Hepatitis B Virus Vaccination Schedule Research Articles

Inadequate Hospital Practices to Prevent Mother-to-Child Transmission of Hepatitis B Virus Infection: A European Survey.

Prevention of vertical transmission of Hepatitis B virus (HBV) infection is crucial to eliminate viral hepatitis as a major public health threat by 2030. We aimed to assess the current hospital policies and practices implemented before, at, and after birth, and to evaluate potential barriers to the full application of international guidelines. A web-based survey was supported by Penta Foundation and distributed across Europe from October to December 2021. Overall, 76 centers with delivery departments completed the survey. HBsAg maternal screening is performed in the first trimester of pregnancy in 53% of the centers and in the third in 46%. HBsAg positive pregnant women are tested for serologic HBV markers and HBV-DNA in 78% and 63% of the departments; 38% of the HBeAg positive women with high HBV-DNA levels are treated during the last trimester of pregnancy. At birth, 91% of the departments administer HBV vaccine to infants born to HBsAg positive mothers within 12 hours of birth; 74% test women with unknown HBsAg status and 78% of them wait for the maternal testing results before administering HBV vaccine to their newborns. After birth, 47% of the departments provide post-vaccination serological testing for infants born to HBsAg positive mothers. The timing of the HBV vaccine schedule varies greatly. There is significant heterogeneity in the hospital policies and correlated procedures. The implementation of a multidisciplinary clinical pathway is a must if a stronger connection between the prenatal, perinatal, and postnatal phases is to be established.

Antibody titer after vaccination against hepatitis B virus with different schedule among patients with endstage renal disease on maintenance hemodialysis

Background: Infection with the hepatitis B virus (HBV) causes high morbidity. Vaccination against HBV is very important for patients receiving hemodialysis due to end-stage renal disease (ESRD). Our study aimed to find out whether 0, 1, 2 and 6 months HBV vaccination schedule produces a better antibody response than the 0, 1, 2 months or 0,1,6 months schedule with two 20 μg [1.0 mL doses] I/M injections administered in 2 sites in each dose and to find out the overall antibody status (effectiveness) of HBV vaccine in a patient with ESRD on maintenance hemodialysis.
 Methods: This cross-sectional study was conducted in the Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD), Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh, from December 2020 to November 2021. All patients were collected from the Department of Hemodialysis and Nephrology diagnosed with ESRD and were on maintenance hemodialysis. Data were collected in a single sitting about their past vaccination status. An anti-HBs antibody test was sent to see the antibody status after vaccination against HBV.
 Results: In this study, a total of 100 patients were selected, aged between 40 and 82 years, and the majority of the patients (63.0%) were male. Among them, 40 (40%) patients received 0, 1, 2 months schedule and 30 (30%) patients received 0, 1, 6 and rest of 30 (30%) patients received 0, 1, 2, 6 months schedule. We found patients who used the 0,1,2,6 months schedule, 54% of them achieved protective antibodies, and for patients who used the 0,1,2 and 0,1,6 months schedule, only 27% and 19% achieved protective antibodies, respectively. Their anti- HBs (titer) mean±SD were 293.93±122.38 (IU/L) with 0,1,2,6 months schedule and 126.14±132.90 (IU/L) and 276.66±152.07 (IU/L) with 0,1,2 months and 0,1,6 months schedule respectively. Overall we found that 37 (37.0%) of the patients had protective antibodies (>100 IU/l), 29 (29.0%) with low protective antibodies (10-100 IU/L), and the remaining 34 (34.0%) respondents we7re found to have nonprotective antibody (<10 IU/L).
 Conclusion: Patients who received a vaccine scheduled 0,1,2,6 months achieved the highest anti-HBs titer, and the highest percentage of patients (54%) developed a protective antibody with the same schedule. So, we found that vaccine schedules (0,1,2,6 months) are preferred for better protection against HBV infection.
 BIRDEM Med J 2023; 13(1): 22-26

Factors associated with receipt of a timely infant birth dose of hepatitis B vaccine at a tertiary hospital in North-Central Nigeria.

