage colony stimulating factor (GMCSF). This study was done to assess the response rate to hepatitis B vaccine in hemodialysis patients with use of GMCSF. Seventeen patients were included in study, all received 40 mcg of hepatitis B vaccine at 0,1 and 2 months. Ten of these received 150 mcg of GMCSF with each dose of vaccine while 7 were taken as controls. Only one patient from control group (14.3%) while 5/10 (50%) patients from GMCSF group, developed protective antibodies, i.e. anti HBS titres > 10miu/ml (p < 0.05). Present study shows the beneficial effect of GMCSF when used as adjuvant with hepatitis B vaccine, in hemodialysis patients.

RESPONSE TO HBV-VACCINE IN PATIENTS TRANSPLANTED FOR HBV-RELATED LIVER DISEASE TREATED WITH HYPERIMMUNE GAMMAGLOBULIN

39 AIM: To assess response to HBV-vaccine (HBV-vac) in patients transplanted for HBV-related liver disease, who were free of recurrence at least 20 months after specific prophylaxis with hyperimmune anti-HBV gammaglobulin (HBIG). PATIENTS AND METHODS: Five male patients (mean aged 42±16 y) with non-replicative HBV-related liver disease (negative HBeAg and HBV-DNA) were transplanted during 1994 and 1995 (see table for underlying diseases) and immunosuppressed with cyclosporin, azathioprin and steroids. They initially received prophylaxis with HBIG, keeping serum anti Hbs titers above 100 IU/L. After a minimum of 20 months free of recurrence (negative serum HBsAg and HBV-DNA and negative liver immunohistochemistry for HBcAg and HBsAg) and under cyclosporin monotherapy, informed consent was obtained and HBIG was stopped. Two months later, HBV-vac (Engerix B, Smith-Kline-Beecham) was administered at a dose of 40 mcg IM, and repeated 1 and 2 months later. A further dose was given then every 2 months, ifanti-HBs titers sis not stabilize or increase. If an anti-HBs titer >=25 IU/L was reached in two consecutive determinations, HB-vac was stopped. If levels fell under 10 IU/L, the patient was considered a non-responder and HBIG was restarted.TableRESULTS: (see table) Four out of five patients (80%) responded, developing sustained anti-HBs levels above 25 IU/L. One patient failed to respond after 7 HBV-vac doses, and HBIG was restarted. Responding patients have been followed 8,6,5 and 5 months, and still maintain protective anti Hbs titers. CONCLUSIONS: 80% of patients transplanted for non-replicative HBV-related liver disease, and initially protected from recurrence by HBIG, responded to anti-HBV vac. This was started at least 20 months after transplantation, under cyclosporin monotherapy. This opens an interesting and resource-saving approach to the long-term prophylaxis of graft reinfection by HBV.

Use of HBV Vaccine in Hemophiliacs

Patients with coagulation defects received three monthly injections of vaccine against Hepatitis B surface antigen (HEVAC B from Institut Pasteur Production, France). We now report preliminary results obtained in 26 hemophiliacs and in 7 patients with other coagulation defects. Very few side effects were observed. Immune response (anti HBs antibody 5–50 mIU/ml) was obtained in 32 patients (97 percent). The geometric mean of anti HBs titer one month after the 3rd injection of vaccine was 2,014 mIU/ml (95 percent confidence interval 1,195 to 3,331 mIU/ml) in 28 patients. Transaminase activity (ALT) was assayed in 31 patients: in 16 it was within normal limits (&gt; 43 IU/L), a subsequent ALT increase was observed in 4. In the 15 other patients ALT was high at the beginning and did not change during the follow‐up. Neither HBsAg nor anti HBc (except for one patient with a low anti HBc level after F IX infusion) was detected. HBV‐DNA assay in the serum performed in patients with abnormal ALT activity, was negative.

Role of Booster Dose on Antibody Titer after Recombinant Hepatitis B Vaccination

Hepatitis B virus infection is an important public health problem with significant morbidity and mortality. Recombinant hepatitis B vaccination for the prevention of hepatitis B virus infection is in practice in different parts of the world since its availability in 1986. Government of Bangladesh has also included hepatitis B vaccine in EPI schedule since 2005. This study was carried out to assess the seroconversion status among hepatitis B vaccinated individuals. A total of 190 individuals including 150 vaccinated persons and 40 non-vaccinated apparently healthy individuals were included as study population. Sources of vaccinated persons were from both EPI and non-EPI schedule of vaccination. Age and sex matched non-vaccinated individuals served as controls for the study. All individuals constituting the study population were screened for HBsAg by Immunochromatographic strip test and only HBsAg-negative persons were included for estimation of their anti-HBs titer. Out of 150 vaccinated individuals, 133(88.67%) were found to have anti-HBs titer in the protective level (e"10 IU/L), while 17(11.33%) individuals had anti-HBs titer below the protective level (&lt;10 IU/L). All non-vaccinated controls had anti- HBs titers below the protective level. Immune response developed among vaccinated individuals, 67.78%, 23.33% and 8.89% were good-responders, hypo-responders and non-responders respectively. Mean titer of anti-HBs was found significantly higher among recipients who received booster dose than those who received 3 doses schedule (863.39 IU/L vs. 262.40 IU/L), indicating high antibody titer develops after booster dose. Vaccinated group included 85 (56.67%) men and 65 (43.33%) women with protective level of anti-HBs titer found in 85.88% male and 92.31% female individuals. doi: 10.3329/jom.v10i2.2817 J MEDICINE 2009; 10 : 67-76