Doses Of Hepatitis B Virus Vaccine Research Articles

Hepatitis B vaccine knowledge and uptake among medical students in Cameroon

Background: Hepatitis B virus (HBV) is the most contagious blood borne pathogen. The risk of occupational exposure to HBV among health care workers is a major concern, especially among medical trainees. In this study, we describe the knowledge of risk factors for HBV infection, history of accidental exposure to blood, awareness of HBV vaccine and the vaccination status among medical students in Cameroon. Methods & Materials: In April 2012, a cross-sectional survey was carried out using a pretested self-administered questionnaire among 111 medical students Results: Sixty-two students (55.9%) had had at least one accidental exposure to blood since the beginning of their medical training, with a median of 2 (IQR, 1-3) exposures. There was a good knowledge of the risk factors for HBV infection and awareness of HBV vaccine among participants. However, only 20 (18%) participants had completed the three doses of primary HBV vaccination. Furthermore, only 2 of the 20 (10%) adequately vaccinated participants had a post-vaccination test to confirm a good immune response and thus an effective protection against HBV infection. The main reason for not being vaccinated was lack of money to pay for the vaccine (45.6%). Forty seven (42.3%) participants had been sensitized by their training institutions about the importance of HBV vaccination. These were more likely to be vaccinated compared to those who had not been sensitized (p < 0,001). Conclusion: There is a high rate of accidental exposure to blood and a very low HBV vaccination uptake among medical students in Cameroon, leading to a high occupational risk of HBV infection. HBV vaccination should be strongly recommended for medical students and the vaccine made available free of charge at the beginning of their training

Immune memory to hepatitis B persists in children aged 7–8 years, who were vaccinated in infancy with 4 doses of hexavalent DTPa-HBV-IPV/Hib (Infanrix™ hexa) vaccine

Protection against hepatitis B disease relies on either protective serum antibodies or on the ability of the immune system to mount an anamnestic response when confronted with the hepatitis B virus (HBV). This open multicenter study (EUDRACT: 2010-022538-10) measured antibodies to HBV surface antigen (anti-HBs) in 7–8-year-old children who had received 4 doses of hexavalent diphtheria-tetanus-acellular pertussis-HBV-inactivated poliovirus-Hemophilus influenzae type b conjugate vaccine (DTPa-HBV-IPV/Hib: Infanrix™ hexa; GlaxoSmithKline Vaccines) in the first 2 years of life through routine vaccine services in Germany. The ability of these children to mount an anamnestic response to a challenge dose of monovalent HBV vaccine (Engerix™ B Kinder; GlaxoSmithKline Vaccines) was also assessed.Before the challenge dose, 78.5% of children had anti-HBs levels ≥6.2 mIU/mL (seropositive) and 72.2% had anti-HBs levels ≥10 mIU/mL (seroprotected). Post-challenge, 98.9% had anti-HBs levels ≥10 mIU/mL and 95.8% had anti-HBs ≥100 mIU/mL. An anamnestic response to the challenge was observed in 96.6% of all subjects. The challenge dose was well tolerated, with a reactogenicity and safety profile consistent with published data. DTPa-HBV-IPV/Hib induces long-lasting immune memory to HBV that appears very similar to that induced by monovalent HBV vaccines. Protection against hepatitis B may be conferred through immune memory in subjects who responded to primary vaccination, even when they subsequently lose detectable levels of circulating anti-HBs antibodies.

Low hepatitis B vaccine uptake among surgical residents in Cameroon

BackgroundHepatitis B virus (HBV) infection is one of the most serious occupational hazards faced by healthcare workers. Surgical personnel are particularly at risk. HBV infection is preventable by vaccination, but no previous study has assessed HBV vaccination coverage among healthcare workers in Cameroon. We assessed knowledge of risk factors of HBV infection, awareness of HBV vaccine, and vaccination status of surgical residents in Cameroon.MethodsA structured pretested questionnaire was administered to 49 of the 70 surgical residents in Cameroon during the 2011–2012 academic year.ResultsSince the beginning of their residency program, 28 (57.1%) had had at least one accidental exposure to blood, with a median of 2 (range 1 to 25) exposures. Most of them had a good knowledge of risk factors for HBV infection. Although 98.0% (n = 48) were aware of the HBV vaccine, and 89.8% (n = 44) knew that they were at high risk of infection, only 24.5% (n = 12) had received a full course of at least three doses of the vaccine. In addition, only 33.3% (4/12) underwent post-vaccination testing to confirm a good immunological response (and thus effective protection against HBV infection). Among the 53.1% (n = 28) who had never had any dose of HBV vaccine, the main reasons for not being vaccinated were lack of time (38.5%), lack of money to pay for vaccine (23.1%), and lack of sufficient information on the vaccine (19.2%). Only 20.4% (n = 10) had been sensitized by their training institutions about the importance of HBV vaccination.ConclusionThere is a low HBV vaccine uptake among surgical residents in Cameroon. As part of occupational safety measures, complete HBV vaccination should be strongly recommended and offered to surgical trainees before the beginning of their training program.

