Hepatitis B Virus Vaccine Series Research Articles

Prevalence and predictors of non-response to hepatitis B vaccination among dialysis patients

Abstract Background: Chronic hepatitis B virus (HBV) infection remains a global health problem and a leading cause of cirrhosis and hepatocellular carcinoma. Dialysis patients have an increased risk of contracting HBV due to shared dialysis machines, use of blood products and arteriovenous fistula or graft needling. The efficacy of HBV vaccination series is reduced in dialysis patients. The efficacy of this intervention needs to be better studied in South Africa. Methods: All patients undergoing dialysis at a large urban hospital who had received the HBV vaccine at least 6 months prior had the following variables documented: demographics; aetiology of end stage kidney disease (ESKD); mode of dialysis; history of smoking or immunosuppression; body mass index (BMI) and serology (HBV, hepatitis C virus (HCV) and human immunodeficiency virus (HIV) status). The prevalence of non-response to the HBV vaccination and predictors of non-response in these patients was determined. Results: 129 patients were included with a median age of 45 years, 52.7% were male, 14.3% were HIV positive and 2.3% were HCV infected. 21% of patients had a BMI greater than 30kg/m². 8.5% of patients received immunosuppression. The commonest cause of ESKD was ‘unknown aetiology’ (39.5%) followed by hypertension (31.0%). 55% were receiving haemodialysis and 45% peritoneal dialysis. 21.7% of the cohort had not adequately responded to the HBV vaccine. Immunosuppression was associated with poorer HBV vaccine response (p = 0.0498); no other variables predicted seroconversion. Conclusion: This study from a large urban hospital in Johannesburg, South Africa, demonstrated a seroconversion rate similar to international studies. Only the use of immunosuppression showed a lower odds ratio of a successful vaccination.

Prevalence and predictors of non-response to hepatitis B vaccination among dialysis patients

Abstract Background: Chronic hepatitis B virus (HBV) infection remains a global health problem and a leading cause of cirrhosis and hepatocellular carcinoma. Dialysis patients have an increased risk of contracting HBV due to shared dialysis machines, use of blood products and arteriovenous fistula or graft needling. The efficacy of HBV vaccination series is reduced in dialysis patients. The efficacy of this intervention needs to be better studied in South Africa. Methods: All patients undergoing dialysis at a large urban hospital who had received the HBV vaccine at least 6 months prior had the following variables documented: demographics; aetiology of end stage kidney disease (ESKD); mode of dialysis; history of smoking or immunosuppression; body mass index (BMI) and serology (HBV, hepatitis C virus (HCV) and human immunodeficiency virus (HIV) status). The prevalence of non-response to the HBV vaccination and predictors of non-response in these patients was determined. Results: 129 patients were included with a median age of 45 years, 52.7% were male, 14.3% were HIV positive and 2.3% were HCV infected. 21% of patients had a BMI greater than 30kg/m². 8.5% of patients received immunosuppression. The commonest cause of ESKD was ‘unknown aetiology’ (39.5%) followed by hypertension (31.0%). 55% were receiving haemodialysis and 45% peritoneal dialysis. 21.7% of the cohort had not adequately responded to the HBV vaccine. Immunosuppression was associated with poorer HBV vaccine response (p = 0.0498); no other variables predicted seroconversion. Conclusion: This study from a large urban hospital in Johannesburg, South Africa, demonstrated a seroconversion rate similar to international studies. Only the use of immunosuppression showed a lower odds ratio of a successful vaccination.

Hepatitis B virus infection, associated factors, knowledge and vaccination status among household contacts of hepatitis B index cases in Mwanza, Tanzania

ObjectivesTo determine the prevalence of hepatitis B virus (HBV) infection, knowledge regarding HBV, vaccination status, and associated factors among household contacts of HBV index cases in Mwanza, Tanzania. MethodsBetween July and August 2023, a cross-sectional study involving 97 index cases and 402 household contacts was conducted. Data were collected using pre-tested structured questionnaire and blood samples were collected from household contacts for HBV surface antigen (HBsAg) testing. ResultsThe prevalence of HBV among household contacts was 5.4% (95% confidence interval, 2.9-9.0) with a significantly high proportion observed in > 45 years (16.6%) and in males (9.9%). A total of 40.0% of the household contacts had completed the full HBV vaccination series. On multivariate analysis, being male was significantly associated with HBsAg positivity (odds ratio: 7.16, 95% confidence interval: 1.81-28.2, P = 0.005). ConclusionAbout one-tenth of adults’ male household contacts were HBsAg positive. In addition, the majority of household contacts had poor to fair knowledge regarding HBV infection with more than half being unvaccinated against HBV. There is a need to enhance awareness and education regarding HBV infection among household contacts in Tanzania and other low- and middle-income countries.