The World Health Organization recommends universal vaccination of medically stable infants with Hepatitis B vaccine within 24 hours of birth to prevent mother-to-child transmission of Hepatitis B virus (HBV) infection. However, the proportion of infants who receive a timely birth dose is extremely low in Nigeria. We reviewed the implementation of an infant HBV vaccine schedule at a single center and identified factors affecting the receipt of a timely birth dose of HBV vaccine. We conducted a retrospective cohort study utilizing data from the INFANT study, a 2013-2017 prospective cohort study of pregnant women with and without HIV and their infants We utilized bivariate and multivariable logistic regression to assess if maternal characteristics, or the day of the week on which the infant was born were significantly associated with timely receipt of a birth dose of HBV vaccine. Receipt of HBV vaccine on the day of birth or the following calendar day were considered a timely birth dose. Among 409 infants in our cohort, 133 infants (33%) received a timely birth dose of HBV vaccine. Only the day of the week on which infants were born was significant (p<0.0001): when compared to Friday, infants born Monday through Thursday had significantly higher odds of receiving a timely birth dose, while infants born on a Saturday or Sunday had similar (low) odds. We found no association between maternal age, education, marital status, HIV status, parity and mode of delivery, and infant receipt of a timely birth dose of HBV vaccine. National immunization programs could improve timely HBV birth dose rates by providing access to vaccine immediately following birth at all infant delivery venues on all days of the week. Where not possible, there should be rapid linkage to the nearest facility where HBV vaccination is immediately available.

Prevalence of hepatitis B surface antigen (HBsAg) in blood donor population in Bosnia and Herzegovina: Impact of the pre-donation questionnaire implementation and mandatory hepatitis B virus (HBV) vaccination schedule-20 years' experience of the University Clinical Hospital Mostar.

Currently, there are limited data on the prevalence of HBsAg in Bosnia and Herzegovina. This study aimed to evaluate the trend of HBsAg prevalence during a period of 20 years in relation to the implementation of pre-donation questionnaires based on parenteral and sexual risk factors and mandatory HBV vaccination. This is a retrospective analysis performed on 67,336 blood donors at the University Clinical Hospital Mostar during three distinct periods: before introducing of mandatory HBV vaccination and pre-donation blood donor questionnaires (1998-2002); after introducing of pre-donation blood donor questionnaires, but without mandatory immunized blood donors (2004-2008); and after introducing of mandatory pre-donation blood donor questionnaires and mandatory vaccination (2015-2019). According to implementation of mandatory pre-donation blood donor questionnaires and mandatory HBV vaccination the prevalence of HBsAg significantly decreased among blood donors in all three studied periods of time (0.303% in 1998-2002, 0.236% in 2004-2008, and 0.021% in 2015-2019; P<0.001). Out of 67,336 tested donors, there were 98 (0.145%) HBsAg-positive donors during analysed periods, with a mean age of 34.76±11.37 years. The mean age of HBsAg-positive donors was 30.72±10.40, 37.56±10.13, and 47.28±12.14) in the 1998-2002, 2004-2008, and 2015-2019 periods, respectively (P<0.001). This study clearly shows a decreased rate of HBV infections among blood donors with respect to implementation of the HBV vaccination schedule and mandatory pre-donation blood donor questionnaires based on parenteral and sexual risk factors.