Applicability and efficacy of a model for prevention of perinatal transmission of hepatitis B virus infection: single center study in Egypt.

To identify possible maternal risk factors for hepatitis B virus (HBV) acquisition and assess the efficacy of immunoprophylaxis given to infants born to hepatitis B virus surface antigen (HBsAg) positive mothers. Screening of 2000 pregnant females was carried out using rapid test and confirmed by enzyme immunoassay. A questionnaire consisting of 20 questions about the possible risk factors for acquisition of HBV infection was filled for every pregnant HBsAg positive female in addition to at least 2 pregnant HBsAg negative females for each positive case. Infants of HBsAg positive women were offered passive and active immunoprophylaxis within the 1st 48 h after birth, in addition to 2nd and 3rd doses of HBV vaccine after 1 and 6 mo respectively. Infants were tested for HBsAg and hepatitis B surface antibodies (HBsAb) at six months of age. HBsAg was confirmed positive in 1.2% of tested pregnant women. Risk factors significantly associated with HBV positivity were; history of injections (OR = 5.65), history of seeking medical advice in a clinic (OR = 7.02), history of hospitalization (OR = 6.82), history of surgery (OR = 4) and family history of hepatitis (OR = 3.89) (P < 0.05). Dropout rate was 28% for HBsAg women whose rapid test was not confirmed and could not be reached to provide immunoprophylaxis for thier newborns. Immunoprophylaxis failure was detected in only one newborn (3.7%) who tested positive for HBsAg at 6 mo of age; and vaccine failure (seronegative to HBsAb after 4 doses of the vaccine) was detected in another one (3.7%). The success rate of the immunoprophylaxis regimen was 92.6%. This pilot study shows that a successful national program for prevention of perinatal transmission of HBV needs to be preceded by an awareness campaign to avoid a high dropout rate.

Hepatitis B virus coinfection in human immunodeficiency virus-infected patients: a review.

Hepatitis B virus (HBV) infection is a leading cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma worldwide. Due to the shared modes of transmission, coinfection with HBV and human immunodeficiency virus (HIV) is not uncommon. It is estimated that 10% of HIV-infected patients worldwide are coinfected with HBV. In areas where an HBV vaccination program is implemented, the HBV seroprevalence has declined significantly. In HIV/HBV-coinfected patients, HBV coinfection accelerates immunologic and clinical progression of HIV infection and increases the risk of hepatotoxicity when combination antiretroviral therapy (cART) is initiated, while HIV infection increases the risk of hepatitis events, cirrhosis, and end-stage liver disease related to chronic HBV infection. With the advances in antiviral therapy, concurrent, successful long-term suppression of HIV and HBV replication can be achieved in the cART era. To reduce the disease burden of HBV infection among HIV-infected patients, adoption of safe sex practices, avoidance of sharing needles and diluent, HBV vaccination and use of cART containing tenofovir disoproxil fumarate plus emtricitabine or lamivudine are the most effective approaches. However, due to HIV-related immunosuppression, using increased doses of HBV vaccine and novel approaches to HBV vaccination are needed to improve the immunogenicity of HBV vaccine among HIV-infected patients.