Knowledge, Health Practices and Policies for Hepatitis for Midwifery and Nurses in Allied and District Hospital Faisalabad

Background: Hepatitis B Virus (HBV) is a critical global health concern with significant morbidity and mortality. Nurses and midwives, as frontline healthcare professionals, are particularly vulnerable to HBV infection. This study focuses on evaluating the knowledge, attitudes, and practices (KAP) related to HBV among these groups in Faisalabad, Pakistan, a region with limited existing research on this topic. Methods: A descriptive, cross-sectional study was conducted in two major public maternity hospitals in Faisalabad (District and Allied hospitals). A structured questionnaire, pre-tested for validity, was administered to assess the KAP towards HBV. Statistical analysis was performed using SPSS Version 21, applying chi-square tests to explore associations between categorical variables. Results: The study sampled 110 healthcare workers (nurses and midwives). Key findings included Knowledge to be 58.2% of participants had an average level of HBV knowledge, Attitudes to be A majority displayed a positive attitude towards HBV prevention, Practices to be 65.5% reported adhering to safe practices. However, a clear percentage of 51.8% had experienced needlestick injuries. Vaccination and PEP found to be only 40.9% completed the HBV vaccination series, and 50% held misconceptions regarding HBV post-exposure prophylaxis. Conclusion: The study reveals a considerable awareness of HBV among nurses and midwives in Faisalabad hospitals, yet highlights critical gaps in both knowledge, particularly concerning PEP, and practices, as evidenced by high rates of needlestick injuries and low vaccination completion. These findings call for intensified efforts in occupational safety, education on HBV, and increasing vaccination coverage among healthcare workers.

Strategies to Prevent Mother-to-child Transmission of Hepatitis B Virus.

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is the primary cause of chronic HBV infection worldwide. MTCT prevention and antiviral treatment of infected individuals could eliminate this public health burden. Antiviral treatment of hepatitis B surface antigen (HBsAg)-positive pregnant women and immunoprophylaxis with HBV vaccine and hepatitis B immune globulin are the most effective strategies to interfere with MTCT of HBV. However, for worldwide application of those strategies, feasibility, availability, cost, safety, and effectiveness should be considered. Cesarean section and breastfeeding avoidance in hepatitis B e antigen-positive mothers with a high viral load and without antiviral therapy during pregnancy could be an option, but more supporting evidence is needed. HBsAg screening of all pregnant women is recommended when initiating antiviral therapy and immunoprophylaxis for MTCT prevention, except in areas with limited resources. Timely HBV vaccination series administered soon after birth might be the mainstay of prevention. This review aimed to provide a concise update on the effectiveness of available strategies to prevent MTCT of HBV.

Improving Hepatitis B Vaccination Rates among At-risk Children and Adolescents with Inflammatory Bowel Disease.

Introduction:Patients with inflammatory bowel disease (IBD) receiving tumor necrosis factor alpha inhibitors (TNFai) may be at higher risk for hepatitis B virus (HBV) infection. We conducted a quality improvement (QI) initiative to improve HBV vaccination rates in seronegative children with IBD.Methods:This QI initiative implemented an HBV vaccination strategy from September 2018 to March 2020 in patients with newly diagnosed IBD with hepatitis B surface antibody (HBsAb) <10 mIU/mL. The project aimed to (1) increase HBV vaccination rates in seronegative patients and (2) document immunogenicity after completing a three-dose vaccine series. Outcome measures included the percentage of seronegative patients who received HBV vaccines (dose 1 and three-dose series). Interventions included applying a standardized vaccination protocol, and creating a vaccine workflow in two clinical areas, previsit planning and stakeholder engagement.Results:One hundred seventy-four children and adolescents with IBD were evaluated during the study period, and 132 (76%) were HBsAb negative. After plan-do-study-act (PDSA) 1, the proportion of eligible patients who received HBV vaccine dose 1 increased from a baseline of 7% to 100% and was sustained for over 12 months. During PDSA 2, the proportion of patients completing the three-dose vaccine series improved from a baseline of 0% to 82% (n = 100); among 93 children in this subgroup who had repeat serology performed, 86 (92%) demonstrated serologic evidence of HBV protection.Conclusions:A multidisciplinary approach applying QI methodology allowed for improved and sustained HBV vaccination rates in at-risk seronegative children and adolescents with IBD. A three-dose HBV vaccine series proved immunogenic in 92% of eligible patients.