Two-year immune effect differences between the 0\u20131\u20132-month and 0\u20131\u20136-month HBV vaccination schedule in adults

BackgroundThe short-term 0–1–2-month hepatitis B virus (HBV) vaccination schedule was previously implemented in the adult population; however, its long-term immune effect remains unclear. The present study aimed to investigate (1) the 2-month and 2-year immune effects of HBV vaccination and (2) the compliance rate between the 0–1–2-month and 0–1–6-month vaccination schedules in adults.MethodA total of 1281 subjects tested for hepatitis B surface antigen HBsAg(−) and hepatitis B surface antibody (anti-HBs)(−) were recruited. Participants from two distant counties were inoculated with the hepatitis B yeast vaccine at 10 µg per dose, with vaccination schedules of 0, 1, and 2 months (n = 606) and 0, 1, and 6 months (n = 675); sequential follow-up was performed at 2 months and 2 years after the 3rd injection.ResultsThere were no significant differences in the anti-HBs seroconversion rates between the those in the 0–1–2-month and 0–1–6-month vaccination schedule groups at 2 months (91.96% vs. 89.42%, p = 0.229) and 2 years (81.06% vs. 77.14%, p = 0.217). The quantitative anti-HBs level in those in the 0–1–2-month vaccination schedule group was not different from that in those in the 0–1–6-month vaccination schedule group at 2 months (anti-HBs1) (342.12 ± 378.42 mIU/ml vs. 392.38 ± 391.96 mIU/ml, p = 0.062), but it was higher at 2 years (anti-HBs2) (198.37 ± 286.44 mIU/ml vs. 155.65 ± 271.73 mIU/ml, p = 0.048). According to the subgroup analysis, the 0–1–2-month vaccination schedule induced better maintenance (p = 0.041) and longer reinforcement (p = 0.019) than the 0–1–6 vaccination schedule. The 0–1–2-month vaccination schedule group also had a higher 3rd injection completion rate (89.49% vs. 84.49%, p = 0.010).ConclusionThe 0–1–2-month vaccination schedule was associated with a similar short-term immune effect and might induce better long-term immune memory and a higher completion rate in the adult population.Trial registration None

Implementation of a neonatal hepatitis B immunization program in rural Karenni State, Myanmar: A mixed-methods study

BackgroundHepatitis B infection is a major health concern in Myanmar. Hepatitis B birth dose vaccination to prevent mother-to-child transmission is not universal, especially in births outside of health care facilities. Little is documented about delivery of immunization programs in rural Myanmar or in conflict-affected regions. To address this gap, this study describes the implementation of a novel community delivered neonatal hepatitis B immunization program in rural Karenni State, Myanmar.MethodsA mixed-methods study assessed the effectiveness and feasibility of hepatitis B birth dose immunization program. 1000 pregnant women were screened for hepatitis B virus (HBV) infection using point of care testing. Neonates of HBV positive mothers were immunized with a three dose HBV vaccine schedule at birth, 1, and 6 months of age. HBV testing was completed for children at 9 months to assess for infection. Descriptive statistics were collected including demographic data of mothers, neonatal vaccination schedule completion, and child HBV positivity at 9 months. Qualitative data examining barriers to implementation were collected through semi-structured interviews, participant-observation, and analysis of program documents. Themes were codified and mapped onto the Consolidated Framework for Implementation Research.Results46 pregnant women tested HBV positive leading to 40 live births. 39 women-child dyads were followed until the 9-month age mark. With the exception of two neonates who received their birth dose past 24 hours, all children received their vaccines on time. None of the 39 children tested positive for HBV at nine months. Themes regarding barriers included adaptability of the program to the rural setting, friction with other stakeholders and not meeting all needs of the community. Identified strengths included good communication and leadership within the implementing ethnic health organization.ConclusionA community delivered neonatal HBV vaccination program by ethnic health organizations is feasible and effective in rural Myanmar.

Levels of hepatitis B antibody titers are affected by age and doses gap time in children from a high endemic area of the western Amazon.