Need and Response to Hepatitis B Virus Booster Immunization among Egyptian Type 1 Diabetic Students 10-17 Years after Initial Immunization: A Quasi- Experimental Comparative Study

Background: Insufficient immune response to hepatitis B virus (HBV) vaccine in diabetics is frequently encountered and anti-HBs levels may persist for a shorter time than among immune competent persons. The present study was conducted to determine long–term persistence of anti-HBs among Egyptian diabetic school students and to assess the need and response to a subsequent challenge with vaccine booster doses. Methods: The study included two phases, a comparative (screening) phase followed by a quasi-experimental (boosting) phase. A baseline serologic screening for anti-HBs titre was carried out among 260 school students aged 10-17 years (130 diabetics and 130 healthy non-diabetics, matched for age and sex) who received the full threedose regimen of HBV vaccine under the Expanded Program of Immunization (EPI) in Egypt. Ninety participants (45 diabetic and 45 healthy ones) with anti-HBs 100 mIU/ml) was achieved after receiving two doses of the vaccine for healthy students and three doses for diabetics. BMI and history of hospitalization due to diabetes were the only significant factors affecting the response to boosting among diabetic students. In conclusion, type 1 DM adolescents express hyporesponsivness to HBV vaccination and more rapid decline of protective anti-HBs compared to healthy ones. A booster dose of HBV vaccine would be recommended at age 12 years for diabetic students.

Serological response to one intradermal or intramuscular hepatitis B virus vaccine booster dose in human immunodeficiency virus-infected nonresponders to standard vaccination

Purpose:Hepatitis B virus (HBV) vaccination is recommended for all human immunodeficiency virus (HIV)-infected patients without HBV immunity. However, serological response to standard HBV vaccination is frequently suboptimal in this population and the appropriate strategy for revaccination of HIV-infected nonresponders remained controversial. We aimed to determine the serological response to one booster dose of HBV vaccine given by intradermal (ID) or intramuscular (IM) route in HIV-positive nonresponders to standard HBV vaccination.Materials and Methods:In this study, 42 HIV-infected nonresponders were enrolled. We randomized them to receive either 10 μg (0.5 mL) for ID (20 cases) or 20 μg (1 mL) for IM (22 cases) administration of HBV vaccine as a one booster dose. After 1 month, anti-HBs titer was checked in all cases. A protective antibody response (seroconversion) defined as an anti-HBs titer ≥10 IU/L.Results:Seroconversion was observed in 47.6% of subjects after 1 ID dose. A total of 30% showed antibody titers above 100 IU/L. Except one case, all responders had CD4+ >200 cells/mm3. Mean anti-HBs titer was 146.5 ± 246 IU/L. After the one IM booster dose, seroconversion was observed in 50% of cases. A total of 36.3% of subjects had anti-HBs ≥100 IU/L. All responders had CD4+ >200 cells/mm3, except one case. Mean anti-HBs titer was 416.4 ± 765.6 IU/L. Responders showed significantly higher CD4+ cell counts, in comparison to nonresponders (P < 0.001).Conclusions:One booster dose administered IM or ID to HIV-infected nonresponders resulted in similar rates of seroconversion, overall response rate 50%. However, higher anti-HBs titers observed more frequently in IM group.

Hepatitis B long-term seroprotection and the response to a challenging dose among vaccinated children in Gharbeya Governorate

Objective The aim of the study was to assess the long-term effectiveness of hepatitis B virus (HBV) vaccine and the need for a booster dose among fully vaccinated children during infancy in Gharbeya Governorate. Patients and methods A cross-sectional study was conducted using a multistage random sampling in one city and three villages in Gharbeya Governorate. Face-to-face interview with parents of 762 children was carried out. Blood samples were collected to assess HBV markers using enzyme-linked immunosorbent assay technique. Children having no HBV seroprotection received a challenging booster dose of HBV vaccine to assess their anamnestic response 3 weeks later. Results None of the participants had an evidence of chronic or breakthrough HBV infection, and the seroprotection rate was 57%. On multivariate analysis, the risk of nonseroprotection was found to be significantly higher among children aged from 5 to less than 10, 10 to less than 15, and 15 years and above compared with those aged less than 5 years [adjusted odds ratio (AOR)=3.4, 10.2, and 18.5, respectively], among girls compared to boys (AOR=1.5), and among those living in Kotour and Elsanta villages compared with Tanta city (AOR=1.8). Of the 265 children with nonseroprotective levels, 91.7% developed anamnestic response after a challenging dose. Anamnestic response rate was 100% at age 1 year and decreased to 89% at age 16 years (P>0.05). Conclusion Long-term immunity exists among children who had complete series of hepatitis B vaccination in infancy even in case of reduced or absent anti-hepatitis B over time. The developed high anamnestic response rate signifies the presence of immune memory and indicates no need for a booster dose.