Sibling status, home birth, tattoos and stitches are risk factors for chronic hepatitis B virus infection in Senegalese children: A cross‐sectional survey

Sub-Saharan Africa's hepatitis B virus (HBV) burden is primarily due to infection in infancy. However, data on chronic HBV infection prevalence and associated risk factors in children born post-HBV vaccination introduction are scarce. We estimated hepatitis B surface antigen (HBsAg) prevalence and risk factors in Senegalese children born during the HBV vaccination era. In 2018-2019, a community-based cross-sectional survey was conducted in Senegal among children born between 2004 and 2015 (ie after the three-dose HBV vaccine series was introduced (2004) but before the birth dose's introduction (2016)). HBsAg-positive children were identified using dried blood spots. A standardized questionnaire collected socioeconomic information. Data were age-sex weighted and calibrated to be representative of children living in the study area. Risk factors associated with HBsAg positivity were identified using negative binomial regression. Among 1,327 children, 17 were HBsAg-positive (prevalence=1.23% (95% confidence interval [CI] 0.61-1.85)). Older age (adjusted incidence-rate ratio [aIRR] 1.31 per one-year increase, 95% CI 1.10-1.57), home vs healthcare facility delivery (aIRR 3.55, 95% CI 1.39-9.02), stitches (lifetime) (aIRR 4.79; 95% CI 1.84-12.39), tattoos (aIRR 8.97, 95% CI 1.01-79.11) and having an HBsAg-positive sibling with the same mother (aIRR 3.05, 95% CI 1.09-8.57) were all independently associated with HBsAg positivity. The low HBsAg prevalence highlights the success of the Senegalese HBV vaccination program. To further reduce HBV acquisition in children, high-risk groups, including pregnant women and siblings of HBsAg-positive individuals, must be screened. Vital HBV infection prevention measures include promoting delivery in healthcare facilities, and increasing awareness of prevention and control procedures.

Perinatal Hepatitis B Prevention: Eliminating Disease and Disparity.

* Abbreviations: HBsAg — : hepatitis B surface antigen HBV — : hepatitis B virus PEP — : postexposure prophylaxis PHBPP — : Perinatal Hepatitis B Prevention Program PVST — : postvaccination serological testing The role of the United States in global efforts to eliminate hepatitis B virus (HBV) infection cannot be overstated when HBV together with hepatitis C virus infection accounts for 96% of the 1.34 million viral hepatitis deaths annually.1 Most HBV infections occur perinatally and in early childhood and thus are preventable by early and widespread HBV vaccination.1,2 In this month’s issue of Pediatrics , Koneru et al3 describe programmatic outcomes among 103 825 infants born to hepatitis B surface antigen (HBsAg)–positive women, case managed by the Centers for Disease Control and Prevention’s national Perinatal Hepatitis B Prevention Program (PHBPP). Starting in 1990, PHBPP has been instrumental in identifying and tracking infants exposed to HBV. Among the estimated number of infants born to HBsAg-positive women, PHBPP has increasingly succeeded in identifying exposed infants, with identified infant rates rising from 42.1% in 1994 to 52.6% in 2017.3,4 From 2014 to 2017, the infant hepatitis B postexposure prophylaxis (PEP) rose from 94.7% to 97%, vaccine completion from 83.1% to 84.7%, and postvaccination serological testing (PVST) significantly increased from 58.8% to 66.8%. … Address correspondence to Esther K. Chung, MD, MPH, 6200 NE 74th St, Box 354920, Seattle, WA 98115. E-mail: ekc16{at}uw.edu

Natural History of Chronic Hepatitis B Infection Among Chinese Children and Young Adults: A Single-Center Experience.