BackgroundDespite completion of the vaccine schedule for hepatitis B virus (HBV), children may display levels of HBV surface antibodies (anti-HBs) that are considered inadequate for sufficient protection (<10 IU/L).AimsOur aim was to investigate if age and gap time between HBV vaccine doses may negatively affect the levels of anti-HBs in children, and if these relationships are modified by sex.MethodsIn a high-endemic HBV region of the western Brazilian Amazon we enrolled children who had completed the HBV vaccine schedule. All children underwent analysis of anti-HBs and a clinical examination.ResultsWe included 522 children (mean age 4.3 ± 0.8 years; 50% male). Median anti-HBs was 28.4 [interquartile range (IQR) 5.4 to 128.6] IU/L and 32% had anti-HBs <10 IU/L. The median gap time from last to preceding dose was 2.4 [IQR 2.1 to 3.3] months. Levels of anti-HBs decreased with higher age (-42% per year increase [95%CI -56% to -24%], p<0.001), but not with longer gap time (+23% per month increase [95%CI -16% to +62%], p = 0.249). After adjusting for relevant confounders, gap time became significant (p = 0.032) and age remained a significant predictor of anti-HBs (p<0.001).ConclusionOne third of assessed children displayed anti-HBs <10 IU/L. Levels of anti-HBs decreased with higher age and increased with longer gap time between the last two doses.

Risk factors associated with horizontal transmission of hepatitis B viral infection from parents to children in Mexico.

Hepatitis B virus (HBV) infection in children is a health problem worldwide. In Mexico, a high prevalence rate of HBV infection and occult HBV infection have been reported in high-risk adults and children. However, studies regarding HBV infection transmitted from HBV-infected parents to children are limited. This study aimed to determine the risk factors associated with HBV transmission of HBV from parents to children in Mexico. A retrospective case-control study was carried out in 24 pediatric patients with clinical HBV infection and 48 healthy controls. Bivariate and forward conditional logistic regression analysis was used to compare demographic variables, the status of HBV vaccination, and risk factors for HBV infection transmission among children and their parents. No newborns were diagnosed with HBV infection, and no significant differences were found in age (p = 0.209) or gender (p = 0.612) compared to the control group. The independent risk factor associated with HBV transmission was the presence of a parent with a history of promiscuity (OR = 30.95, 95%CI = 3.382-283.326; p = 0.002), whereas having completed the HBV vaccination schedule for their age was a protective factor against HBV infection in the children (OR = 0.245, 95%CI = 0.079-0.764; p = 0.015). HBV infection in Mexican children is associated with close interpersonal contact with a parent engaged in high-risk sexual practices suggesting that the horizontal route could be the primary mode of infection. Child and adult vaccination campaigns should be reinforced to avoid HBV infection in Mexico.

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.

Predictors of hepatitis B vaccination completion among people who use drugs participating in a national program of targeted vaccination

BackgroundTargeted vaccination strategies are necessary to prevent people who use drugs (PWUD) becoming infected with hepatitis B virus (HBV). The aims of this study were to provide an overview of the activities for PWUD in a decentralised vaccination program in the Netherlands and to explore the determinants associated with completing a standard hepatitis B vaccination series. MethodsWe used data for behavioural risk groups from the register of the national vaccination program. The data concerned PWUD who were immunised against hepatitis B in the Netherlands between 2002 and 2011. A standard series of three vaccinations (at 0, 1, and 6 months) was offered at inclusion and was continued if serological markers for past or chronic HBV infection were absent. Completion of a vaccination series (at least three vaccinations, irrespective of timing) was a dependent variable in our logistic regression analysis. ResultsThe program reached 18,054 PWUD. Of the 15,746 participants eligible for vaccination (i.e. they were neither carriers of hepatitis B nor immune to hepatitis B), 9089 (58%) completed a series of three hepatitis B vaccinations. Factors associated with a higher completion rate of a vaccination series (p < 0.01) were: starting vaccination in the earlier years of the program, older age of PWUD, intravenous drug use, vaccine administration by addiction care centres, and flexibility in location of vaccine delivery. ConclusionDespite using a standard HBV vaccination schedule and no financial incentives, vaccination completion among PWUD was relatively high. Our results suggest that flexibility of vaccination location and administration of vaccines by healthcare workers with sustainable contact with PWUD could improve vaccination programs for this risk group.

