Mean Titers Of anti-HBs Research Articles

Comparing the Efficacy of Double Dose Hepatitis B Vaccine with Conventional Dose Hepatitis B Vaccine in CLD Patients

Aim: To compare the efficacy of double dose hepatitis B vaccine with conventional dose hepatitis B vaccine in hepatitis C related chronic liver disease patients. Study design: Interventional study (randomized controlled clinical trial) Place and duration of study: Outpatient Department of Medicine, Services Hospital, Lahore from 12th August 2019 to 12th February 2020. Methodology: One hundred and ten patients of both male and female age group 30 to 70 years diagnosed with chronic liver disease on the basis of changed liver echo texture on ultrasound were included. Patients were divided into two groups, each group having 55 patients. One group was given double dose (2ml) while the other was given conventional dose (1ml). Both groups were compared for efficacy in terms of prevention of CLD. Results: The mean age of conventional group was 33.8±9.6 years while 33.7±9.1 years in the double dose group with male predominance (69.10%). Hypo-responsiveness was detected in 23.6% and 32.7% of conventional low dose group and double dose group respectively. There were gender variations in mean Anti-HBs levels. It was 129.80±70.53 mIU/mL in males and 113.26±75.57 mIU/mL in female patients (P= 0.039). Mean titers of anti-HBs in conventional dose group and high dose group were 127.82±67.59 mIU/mL and 121.56±77.00 mIU/mL, respectively (P= 0.52). Conclusion: Double dose hepatitis B vaccination in chronic HCV infected patients efficiently increases the response rate and hence protection against chronic hepatitis B. Keywords: Double dose hepatitis B vaccine, conventional hepatitis B vaccine, chronic hepatitis.

A New Insight into Updating the Hepatitis B Vaccination Strategy from an Experimental Study in Mice

Background: A new phenomenon has appeared that more and more child-bearing age women are positive for anti-HBs as a result of the effective hepatitis B vaccination. Whether maternal anti-HBs acquired transplacentally plays a negative role in newborn infants' immune response to hepatitis B vaccine (HepB Vac), it remains controversial and has not been paid enough attention. We first design the study to access if maternal anti-HBs inhibit the immune response of HepB Vac in mice Methods: From 2016 to 2018, 361 BALB/c mice were bred. All the mice were divided into two groups (group A and group B) according to the different doses of HepB Vac (2μg, 5μg) injected to mice. Each group was sub-divided into four subgroups according to the different doses of hepatitis B immunoglobulin (HBIG) (50 IU, 25 IU, 0 IU) injected combined with the first dose of HepB Vac and different intervals between HepB Vac doses (0- 4-8 week, 0-1-2 week). Antibody against hepatitis B surface antigen (anti-HBs) was tested four weeks after the third dose of HepB Vac. Findings: Among 361 mice, 10 were anti-HBs＜10 mIU/mL, 31 were anti-HBs＜ 100 mIU/mL and 199 were anti-HBs >1000 mIU/mL. Multivariate logistic regression analysis showed that among groups of HBIG=0 IU(1), HBIG=25IU(2) and HBIG=50 IU(3), anti-HBs＜100 mIU/mL accounted for 1*1%, 23*1%, 20*7% respectively, p= 0*002, (1) vs (3), RR= 0*032, 95% CI [0*004, 0*255], p= 0*001, (2) vs (3), RR= 1*359, 95% CI [0*588, 3*144], p= 0*473; HepB Vac 5 μg vs 2 μg, the rate of anti-HBs＜100 mIU/mL was 4*5% vs 25*6%, RR=0*093, 95% CI [0*035, 0*250], p=0*000; intramuscular injection vs hypodermic injection, the rate of anti-HBs＜100 mIU/mL was 6.1% vs 23*7%, RR=0*139, 95% CI [0*056, 0*346], p= 0*000. Among groups of HBIG= 0 IU, HBIG= 25 IU and HBIG= 50 IU, the mean titer of anti-HBs (log10mIU/m) in subgroup of HepB Vac 5 μg was 5*09±0*36, 4*29±1*07, 3*97±1*02 respectively, p= 0*000; the mean titer of anti-HBs (log10mIU/m) in subgroup of HepB Vac 2 μg was 4*89±0*59, 3*32±1*21, 2*56±0*85 respectively, p= 0*000. Group of 0-4-8 week vs 0-1-2 week, the mean titer of anti-HBs (log10mIU/m) in subgroup of HepB Vac 5 μg was 4*54±0*83 vs 5*09±0*36, p= 0*003; the mean titer of anti-HBs (log10mIU/m) in subgroup of HepB Vac 2 μg was3*97±0*85 vs 4*89±0*59, p= 0*000. Another multivariate logistic regression analysis showed that HBIG= 0 IU, HepB Vac 5μg and intramuscular injection are the independent promotion factors for anti-HBs >1000 mIU/mL. Interpretation: HBIG has a negative impact on both the rate of effective immune response and the response level of anti-HBs. Schemes of higher dose of HepB Vac, longer intervals between doses of HepB Vac and intramuscular injection can be considered as factors contributed to obtaining an optimal immune effect. Funding Statement: This study was funded by National Nature Science Foundation (youth scientific fund). grant number 81502900 Declaration of Interests: The authors declare that they have no conflict of interest. Ethics Approval Statement: The study was approved by the Ethics Committee of Qingdao Municipal Hospital affiliated with Qingdao University.