There are limited data on the natural history of chronic hepatitis B virus (HBV) infection in Asian American children. The aim of the present study was to describe a single-center experience of chronic HBV infection in Chinese American patients in New York City. A retrospective chart review was conducted for patients with chronic HBV infection who had pediatric visits from 2006 to 2017. Clinical and laboratory data were collected to characterize the status of HBV infection and its disease course both cross-sectionally and longitudinally. Available maternal charts were reviewed. Of the total 353 patients, 72 patients (20%) were US-born. Positive hepatitis B envelope antigen (HBeAg) was documented in 208 patients (58%). Three phases of chronic HBV infection were categorized for 329 patients: immune-tolerant 112 (34%), HBeAg-positive immune-active 47 (14%), and inactive carrier 82 (25%). The remaining 88 patients (27%) did not fit into a particular category with 26 of 88 patients meeting the criteria for inactive carrier except for mildly elevated alanine aminotransferase. Age and liver enzyme levels were significantly different between HBeAg-positive and HBeAg-negative groups (P < 0.05). Among 179 patients followed for ≥5 years, the spontaneous seroconversion rate was 38%. In eight patients with linked maternal data, all children completed the HBV vaccine series and seven of eight received hepatitis B immunoglobulin. All mothers were HBeAg-positive with high HBV DNA and had no anti-viral therapy during pregnancy. Both immune-tolerant and inactive carrier phases were common for chronic HBV infection with a spontaneous seroconversion rate of 38%. All US-born patients were born in the era of implemented universal immune-prophylaxis.

Vaccination Coverage and the Risk of Hepatitis B Virus Infection amongst Medical and Paramedical Students Practicing at the Bamenda Regional Hospital in Cameroon Sub-Saharan Africa

Introduction: The endemic nature of hepatitis B virus (HBV) in Sub-Saharan Africa is a significant public health problem that places health care providers (medical students inclusive) at increased risk of occupational exposure. However, vaccination against HBV is not systematic among medical students in Cameroon. Thus, we sought to evaluate awareness and HBV vaccine coverage amongst medical students in Cameroon. Aim: The present study was aimed at determining the proportion of Medical and Paramedical students on internship at the Bamenda Regional Hospital (BRH) who are vaccinated and immune to hepatitis B virus (HBV). Methods: This was a hospital-based cross sectional study carried out at the BRH in Cameroon. Questionnaires were administered to 120 participants who signed an informed consent form and venous blood samples collected in dry tubes for the HBV-5 PANEL test. Data were collected within a period of two weeks. HBV vaccine status was defined as complete (3 doses), partial (1 or 2 doses), and unvaccinated. Results: Of 120 participants (87 females and 33 males), 56 (46.7%) were vaccinated at least once against HBV; 15 (12.5%) were partially vaccinated and 41 (34.2%) completely vaccinated. Out of the 56 vaccinated individuals, only 13 (23.2%) were confirmed immunized against HBV by testing positive for hepatitis B surface antibodies. Only 3 (5.4%) students had done post-vaccination serologic test to confirm their immunized status. There was high exposure to potentially infected body fluids like blood (97.5%) and urine (87.5%). There was equally poor practice of adequate preventive measures like regular hand washing and the proper use of personal protective equipment. A prevalence of 3.1% of HBV amongst the unvaccinated group was recorded. Conclusion: Only 1 in 3 medical students had completed the HBV vaccination series and only 26.8% of this cohort was confirmed immunized against HBV. This highlights the need for improved health policies aimed at increasing access and coverage of HBV immunization in high risk groups such as health workers.

Vaccine-induced protection against hepatitis B in pediatric solid organ transplant patients.

Vaccination against hepatitis B virus (HBV) has led to a worldwide reduction in disease burden and mortality. Vaccine immunogenicity data in transplanted children are limited, and vaccine-induced protection may be reduced. We evaluated HBV vaccination coverage, seroprotection rates, and factors influencing vaccine immunity among pediatric solid organ transplant (SOT) patients. We retrospectively identified patients ≤21years of age evaluated for SOT and/or transplanted at our center between January 1, 2015, and December 31, 2018. A detailed chart review was conducted using a standard questionnaire to gather information on demographic, clinical, and laboratory features of patients' HBV vaccination, and hepatitis B surface antibody (HBsAb) titers. A total of 381 patients undergoing evaluation and/or transplantation were included: 139 (36.5%) liver, 138 (36.2%) kidney, and 104 (27.3%) heart. Overall, HBsAb at evaluation was reactive in 216 (56.7%), indeterminate in 17 (4.5%), non-reactive in 138 (36.2%), and not available in 10 (2.6%). Of those that completed a primary HBV vaccine series (n=304), HBsAb was reactive in 164 (53.9%), indeterminate in 13 (4.3%), non-reactive in 119 (39.1%), and not available in 8 (2.6%). For those up to date for age on HBV vaccinations with non-reactive/indeterminate titers at evaluation, revaccination and a follow-up HBsAb were available in 45 patients of which 33 (73.3%) seroconverted to a reactive HBsAb titer. Vaccine-induced protection against HBV infection among high-risk pediatric SOT recipients can be improved by serology-based intervention. Though the absence of HBsAb does not always indicate loss of protection, boosting or completing primary series is recommended.