Hepatitis B Vaccination Induced TNF-α- and IL-2-Producing T Cell Responses in HIV- Healthy Individuals Higher than in HIV+ Individuals Who Received the Same Vaccination Regimen.

We investigated cytokine production and expression of degranulation marker CD107a after different strategies of hepatitis B virus (HBV) vaccination in human immunodeficiency virus-infected individuals, which were three doses of 20 μg (standard dose group), four doses of 20 μg (four doses group), or four doses of 40 μg (four double doses group), compared to standard dose vaccination in healthy controls. PBMCs collected at different time points were stimulated in vitro with recombinant hepatitis B surface antigen and analyzed by flow cytometry. There was an increase in TNF-α production of total and memory CD4+ T cells at 7 months after vaccination in healthy controls compared to the HIV+ group, which received the same standard vaccination regimen. An increase in the IL-2-producing memory CD4+ T cells in the healthy control group was also observed at 7 months after vaccination. No differences were observed between the healthy controls and both groups of four doses at any time point of study. These results suggest that the standard HBV vaccination schedule might induce better production of TNF-α and IL-2 from CD4+ T cells in healthy individuals. Modification of HBV vaccination schedule by increasing the frequency and/or dosage may improve the CMI response in HIV-infected individuals. This trial is registered with NCT1289106.

Antenatal maternal hepatitis B care is a predictor of timely perinatal administration of hepatitis B immunoglobulin.

Mother-to-child transmission of hepatitis B virus continues to occur despite universal recommendations for neonatal immune prophylaxis therapy (IPT) and infant vaccination. To characterise the risk factors for failure to provide timely IPT and completion of the infant hepatitis B vaccination schedule for children born to mothers with chronic hepatitis B (CHB). We conducted a retrospective cohort study to assess compliance with universal guidelines for neonatal IPT for children born to CHB mothers at Monash Health, Australia from 2008 to 2013. These mothers were invited to participate in a telephone interview regarding post-partum hepatitis B virus (HBV) care and infant vaccination status. Multivariate logistic regression analysis was utilised to identify the predictors for engagement with specialist HBV care, timely administration of IPT, completion of HBV vaccination schedule and serological testing of the baby. A total of 451 CHB mothers delivered 454 live births. HBV immunoglobulin (HBIg) was dispensed within 12 h in 79.52% of births. HBIg was not administered to eight neonates. Of the 451 women, 125 were interviewed: 88.8% of babies completed the vaccine schedule, and 19.2% of infants had post-vaccination testing. Antenatal HBV care was independently associated with a greater likelihood of timely HBIg administration (odds ratio 1.64, P = 0.04, 95% CI: 1.03-2.61). There were no significant predictors for engagement with specialist HBV care, vaccine coverage or serological testing of the baby. Targeted interventions to improve timely HBIg and completion of the vaccine schedule are recommended. All pregnant women with CHB should be referred for HBV-specific antenatal care regardless of viral replicative status.

Development of immunity following financial incentives for hepatitis B vaccination among people who inject drugs: A randomized controlled trial