The efficacy of hepatitis B vaccination program in upper Egypt: Flow cytometry and the evaluation of long term immunogenicity.

Anti-HBs levels wanes with time. Many studies discussed the B cell response to HBV vaccine. However, the data about memory T cell response are limited. To evaluate the efficacy of hepatitis B vaccine via evaluating anti-HBs levels and HBsAg specific memory T-lymphocytes through descriptive study. The study was conducted in a tertiary care setting. This study included 440 vaccinated persons during infancy. Group I: 6 to less than 10 years old; Group II: 10 to less than 14 years old; Group III: 14 to less than 17 years old; Group IV: 17 years old. The serum samples were screened for HBV markers. Cytokines secretion by HBsAg-specific memory CD45RO(+) CD4(+) T cells was measured after in vitro culture using flow cytometry. The mean titer of anti-HBs was higher in group I in comparison to others (P-value = 0.000 for each). IFN-γ and IL-4 secreted by memory CD4(+) T cells were positive in all with anti-HBs >100 mIU/ml, while positive in 87% and 75% of participants with anti-HBs <10 mIU/ml and positive in 73% and 32% of participants with absent anti-HBs. The percentage of cells secreting IFN-γ and those secreting IL-4 were higher among participants with serum anti-HBs >100 mIU/ml than those having <10 mIU/ml or absent (P < 0.001 for each). Anti-HBs positivity decreased with time since childhood vaccination. Breakthrough infections are rare in vaccinated persons. Hepatitis-B vaccine is efficient in controlling HBV infection. Flow cytometry is a useful tool to assess the long term persistence of T cell memory after childhood vaccination. J. Med. Virol. 88:1567-1575, 2016. © 2016 Wiley Periodicals, Inc.

Immunoprophylaxis of Compulsory Hepatitis B Vaccination in Sharkia, Egypt

Background and study aim: Hepatitis B vaccination has been included in routine infant's immunization in Egypt since 1991. Although it could provide high levels of sero-protection, the duration of that protection remains largely unknown. The aim of this study was to evaluate the initial immunoprophylaxis response to compulsory hepatitis B vaccination and its long term protection in Egyptian children. Patients and methods: Antibodies to hepatitis B surface antigen (anti-HBs) was assessed in 200 apparently healthy Egyptian children.They were all vaccinated with hepatitis B vaccine in infancy through the compulsory vaccination program. They were classified into two groups, each contained 100 children. The 1st group included infants at least 2 months after completion of the 3 doses of the vaccine (≥8 months old). While the 2nd group included children aged 6-12 years old. Sera were obtained from all children and were tested for anti-HBs titer, HBsAg and antibodies to hepatitis B core antigen (anti-HBc) by ELISA. Children who were discovered to have non-protective titers (≤10 mIU/mL) received a booster dose of the vaccine and were re-evaluated within 2-4 weeks. Different factors associated with poor immune response were analyzed. Results: The initial responders rate of 83% was detected in group І which was significantly higher than that in group П of only 52%. Moreover, mean titer of Anti-Hbs was significantly decreased with age,( 48.9 ±15.8 mIU/ml in group І vs 12.6 ± 5.2 mIU/ml in group II). Also, within the 2nd group, a negative correlation between Anti-HBs mean level and age in years was displayed. No significant difference could be detected in the percentage of infected children between both groups (4% in group I vs.6% in group IІ). Sixty two percent of the boosted children showed a significant increase in their mean anti-HBs titer. Male gender and rural residence were associated with poor vaccine response in both groups. Conclusion: As maternal screening is not feasible in our country, Hep-B vaccine birth dose is a necessity to prevent perinatal infection. Most of infants vaccinated with compulsory Hep-B vaccine retained their immune protection years after vaccination either by high antiHBs titer or efficient memory T cells. However, large scale and long term follow up study is still needed before clearly answering the question about the need for booster dosing and its proper timing.