Use of Capture-Recapture Analysis to Assess Reporting Completeness of Births to Hepatitis B-Positive Women in New York City, 2013-2014.

The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) depends on reporting by health care facilities and laboratories for disease surveillance. Our objective was to evaluate the completeness of DOHMH surveillance to identify births to hepatitis B virus (HBV)-positive women to prevent perinatal transmission. We identified infants born to HBV-positive women by matching mothers of all infants born in NYC during May 1, 2013-May 1, 2014, identified from the Citywide Immunization Registry (CIR) to persons with HBV-positive laboratory reports in the Electronic Laboratory Reporting (ELR) system. We then matched infants born to mothers identified in the CIR/ELR match to infants born to HBV-positive women from the DOHMH perinatal HBV surveillance database. We performed capture-recapture analysis to evaluate completeness of DOHMH case identification. We compared the proportion of infants born to HBV-positive mothers reported to DOHMH with the proportion of infants identified only through the CIR/ELR match for receipt of postexposure prophylaxis (PEP) and completion of the HBV vaccination series and post-vaccination serology testing. Of 1662 infants identified from the CIR/ELR match and 1554 infants in the DOHMH database, 1493 infants matched. Of 169 infants only in the CIR/ELR data set, 55 were born to HBV-positive women residing in NYC. Sixty-one infants were only in the DOHMH database. An estimated 2 infants were not identified by either method. The CIR/ELR match increased infant identification by 3.5%, from 1554 to 1609 infants. The proportion of infants who received PEP was significantly higher among infants whose mothers were reported to DOHMH (vs not reported to DOHMH). Use of the CIR/ELR match may further improve DOHMH identification of infants born to HBV-positive women and receipt of infant PEP.

Outcome of Repeated Vaccination to Hepatitis B Virus in Patients Failing to Respond to Vaccination Following Allogeneic Hematopoietic Stem Cell Transplantation (HSCT): If at First You Don't Succeed, Try Try Again

Background: Recipient immunity is compromised after HSCT, obligating patients (pts) to take prophylactic antimicrobial and antiviral agents and to be reimmunized to viral and bacterial pathogens. Hepatitis B virus (HBV) infection is a major public health problem, with about 30% of the world population having serological evidence of current or past HBV infection. HBV vaccination post-HSCT is imperative in these pts, as most lose protective HBV surface antibodies (anti-HBs) following conditioning, placing them at high risk for HBV reactivation. Guidelines recommend delaying vaccination (including HBV) for 6-12 months following transplantation to allow for cellular and humoral immune recovery. Even with delaying vaccination, immunosuppression, graft-versus-host disease (GVHD), and delayed immune reconstitution hinder the effectiveness of vaccines. The efficacy of HBV vaccination is not well defined in pts on immunosuppressive therapy (IST) and/or in those with GVHD. Further, little data exists on the efficacy of HBV revaccination in pts failing to respond to the 1st vaccination series. We studied factors impacting the success of vaccination in pts undergoing one to four HBV vaccination series after HSCT. Methods: This single-center, retrospective study evaluated the effectiveness of HBV vaccine in HSCT pts by assessing protective antibody generation after vaccination. Fifty-two pts (25 female, 27 male) who received at least one 3-dose HBV vaccination series post-HSCT and who had evaluable post-vaccine anti-HBs titers were included in the analysis. Pts with negative or indeterminate anti-HBs titers following the first vaccine series were eligible to receive one or more additional series of HBV vaccinations. All pts were treated with cyclophosphamide and fludarabine based conditioning (± anti-thymocyte globulin) and received GVHD prophylaxis with either cyclosporine/tacrolimus with or without mycophenolate mofetil. The vaccine response rate over a series of vaccinations was estimated by Kaplan-Meier methods. The development of response after the first vaccination was correlated with patient baseline and post-HSCT factors including pretransplant HBV titers, vaccination time post-transplant, use of rituximab and IST and absolute lymphocyte count (ALC), CD4, and CD8 cell counts and history of acute or chronic GVHD. Results: The studied cohort included 52 HSCT pts with a median age of 22 years (range 7-62) and a variety of diagnoses (38 aplastic anemia, 6 myelodysplastic syndrome and 8 hematological malignancies). Thirty-five pts underwent HSCT from an HLA-matched donor and 17 pts received a combined haploidentical and umbilical cord blood transplant. The median time to first HBV vaccination was 12 months (8-37) post-HSCT. Following the 1st vaccination series; 19, 4 and 2 pts received a 2nd, 3rd and 4th vaccination series. The estimated cumulative anti-HBs response rates were 51.9%, 82.3%, 91.1% and 100% for the four vaccination series, respectively (Figure). A logistic regression analysis revealed: a) Pts who achieved a response after the initial vaccination series had higher CD4 counts compared to those who failed to mount a response (median CD4 count 450 vs. 300/μL, P= 0.024, Figure); b) Pts without a history of acute GVHD (n=23) were significantly more likely to respond to the 1st vaccination series compared to those with acute GVHD (n=29) (response: 69.6% vs 37.9%, P= 0.029). Other factors included in this analysis were not found to be correlated with the anti-HBs response after the initial vaccination series. Conclusions: Multiple rounds of HBV vaccination may be required before a protective antibody response is achieved. After the first vaccination series, only 51.9% of pts achieved a response, with lower pre-vaccination CD4 counts and a prior history of acute GVHD being negatively associated with vaccine success. Remarkably, with continued vaccination attempts (up to four vaccination series), all evaluable pts ultimately developed a protective anti-HBs response. Figure Disclosures Shalabi: GlaxoSmithKline: Other: Spouse is employed by GSK Pharma.