BackgroundPeople who inject drugs (PWID) are at risk of hepatitis B virus (HBV) but have low rates of vaccination completion. The provision of modest financial incentives increases vaccination schedule completion, but their association with serological protection has yet to be determined. ObjectiveTo investigate factors associated with vaccine-induced immunity among a sample of PWID randomly allocated to receive AUD$30 cash following receipt of doses two and three (‘incentive condition’) or standard care (‘control condition’) using an accelerated 3-dose (0,7,21 days) HBV vaccination schedule. Study designA randomised controlled trial among PWID attending two inner-city health services and a field site in Sydney, Australia, assessing vaccine-induced immunity measured by hepatitis B surface antibodies (HBsAb≥10mIU/ml) at 12 weeks. The cost of the financial incentives and the provision of the vaccine program are also reported. ResultsJust over three-quarters of participants – 107/139 (77%) – completed the vaccination schedule and 79/139 (57%) were HBsAb≥10mIU/ml at 12 weeks. Vaccine series completion was the only variable significantly associated with vaccine-induced immunity in univariate analysis (62% vs 41%, p<0.035) but was not significant in multivariate analysis. There was no statistically discernible association between group allocation and series completion (62% vs 53%). The mean costs were AUD$150.5, (95% confidence interval [CI]: 142.7–158.3) and AUD$76.9 (95% CI: 72.6–81.3) for the intervention and control groups respectively. ConclusionDespite increasing HBV vaccination completion, provision of financial incentives was not associated with enhanced serological protection. Further research into factors which affect response rates and the optimal vaccination regimen and incentive schemes for this population are needed.

Serum Level of Anti-Hepatitis B Surface Antigen Among Students in Guilan, Iran

Background: Hepatitis B virus (HBV) is considered as a serious public health concern. The health care workers and medical students are at a higher risk of HBV infection than the general population through occupational exposure. Vaccination against HBV is considered an effective means of infection prevention. Objectives: The aim of the present study was to determine anti-HBs titers among the medical students of Guilan University of Medical Sciences within the national HBV vaccination schedule. Patients and Methods: This cross-sectional study comprised 209 medical students born between the years 1989 - 92 within a national vaccination gap of HBV and received HBV vaccine before age 18 years. The levels of anti-HBsAg ≥ 10 mIU/mL detected by ELISA were considered as protective against HBV. Results: Of 209 students participated in this study, 11 (5.3%) showed no response to HBV vaccination. The protective titers of 10 - 1000 mIU/ mL, and greater than 1000 mIU/mL of anti-HBs were found in 126 (60.2%) and 72 (34.5%) of students, respectively. Conclusions: The periodic monitoring of anti-HBs titers in medical students is important because of their awareness about the risk factors associated with HBV infection.

Immunogenicity of hepatitis B vaccine in patients with inflammatory bowel disease and the benefits of revaccination.

The vaccination against hepatitis B virus (HBV) is recommended in patients with inflammatory bowel disease (IBD). However, the response to this vaccine seems to be lower in IBD patients than in the general population. This study aims to evaluate the immunogenicity of the HBV vaccine in a cohort of patients with IBD, to associate factors with the response and to analyze the effects of a second schedule vaccination. We conducted a retrospective cohort study of adults with IBD, susceptible to HBV infection. All patients received a three-dose standard schedule of HBV vaccine. Non-responders were revaccinated with a second three-dose standard schedule. Adequate immunity to HBV was defined as antibodies against hepatitis B surface antigen (anti-HBs) ≥ 10 mIU/mL. Age, comorbidities, treatment, and other variables were collected. One hundred seventy-two patients were included and received the first HBV vaccine schedule. Eighty-seven developed anti-HBs ≥ 10 mIU/mL (50.6%; 95% confidence interval [CI]: 42.9-58.3). From the non-responders, 53 were revaccinated and 28 showed an adequate serological response (52.8%; 95% CI: 38.6-66.7). Age older than 55 years (OR: 3.6; 95% CI: 1.3-10.2) and comorbidities (OR: 2.8; 95% CI: 1.1-7.1) were associated with suboptimal response. In the multivariate analysis, only age was a predictor of non-response (age higher than 55 years; OR: 3.9; 95% CI: 1.3-11.9) CONCLUSION: The response rate to the HBV vaccine is lower in patients with IBD compared with the general population, especially in those older than 55 years. Revaccination improved response rate by 50%.

A double-dose hepatitis B vaccination schedule in travelers presenting for late consultation.