Occupational exposure to blood, hepatitis B vaccine knowledge and uptake among medical students in Cameroon

BackgroundHepatitis B virus (HBV) is the most contagious blood borne pathogen. The risk of occupational exposure to HBV among health care workers is a major concern, especially medical trainees. In this study we describe the knowledge of risk factors for HBV infection, history of accidental exposure to blood, awareness of HBV vaccine and the vaccination status among medical students in Cameroon.MethodsIn April 2012, a cross-sectional survey was carried out using a pretested self-administered questionnaire among 111 medical students.ResultsSixty-two students (55.9%) had had at least one accidental exposure to blood since the beginning of their medical training, with a median of 2 (IQR, 1-3) exposures. There was a good knowledge of the risk factors for HBV infection and awareness of HBV vaccine among participants. However, only 20 (18%) participants had completed the three doses of primary HBV vaccination. Furthermore, only 2 of the 20 (10%) adequately vaccinated participants had a post-vaccination test to confirm a good immune response and thus an effective protection against HBV infection. The main reason for not being vaccinated was lack of money to pay for the vaccine (45.6%). Forty seven (42.3%) participants had been sensitized by their training institutions about the importance of HBV vaccination. These were more likely to be vaccinated compared to those who had not been sensitized (p<0,001).ConclusionThere is a high rate of accidental exposure to blood and a very low HBV vaccination uptake in medical students in Cameroon, leading to a high occupational risk of HBV infection. HBV vaccination should be strongly recommended for medical students and the vaccine made available free of charge at the beginning of their training.

Maternal immunization promotes the immune response of neonates towards hepatitis B vaccine

Infants infected with hepatitis B virus (HBV) face the risk of developing severe complications. Unfortunately, in spite of universal vaccination programmes, 5% or more of vaccinated newborns still do not achieve protective levels of anti-hepatitis B virus surface antigen titres (anti-HBs). The aim of this study was to use animal experiments and population-based research to determine whether maternal vaccination against HBV affects the outcome of neonatal vaccination. Six sows and 53 newborn piglets were used for this study and randomly assigned to the vaccination group (three 20 μg doses of recombinant HBV vaccine). All the piglets were followed up to 10 weeks of age, and peripheral blood was withdrawn for measurement of anti-HBs. A cross-sectional study was also conducted on 449 mothers with infants. A structured questionnaire was used to collect demographic, medical and maternal data, and their peripheral blood was collected for measurement of anti-HBs. The results of animal experiments demonstrated that nonvaccinated piglets born to vaccinated sows and nonvaccinated piglets born to nonvaccinated sows were negative for anti-HBs. Repeated measures analysis of variance showed that the titres of anti-HBs in vaccinated piglets born to vaccinated sows were significantly higher than in vaccinated piglets born to nonvaccinated sows (P < 0.05). In a population-based study, a cumulative logistic regression analysis showed that the strongest influences on neonatal anti-HBs titres were delay of the first vaccination dose [OR = 3.02(95% CI: 1.72-5.30)] and maternal anti-HBs titres [OR = 2.48(95% CI: 2.03-3.04)]. In conclusion, high maternal anti-HBs titres can enhance the response to HBV vaccination in infants.

Double-Dose Hepatitis B Revaccination in Nonresponsive HIV-Infected Adolescents

There is no consensus regarding a best dosing regimen of hepatitis B virus vaccine (HBVV) for non-responsive HIV-infected individuals. Double-dose of hepatitis B vaccine (DDHBVV) could enhance immunogenicity to HBVV in non-responsive HIV-infected adults. We assessed the immunogenicity of DDHBVV in HIV-infected adolescents who failed to respond to standard HBVV revaccination. HIV-infected adolescents with current CD4 ≥ 200 cells/mm(3) and no protective antibody concentration of hepatitis B surface antibodies (antiHBs) after HBVV revaccination received DDHBVV, at months 0, 1, 2. The HBVV doses were 20 microgram per dose for adolescents aged < 18 years and 40 microgram per dose for adolescents aged ≥ 18 years. AntiHBs titers were measured at 1, 2, 3 months after first DDHBVV. AntiHBs ≥ 10 mIU/ml was considered protective. Seven adolescents were enrolled; mean age was 15.4 years, CD4 was 775 cells/mm(3) and all had HIV-RNA < 50 copies/ml. Proportions of adolescents with protective antiHBs were 86% at months 1 and 2, and 100% at month 3. Geometric means of antiHBs were 1.1 at baseline, 101.6 at 1 month, 137.1 at 2 months, and 355.9 mIU/ml at 3 months after the first DDHBVV. No grade 3-4 adverse event was reported. DDHBVV is an option for HIV-infected adolescents who are non-responder to standard HBVV revaccination.