Stability of hepatitis B viral load during pregnancy and implications for antepartum prophylaxis: A prospective cohort study.

We examined changes in hepatitis B virus (HBV) viral loads (VLs) in pregnancy, their association with hepatitis B e antigen (HBeAg), and the associated infant outcomes. We prospectively followed 132 mothers positive for hepatitis B surface antigen (HBsAg) and their 135 infants from 2011 to 2015 in Vancouver, British Columbia. Outcome measures included association between maternal HBeAg and high (>200,000 IU/mL) or low (≤200,000 IU/mL) HBV VL, changes in HBV VL through pregnancy, infant HBsAg status, and infant completion of the HBV vaccination series. f the 91 participants with an available HBV VL, 13 (14.3%) had an HBV VL of more than 200,000 IU/mL. Of 59 participants with paired HBeAg and HBV VL in pregnancy, 6 had an HBV VL of more than 200,000 IU/mL; of interest, 2 of the 6 (33.3%) were HBeAg-negative. Thirty-eight participants had HBV VL results at both mid-trimester and delivery. For these 38 participants, Wilcoxon signed-ranks test for paired data found that an HBV VL remained stable (p = .58). We observed no perinatal transmissions. However, 20.7% of infants did not have a documented complete HBV vaccination series, 20.0% did not have post-vaccination HBsAg testing completed, and 18% did not have anti-HBs titres measured by age 12 months. Our study demonstrates that HBeAg and HBV VL are not reliably predictive of each other. This supports the improved predictive value of VL measurement in pregnancy to risk stratify pregnant patients to offer antiviral treatment when indicated and further minimize the risk of perinatal transmission.

Response to hepatitis B vaccination in patients with inflammatory bowel disease: a prospective observational study in Korea.

Background/AimsTesting for hepatitis B virus (HBV) serologic markers and appropriate vaccination are required in the management of inflammatory bowel disease (IBD) patients. We evaluated immunogenicity for HBV in IBD patients and the response to the HBV vaccination.MethodsFrom May 2014 to August 2016, patients diagnosed with IBD were prospectively included and evaluated for antibody to hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen. Among the 73 patients who were confirmed with nonimmunity to HBV, 44 patients who had completed the 3-dose HBV vaccination series received a single booster vaccination, while 29 patients who had not completed the vaccinations series or were unsure of receiving the vaccination received a full vaccination series.ResultsAn optimal response was obtained in 70.5% of the patients in the booster group, and 89.7% of the patients in the full vaccination group. Age younger than 26 years (odds ratio [OR], 6.01; 95% confidence interval [CI], 1.15–31.32; P=0.033) and a complete previous vaccination series (OR, 0.15; 95% CI, 0.03–0.80; P=0.026) were associated with optimal vaccine response. Previous complete vaccination series (OR, 0.11; 95% CI, 0.02–0.73; P=0.022) was the only predictive factor for lower compliance.ConclusionsThe response to the HBV vaccination was lower in patients older than 26 years and for those patients with a complete vaccination history. Since patients with a complete vaccination history also had poor compliance, serum HBV-titers should be checked more thoroughly, and a full vaccination series should be administered in cases when there is a negative response to the booster vaccination.