Vaccination against hepatitis B virus (HBV) is recommended for all travelers visiting HBV-endemic countries. However, travelers often present with insufficient time for the standard HBV vaccine schedule (SVS). We examined seroprotection against HBV following an alternative two-visit vaccination schedule (TVS) with currently available vaccine products, and completion rates with this TVS. A retrospective cohort study was conducted in three travel clinics in British Columbia, Canada. Adults ≥20 years old traveling to an HBV-endemic country, and unable to complete the standard or rapid HBV vaccination schedule before departure, were offered a TVS that consisted of a double dose of HBV vaccine at day 0, followed by a single dose in 4 to 12 months. Immunity to HBV [anti-HBV surface antigen (HBs) ≥10 mIU/mL] was determined 1 to 6 months following the final dose of HBV vaccine. Logistic regression modeling was used to assess correlates of seroprotection. We also determined completion rate with this TVS at two clinics. In total, 117 participants (age range, 21-81 years, median age 57) met the inclusion criteria. Of these, 97 (82.9%) were immune after the TVS. Immunity was demonstrated in 93.1% of patients <50 years old and 79.5% of patients ≥50 years old. Increasing age was associated with reduced odds of developing immunity to HBV using the TVS [adjusted odds ratio = 0.954, 95% confidence interval (CI): 0.904, 1.008]. The completion rate of the TVS was 32.6% over a 12-month period. Completion rates varied between clinics (23.5% vs 48.4%, p < 0.001), suggesting that clinic-specific follow-up policies were important. Seroprotection with completion of this TVS was similar to or exceeded that published in the literature for the SVS by age. However, even with a TVS, completion rates were low, underscoring the importance of follow-up. Further research is needed to determine whether travelers are protected prior to completion of this TVS.

Hepatitis B Virus Exposure During Childhood in Cameroon, Central African Republic and Senegal After the Integration of HBV Vaccine in the Expanded Program on Immunization

More than 2 billion people worldwide have been exposed to hepatitis B virus (HBV). To prevent these infections, Senegal and Cameroon integrated the HBV vaccine into their Expanded Program on Immunization (EPI) in 2005, as did the Central African Republic (CAR) in 2008. We evaluated the prevalence of HBV exposure and infection after the integration of the HBV vaccine in the EPI. An observational cross-sectional study was conducted among the hospitalized children 3 months to 6 years of age in Cameroon, CAR and Senegal. Plasma was collected for the detection of anti-HBc, anti-HBs and hepatitis B surface antigen in children with anti-HBc and anti-HBs. Between April 2009 and May 2010, 1783 children were enrolled, 19.4% of whom were anti-HBc positive. The percentage of children with anti-HBc was 44.4% among the children younger than 6 months, decreasing after 6 months to reach 18.8% at 12 months. This decline was followed by a rapid increase in anti-HBc positivity rate in CAR observed as early as 12 months of age compared with Cameroon and Senegal, where the anti-HBc increased between 18 and 36 months of age, respectively. The prevalence of hepatitis B surface antigen-positive children was significantly higher in CAR than that in Cameroon and Senegal (5.1% versus 0.7% and 0.2%; P < 0.001). Socioeconomic level, age and country were factors associated with the presence of anti-HBc. Passive transfer of anti-HBc maternal antibodies versus HBV exposure could be differentiated as early as 12 months of age. The low prevalence of anti-HBc and hepatitis B surface antigen among children born after the integration of HBV vaccine in the EPI in Cameroon and Senegal suggests a positive impact of HBV vaccination.

Serological pattern of hepatitis B virus among HBsAg negative blood donors in Alexandria, Egypt

This study in Alexandria, Egypt was conducted to investigate the distribution of different hepatitis B virus (HBV) markers in apparently healthy blood donors who were hepatitis B surface antigen (HBsAg) negative, and to determine the major independent risk factors. Evidence of past exposure to HBV was found in 148/508 screened donors (29.1%). The most prevalent marker was anti-NBc in 124/508 donors (24.4%), half of whom (63/124) showed anti-HBc only. Anti-HBs prevalence was 15.9%, combined anti-NBc and antiHBs was 12.0% and anti-HBe was 5.7%. Independent risk factors associated with the presence of at least 1 markerwere: being married (OR 3.82), history of blood transfusion (OR 3.04) and parenteral antibilharzial treatment (OR 2.49). Receiving a full HBV vaccination schedule was reported by 39 donors, but only 1 of them had isolated anti-HBs. The relatively high prevalence of HBV exposure necessitates solid infection control measures and adult vaccination programme awareness.