Vaccine-Induced Anti-HBs Level in 5-6 Year-Old Malnourished Children.

BackgroundMalnutrition is the most common cause of immune deficiency. It results in reduced secretion of T-cells and B-cell-stimulating factors leading to declining of special immunoglobulins. On the other hand, hepatitis B, as a major world health problem, can be prevented effectively by vaccination. Three doses of hepatitis B virus (HBV) vaccine induce protective levels of anti-hepatitis B surface (anti-HBs) in 95% of healthy children. This level decreases gradually over time.ObjectivesThe goal of this study was to assess anti-HBs in malnourished children, who confronted to some degrees of immune deficiency.Patients and MethodsThis is a cross-sectional study conducted during May to August 2010 in therapeutic clinics of Yazd, Iran. Samples were selected simply and consecutively among 5-6 year-old children with a history of three doses of HBV vaccine in infancy. On the basis of World Health Organization’s definition on malnutrition, which considers anthropometric measurements, malnourished children entered the study. Totally 83 cases (37 boys and 46 girls) were gathered and classified into three groups of mild, moderate, and severe malnutrition. One milliliter of venous blood was taken and anti-HBs were tested by enzyme linked immunosorbant assay (ELISA).ResultsOverall, seroprotection rate and geometric mean titer (GMT) of anti-HBs were 60.2% and 15.47 ± 10.92 mIU/mL, respectively. Seroprotection rate was 71.4%, 55.2%, and 72.7% in mild, moderate, and severe malnourished children, respectively. GMT was 30.78 mIU/mL, 12.15 mIU/mL, and 22.95 mIU/mL in these groups, respectively. None of these two indices were significant in these groups (P = 0.471, P = 0.364). Seroprotection rate and GMT were 54.1% and 13.26 ± 11.59 mIU/mL in boys, and 65.2% and 17.5 ± 10.59 mIU/mL in girls, respectively, showing no significant relationship with gender (P = 0.302, P = 0.602). Lowest seroprotection rate was in stunted cases (47.1%) and highest in wasted children (77.8%). This difference also was not significant (P = 0.43).ConclusionsThe seroprotection rate and GMT of anti-HBs observed in this study do not show a high level of immunity. These two indices were not related to severity of malnutrition. We conclude that severity of malnutrition does not affect vaccine-induced antibody level and seroprotection rate; however small sample size in each group of study hinders decisive conclusion. Moreover, GMT and seroprotection rate showed no relationship with type of abnormal anthropometric index, including weight for height, weight for age, and height for age.

P-164 Hepatitis B Immunity and Response to Booster Vaccination in WV Children with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract associated with significant morbidity and mortality in children and adults. The treatment of IBD is usually requires chronic immunosuppressive drugs which put the patients at a risk for Hepatitis B virus (HBV) infection and reactivation. Assessment of the HBV immune status has been suggested for children with IBD, and booster vaccination is recommended for the non-immune children. Previous report showed that almost half of patients with IBD had no baseline immunity to HBV and up to 14% could not mount an effective immune response after booster vaccination (Moses J. 2012). The rate of HBV immune status in IBD children living in rural communities of West Virginia has never been reported. Aim: Evaluate the rate of HBV exposure and immunity in a cohort of pediatric patients with IBD and examine the response to HBV vaccine in the non-immune patients. A retrospective chart review of pediatric patients treated for IBD was performed. Hepatitis B surface antigen (HBsAg) and antibody (HBsAb) were checked. Patients found to be non-immune for HBV, received a booster vaccination series and the immune status was rechecked. Immune status was defined at HBV antibody level >10 mLU/mL. A total of 31 patients with IBD were analyzed. The mean age was 14.5 years; 14/31 (45%) were female. Twenty five (81%) patients were diagnosed with Crohn’s disease and 6 (19%) patients had ulcerative colitis. Immunomodulator drugs therapy included: prednisone (n = 17pts), azathioprine (n = 9pts), infliximab (n = 13pts), and adalimumab (n = 7pts). Twenty six (84%) patients were receiving immunosuppressive therapy at the time of analysis. Twenty (65%) patients had no HBV immunity of whom 7 (35%) had prior documentation of HBV vaccine in infancy. At present, booster vaccine was given to 17 (85%) non-immune children, and adequate immune response is available in 16 (92%). Post booster antibody is available in 14 children of whom 13 (92%) achieved adequate antibody level after 2 doses of booster vaccine. The majority of our IBD cohort lack protective antibodies and are at risk of HBV infection, even in those with history of vaccination at infancy. Two doses of HBV vaccination provided protective immunity for most of our patients, in spite of immunosuppressive therapy. Careful assessment of the HBV immunity status in children with IBD is vital, and revaccination is recommended in order to achieve full protection for these high risk patients.