Hepatitis A and B Seroimmunity in Vaccinated Children With Cirrhosis: Presidential Poster Award

Introduction: Superinfection with vaccine-preventable virus like hepatitis A virus (HAV) or hepatitis B virus (HBV) in patients with cirrhosis may induce rapid decompensation. Cirrhotic patients achieve lower response to HBV vaccination compared to healthy adults. HAV antibody titer is lower in patients with decompensated cirrhosis versus compensated cirrhosis. Our study aims to assess the incidence of hepatitis B surface antibody (HBV S Ab) titer (Ab QN) < 10 IU/l and non-reactive hepatitis A antibody (HAV Ab) titer (Ab QL) in vaccinated children with cirrhosis. Methods: All children, between ages 6 months and 17 years, with biopsy proven cirrhosis or clinically evident portal hypertension (CEPH) as defined by Childhood Liver Disease Research Network, who have confirmed completion of 3 dose HBV vaccination series and/or 2 dose HAV vaccination series were prospectively enrolled in our study. Children with past or present medical history of HAV or HBV infection and children with non-cirrhotic causes of portal hypertension were excluded. Once enrolled, we reviewed their basic demographics, physical exam findings, endoscopic findings, and lab results including HAV Ab QL and HBV S Ab QN from EMR. Results: So far, we have enrolled 12 patients, 4 boys and 8 girls with a mean age of 9.33 years. Ten patients have underlying diagnosis of biliary atresia. Half of these patients have biopsy proven cirrhosis. Onethird of our patients have platelet level < 150 k/cumm and half of our patients have splenomegaly on physical exam. In our preliminary data, the incidence of HBV S Ab < 10 IU/l is 41.7% and the incidence of non-reactive HAV Ab is 16.7%. All children with HBV S Ab < 10 IU/l and non-reactive HAV Ab are older than 5 years of age. The incidence of HBV S Ab < 10 IU/l and non-reactive HAV Ab in children older than 5 years of age is 62.5% and 25% respectively. All children found to have non-reactive HAV Ab are African American. Low HBV S Ab were present in 50% of children with documented splenomegaly compared to 33% without splenomegaly. Similarly, 60% of children with thrombocytopenia had HBV S Ab < 10 IU/l. Conclusion: There is a high incidence of low immune reactivity to HBV and HAV vaccination in children with cirrhosis. This reactivity seems to be lost with increasing age of the patients. Low HBV S Ab and non-reactive HAV Ab are associated with age > 5 years and African American race.1052 Figure 1 No Caption available.

Antibody Response to Hepatitis B Virus Vaccine is Impaired in Patients With Inflammatory Bowel Disease on Infliximab Therapy.

Studies have demonstrated an association between anti-TNF/immunomodulator agents used in inflammatory bowel disease (IBD) and impaired hepatitis B virus (HBV) vaccine immunogenicity, but little data exist on whether specific medication types affect protective HBsAb titers. Our aim was to analyze this association. This is a retrospective cohort study. Inclusion criteria: age ≥18, diagnosis of Crohn's disease (CD) or ulcerative colitis (UC), previous HBV vaccination series and/or ≥1 positive HBsAb, and record of IBD therapy in 6 months before titer level. Patients were stratified based upon medication exposures: anti-TNF, immunomodulator, combination anti-TNF and immunomodulatory, and a reference arm. Titer levels following vaccination and specific medication types given in the 6 months before titer were recorded. Seroprotection was defined as HBsAb ≥10 IU/l and ≥100 IU/l. The study cohort (N = 391) was 70.8% white, 51.4% female and 64.2% had CD and 35.8% had UC. The mean age was 45.8 years. A significantly lower percentage of patients exposed to anti-TNF, immunomodulator or dual therapy had titers ≥10 (P < 0.01). Regarding specific medications, only patients exposed to infliximab (P < 0.01) were less likely to have titer levels ≥10, after controlling for other medication exposures, age at titer level, and interval time between vaccination/titer level. This was not found for patients exposed to adalimumab, methotrexate, 6-mercaptopurine, or azathioprine. Patients exposed to infliximab were significantly less likely to have protective HBsAb titer levels following vaccination, a trend not seen in patients on adalimumab. Efforts to vaccinate IBD patients against HBV before use of immunomodulators and anti-TNFs, infliximab specifically, and screen periodically thereafter must be reinforced.

Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial.

Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample. A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention. Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.

High Prevalence of Hepatitis B Nonimmunity in Vaccinated Pediatric Liver Transplant Recipients

Durable protection from hepatitis B virus (HBV) and other vaccine-preventable diseases assumes great importance due to improved long-term patient and graft survival rates in pediatric liver transplantation. Vaccine immunogenicity data in transplanted children is limited. This was a cross-sectional, single-center, point-prevalence study evaluating HBV immunity in 160 pediatric liver transplant recipients. Patients with hepatitis B surface antibody levels <10 IU/L were considered nonimmune. Predictor variables for nonimmunity identified in univariate analyses were later analyzed within a logistic regression model. All subjects received the full HBV vaccination series prior to transplant. The majority (67%) of previously immunized pediatric liver transplant patients were nonimmune. Older children (p < 0.001) and children who were further out from transplant (p < 0.001) were more likely to be nonimmune in univariate analyses, but only time from transplant was a significant predictor of nonimmunity in a logistic regression model (odds ratio 1.3, p < 0.001 at 1 year). The mean time since transplant was 5.6 years ± 4.6. Markers of nutrition, immunosuppression, white blood cell parameters and type/severity of disease did not correlate with HBV immunity. Information on the anamnestic response to boosting or revaccination is needed to adequately address this vulnerable group.

Efficacy of neonatal HBV vaccination on liver cancer and other liver diseases over 30-year follow-up of the Qidong hepatitis B intervention study: a cluster randomized controlled trial.

Neonatal hepatitis B vaccination has been implemented worldwide to prevent hepatitis B virus (HBV) infections. Its long-term protective efficacy on primary liver cancer (PLC) and other liver diseases has not been fully examined. The Qidong Hepatitis B Intervention Study, a population-based, cluster randomized, controlled trial between 1985 and 1990 in Qidong, China, included 39,292 newborns who were randomly assigned to the vaccination group in which 38,366 participants completed the HBV vaccination series and 34,441 newborns who were randomly assigned to the control group in which the participants received neither a vaccine nor a placebo. However, 23,368 (67.8%) participants in the control group received catch-up vaccination at age 10-14 years. By December 2013, a total of 3,895 (10.2%) in the vaccination group and 3,898 (11.3%) in the control group were lost to follow-up. Information on PLC incidence and liver disease mortality were collected through linkage of all remaining cohort members to a well-established population-based tumor registry until December 31, 2013. Two cross-sectional surveys on HBV surface antigen (HBsAg) seroprevalence were conducted in 1996-2000 and 2008-2012. The participation rates of the two surveys were 57.5% (21,770) and 50.7% (17,204) in the vaccination group and 36.3% (12,184) and 58.6% (17,395) in the control group, respectively. Using intention-to-treat analysis, we found that the incidence rate of PLC and the mortality rates of severe end-stage liver diseases and infant fulminant hepatitis were significantly lower in the vaccination group than the control group with efficacies of 84% (95% CI 23%-97%), 70% (95% CI 15%-89%), and 69% (95% CI 34%-85%), respectively. The estimated efficacy of catch-up vaccination on HBsAg seroprevalence in early adulthood was 21% (95% CI 10%-30%), substantially weaker than that of the neonatal vaccination (72%, 95% CI 68%-75%). Receiving a booster at age 10-14 years decreased HBsAg seroprevalence if participants were born to HBsAg-positive mothers (hazard ratio [HR] = 0.68, 95% CI 0.47-0.97). Limitations to consider in interpreting the study results include the small number of individuals with PLC, participants lost to follow-up, and the large proportion of participants who did not provide serum samples at follow-up. Neonatal HBV vaccination was found to significantly decrease HBsAg seroprevalence in childhood through young adulthood and subsequently reduce the risk of PLC and other liver diseases in young adults in rural China. The findings underscore the importance of neonatal HBV vaccination. Our results also suggest that an adolescence booster should be considered in individuals born to HBsAg-positive mothers and who have completed the HBV neonatal vaccination series. Please see later in the article for the Editors' Summary.