A randomised controlled trial of financial incentives to increase hepatitis B vaccination completion among people who inject drugs in Australia

ObjectiveThis study aimed to investigate the efficacy of modest financial incentives in increasing completion of an accelerated 3-dose hepatitis B virus (HBV) vaccination schedule (0, 7, 21days) among people who inject drugs (PWID). MethodsRandomised controlled trial. Participants were randomly allocated to receive $30 Australian Dollars cash following receipt of vaccine doses two and three (‘incentive condition’), or standard care (‘control condition’). Serologically confirmed HBV-susceptible PWID. Two inner-city health services and a field study site in Sydney, Australia. The primary outcome was completion of the vaccination series. Additional assessments included self-reported demographic, drug use and treatment, and risk-taking histories. ResultsCompared to the control condition, significantly more participants in the incentive condition received all three vaccine doses, under intention-to-treat analyses (n=139; 87% versus 66%; p=.004); and within the specified window periods under per protocol analyses (n=107 received three vaccine doses; 92% versus 67%; p=.001). Multivariate analysis indicated that the incentive condition and longer injecting histories significantly increased the likelihood of series completion. Aboriginal/Torres Strait Islanders were significantly less likely to complete the series. ConclusionsModest financial incentives, per-dose, increased adherence to the accelerated HBV vaccination schedule among PWID. Results have implications for increasing HBV and, potentially, other vaccine-preventable infections, among PWID.

Knowledge, attitude and practice on cholera and cholera vaccine among low socio-economic group of people in urban Dhaka, Bangladesh

Background: Since 1998 men who have sex with men (MSM) living in Amsterdam are offered free vaccination against hepatitis B virus (HBV) as part of a risk-group vaccination campaign. Time trends of acute HBV in MSM in Amsterdam (1992-2011) are examined to evaluate the effects. Methods: All acute HBV infections in Amsterdam MSM, notified from 1992 till 2012 were analyzed. Incidence of acute HBV was calculated using the estimated annual number of MSM residing in Amsterdam (10% of the male population aged 15-64 years). Data of the HBV vaccination campaign (1998-2009) were used to estimate the number of immune and susceptible MSM residing in Amsterdam. Results: The 20 year time trend of the overall incidence in the MSMpopulation showsa significantdecline (IRR97.5%; 95%CI 95.399.8%, p < 0.05), but this disappeared when controlling for age group. Themedian age at infection increased from 29 years in 1992 to 46 years in 2011 (z statistic = 6.12 p < 0.00). As 63% (117/220) of all patients were born between 1961 and 1970, a birth cohort effect is to be expected. An age cohort period analysis is in progress and results will be presented at the conference. Figure 1 shows the HBV incidence in the Amsterdam MSM population. Since 1998 a total of 10,581MSM participated in the HBV vaccination campaign of whom 20% was anti-HBc positive at first contact, and 58% completed the HBV vaccination schedule. A third of all included MSM was born between 1961 and 1970. In 2011 the number of susceptible MSM living in Amsterdam is at least 20,000 (approximately 70% of all MSM). Conclusion: The observed declining incidence of acute HBV in Amsterdam MSM is not readily explained as an effect of the HBV vaccination campaign, as the number of susceptible MSM in the Amsterdam population remains high. Also several other studies indicate that the sexual risk-behaviour among MSM has increased in the last decennium. Yet it seems likely that the campaign has been successful in reaching a specific high-risk cohort of MSM responsible for most HBV transmission over the past 20 years.