Successful Kidney Transplantation From a Hepatitis B Surface Antigen–Positive Donor to an Antigen-Negative Recipient Using a Novel Vaccination Regimen

Transplanting a kidney from a hepatitis B surface antigen (HBsAg)-positive donor to an HBsAg-negative recipient who is naturally immune has been successful in countries endemic for hepatitis B virus (HBV). However, in most of these cases, the donors were deceased. We present a report of a successful HBsAg-discordant kidney transplantation in the United States; in this case, a living donor kidney was transplanted to a vaccinated recipient. The wife of a 58-year-old HBsAg-negative man volunteered to donate a kidney to her husband. She had chronic hepatitis B but undetectable HBV DNA. She tested positive for HBsAg and antibody to hepatitis B core antigen, but hepatitis B e antigen was undetectable. The recipient failed to develop an antibody response to 3 doses of intramuscular recombinant HBV vaccine given in consecutive months. Immunity was induced by using biweekly intradermal vaccine. However, antibody titer tapered to <10 mIU/mL over 14 months. An intramuscular booster vaccine resulted in a prolonged anamnestic response, allowing for successful living unrelated donor transplantation. During the 10 years since transplantation, the patient has continued to have normal liver function, with undetectable HBsAg and HBV DNA. Antibody titers to HBsAg slowly decreased to 5.8 mIU/mL during the 10 years. Transplant function has been well preserved. This approach to inducing long-term immunity for transplantation merits further study in the United States.

Persistence of protection of hepatitis B vaccine and response to booster immunization in 2- to 12-year-old children

Neonatal vaccination against hepatitis B virus (HBV) infection was launched in 1998 in Turkey. The aim was to evaluate the persistence of seroprotection after HBV vaccination in order to determine the necessity of a single booster dose in 2- to 12-year-old children. This study was conducted retrospectively using hospital records of the children aged 2-12 years old who attended the pediatric outpatient clinics of Diskapi Training and Research Hospital, Ankara, Turkey between January 2010 and June 2011. Children who had received three doses of HBV vaccination in their infancy were included. A total of 530 children enrolled into the study, and 352 (66.4 %) of them had protective antibody to hepatitis surface antigens (anti-HBs) titer greater than 10 mIU/ml. The proportions of children with low, intermediate, and high anti-HB titers are different for those under 3 years of age. The majority were in the intermediate category. Those aged 4-10 years and 11 or older represented two-thirds of the children with high titers (p = 0.000). None of the children had chronic HBV infection. Unprotected children responded well after receiving the booster dose. The mean anti-HB concentration after the booster dose was more than 200 times higher than the mean antibody concentration before (p < 0.001). Our data suggest that HBV vaccination may confer long-term immunity. Use of routine booster doses of vaccine at these ages does not appear necessary to maintain long-term protection in successfully vaccinated immunocompetent children in the region.

Abstract SY26-03: Screening and strategies for liver cancer prevention

Abstract Liver cancer is one of the five leading cancer death in human. Chronic hepatitis B virus (HBV) infection is the most common cause of liver cancer in the world. In high incidence regions for liver cancer, such as Asia and Africa, HBV infection is highly endemic. Primary prevention by universal HBV immunization in infancy is currently the most effective way to prevent liver cancer. Using antiviral therapy to treat hepatitis B or hepatitis C with active viral replication is the method of secondary liver cancer prevention. Screening is needed to pick up high risk subjects of liver cancer (e.g. screening HBsAg among males &amp;gt; 40 years old in endemic areas of HBV infection and children of HBsAg carrier mothers, intravenous drug users; and screening hepatitis C virus antibody (anti-HCV) among intravenous drug users, children of HCV infected mothers, etc.). Regular follow-up of those subjects with positive serum HBsAg /anti-HCV is very helpful to find out the suitable target subjects for secondary prevention. We have provided the first evidence to support that universal HBV immunization can effectively reduce approximately 90% of chronic HBV infection and 70% of the incidence of hepatocellular carcinoma in children and adolescents. After universal HBV immunization in Taiwan, around 90% of chronic HBV infection occurs in children of mothers with chronic HBV infection. Globally, the difficulties of liver cancer prevention include inadequate resources, poor compliance, and breakthrough infection of HBV by mother-to-infant transmission. In order to prevent mother-to-infant transmission, globally there are three main HBV immunization strategies to screen or not to screen the HBsAg /HBeAg among pregnant women, and to give or not to give HBIG. In under-developed or developing environment with limited resources, no screening of maternal HBsAg/HBeAg and thus no HBIG but three doses of HBV vaccine are given to the infants. This is the most commonly applied strategy in the world. Another two different screening strategies for pregnant women were provided in the environment with relatively adequate resources: (1) screening pregnant women for HBsAg only (e.g. in the U.S.A) and give HBIG for all infants of HBsAg positive mothers, or (2) screening for both HBsAg and HBeAg (e.g. in Taiwan), and give HBIG for infants of HBeAg positive HBsAg carrier mothers only. Which of the above mentioned strategies are more cost-effective is still debatable Our recent studies revealed that infants born to HBeAg seropositive HBsAg carrier mothers were the major high risk group of breakthrough chronic HBV infection in an HBV immunized birth cohort. Pregnant women screening for both HBsAg and HBeAg is favorable for both maternal- child health and liver cancer prevention. In conclusion, universal HBV immunization and screening of high risk groups are needed for a successful control of liver cancer. The successful experience of liver cancer prevention may be applied to the prevention of other infection related cancers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr SY26-03. doi:1538-7445.AM2012-SY26-03

More Lessons From the Taiwanese Hepatitis B Virus Vaccine Program

In this issue of The Journal of Infectious Diseases, the Taiwan National Children’s Hospital group, under the capable leadership of Dr Mei-Hwei Chang, has once again used carefully constructed national surveillance data to teach us something about hepatitis B virus (HBV) infection in young subjects who received neonatal HBV vaccine. As one would predict, the highest rates for acute HBV infection were in unvaccinated individuals. Also, as expected, rates of acute HBV infection were lower in vaccinated birth cohorts aged 15–24 years than in unvaccinated birth cohorts, demonstrating once again the efficacy of the universal newborn vaccination program. The biggest disappointment was that, due to breakthrough HBV infection from mother-to-infant transmission, vaccinated infants (0.78 per 100 000) had higher rates than those aged 1–14 years (0.04 per 100 000), who had the lowest rates. It is disconcerting that the 8 infants who were born to mothers with hepatitis B e antigen, and who developed acute HBV infection in the first year of life, were not given neonatal hepatitis B immunoglobulin (in accordance with Taiwan national vaccine policy). Although the authors discuss this problem and acknowledge that the combination of active and passive vaccination for all infants born to hepatitis B surface antigen (HbsAg)–positive women is 85%–95% effective in preventing transmission, it is puzzling that the authors do not recommend a change in the Taiwan national vaccine policy to that effect. The authors also do not comment on the fact that the infants were given the first dose of recombinant HBV vaccine at 2–43 days of life instead of within 12 hours of birth, as per the recommendation of the American Academy of Pediatrics. It is also unfortunate that there is no clinical information available to inform us whether the cases of acute HBV in vaccinated subjects differed phenotypically from cases in unvaccinated subjects. Likewise, with somewhat incomplete information, it is difficult to know if reporting physicians could be 100% accurate in differentiating acute HBV from acute on chronic HBV infection, because a liver biopsy and previous serology were necessary for that distinction but not always available. Although the success of the aggressive universal infant vaccine program was mentioned only in passing, it is important to acknowledge the tremendous achievement this program (95% vaccine coverage beginning in 2001) has already demonstrated by its efficacy in reducing rates of chronic HBV, fulminant HBV, and hepatocellular carcinoma in children. Certainly, the decline in acute HBV cases in Taiwan from 2001 to 2008 is a remarkable success. The most useful and cost-effective conclusions from this careful study are that energetic follow-up during the first 12 months of life should be focused on infants born to HbsAg-positive mothers and that, in a country like Taiwan where HBV is endemic, vaccine efforts could be focused on subjects $25 years of age who have not benefited from the universal newborn vaccination program. Given the cost in terms of both human suffering from chronic HBV liver disease and hepatocellular carcinoma and related public health expenditures, we should all continue to admire the Taiwan National Children’s Group for their efforts to analyze how best to reduce those costs, and to learn from them.

Intramuscularvsintradermal route for hepatitis B booster vaccine in celiac children

To compare intradermal (ID) and intramuscular (IM) booster doses, which have been used in healthy and high risk subjects, such as healthcare workers, haemodialysis patients, human immunodeficiency virus patients, and renal transplant recipients unresponsive to initial hepatitis B vaccination, in celiac individuals. We conducted our study on 58 celiac patients, vaccinated in the first year of life, whose blood analysis had showed the absence of protective hepatitis B virus (HBV) antibodies. All patients had received the last vaccine injection at least one year before study enrolment and they had been on a gluten free diet for at least 1 year. In all patients we randomly performed an HBV vaccine booster dose by ID or IM route. Thirty celiac patients were revaccinated with recombinant hepatitis B vaccine (Engerix B) 2 μg by the ID route, while 28 celiac patients were revaccinated with Engerix B 10 μg by the IM route. Four weeks after every booster dose, the anti-hepatitis B surface (HBs) antibody titer was measured by an enzyme-linked immune-adsorbent assay. We performed a maximum of three booster doses in patients with no anti-HBs antibodies after the first or the second vaccine dose. The cut off value for a negative anti-HBs antibody titer was 10 IU/L. Patients with values between 10 and 100 IU/L were considered "low responders" while patients with an antibody titer higher than 1000 IU/L were considered "high responders". No significant difference in age, gender, duration of illness, and years of gluten intake was found between the two groups. We found a high percentage of "responders" after the first booster dose (ID = 76.7%, IM = 78.6%) and a greater increase after the third dose (ID = 90%, IM = 96.4%) of vaccine in both groups. Moreover we found a significantly higher number of high responders (with an anti-HBs antibody titer > 1000 IU/L) in the ID (40%) than in the IM (7.1%) group, and this difference was evident after the first booster dose of vaccination (P < 0.01). No side effects were recorded in performing delivery of the vaccine by either the ID or IM route. Our study suggests that both ID and IM routes are effective and safe options to administer a booster dose of HBV vaccine in celiac patients. However the ID route seems to achieve a greater number of high responders and to have a better cost/benefit ratio.

Hepatitis B Immunization in Health Care Workers: Needs and Opportunities

Hepatitis B Immunization in Health Care Workers: Needs and Opportunities

Effect of High-Flux Hemodialysis on Delayed Hepatitis B Virus Vaccination Response in Hemodialysis Patients

Objectives: The aim of the study was to evaluate the effect of high-flux (HF) hemodialysis (HD) on delayed protective hepatitis B virus (HBV) antibody seroconversion in HD patients who had no response to the classic third dose of HBV vaccination. Methods: We performed a prospective cohort study. Forty-two patients who did not respond within 6 months after the third dose of the vaccination were enrolled in the study. The patients were randomized to either an HF HD treatment group (n =19) or a conventional HD treatment group (n = 23). Patients' serum hepatitis B surface antibody levels were followed monthly. Results: After 6 months of follow-up, there were 15 (78.9%) patients in HF group and 7 (30.4%) patients in the control group showing delayed HBV vaccination response. The level of antibody titer of HBV vaccination responders was 103.6 ± 48.3 mIU/mL in the HF group and 23.5 ± 15.7 mIU/mL in the control group. The antibody titer did not correlate with sex, age, serum albumin, or hemoglobin in either group. Four patients in control group lost HBV vaccination response > 2 times after 3 months of follow-up, whereas no patients in the HF group lost HBV vaccination response. Conclusion: Hemodialysis patients who do not respond to the classic third dose of HBV vaccination could reobtain a delayed higher protective HBV antibody seroconversion rate by HF HD without other intervention.