Immunogenicity of a new, low-cost recombinant hepatitis B vaccine derived from Hansenula polymorpha in adults

Background Hepatitis B virus (HBV) infection is highly prevalent world over, especially in developing countries. A new recombinant hepatitis B virus (GeneVac-B; Serum Institute of India Ltd.) vaccine is developed using Hansenula polymorpha yeast. We decided to assess the immunogenicity, and reactogenicity of this vaccine in a large adult population. Material and methods Seven hundred eighty-eight adults subjects (age: 19–57 years, male:female ratio 35:1) received three 20 μg doses of a H. polymorpha-derived recombinant hepatitis B vaccine in months 0, 1, and 6. All the eligible subjects had negative baseline serum HBs Ag, and anti-HBs. The anti-HBs titer was obtained 1 month after the last dose of vaccine and was considered seroconverted if more than 1 mIU/ml, and seroprotective if more than 10 mIU/ml. Results The seroprotection rate was 96% and seroconversion rate was 97%. Seroconversion and seroprotection rates declined with increasing age. The minimum geometric mean titre of anti HBs was 443 mIU/ml (95% CI 407–482). Seroprotection was 96% in age group <40 years, while the same was 91% in >40 years group (Odd's ratio—2.9100, Z value—2.6183, highly significant). No other factor like smoking, tobacco-chewing, alcohol consumption, chronic diseases, and obesity, affected the immune response. No significant adverse reactions were reported in any of the subjects. Conclusions Three standard doses of the H. polymorpha-derived recombinant HBV vaccine are highly immunogenic and safe in a predominantly male adult population. Young adults respond better with this vaccine. Because of its low cost, the vaccine may be a good choice in prevention of hepatitis B infection.

Immunogenicity of a combined hepatitis A and B vaccine in healthy young adults

Combining several vaccines in a single formulation can change the potency of the vaccine antigens. Previous studies suggested a higher immunogenicity of a new combined hepatitis A and B vaccine compared with the monovalent hepatitis B vaccine. We investigated the immune response to hepatitis B surface antigen 1 month after the third vaccine dose in 282 healthy adults who had received either a monovalent hepatitis B vaccine ( n=148) or the combined hepatitis A/B vaccine ( n=134). A slight trend towards higher geometric mean titres of anti HBs was found at this point in time in the group immunised with the combined vaccine, especially in the few vaccinees with preexisting antibodies against hepatitis A virus. However none of these differences was statistically significant, arguing against an advantage of the combined vaccine regarding hepatitis B immunisation.

Accelerated schedule of hepatitis B vaccination in patients with hemophilia

Early development of immunity after hepatitis B vaccination is particularly important for patients such as hemophiliacs, at high risk for acquiring hepatitis B from potentially infectious plasma-derived concentrates. The purpose of this study was to evaluate whether or not protective antibody titers could be achieved quickly and maintained in hemophiliacs by an accelerated vaccination schedule. A yeast-recombinant hepatitis B vaccine (Engerix B, SKF Ritt) was given subcutaneously in the deltoid region and repeated 2 and 6 weeks later to 85 hemophiliacs negative for hepatitis B virus (HBV) markers. After the first 22 patients had been enrolled, a modification of the schedule involving a fourth booster dose 24 weeks after the first dose of vaccine was applied to the next 63 consecutive vaccines. Fifty-three percent of vaccinees had antibody titers to hepatitis B surface antigen (anti-HBs > or = 10 mlU/ml) by week 6, even though the mean titers of anti-HBs were somewhat lower than those achieved historically in normal individuals. The protection rate had increased to 87% by week 10, one month after the third dose of vaccine, and to 93% by week 24. One year after starting vaccination, the rate for the vaccinees who did not receive the fourth booster dose was 71%, and 96% for those who did receive the fourth dose, with only 2 patients not responding despite the booster dose. It is concluded that even though the accelerated schedule of immunization produced rapidly high rates of protective antibody titers, a booster dose is required to obtain higher titers and provide more persistent immunity.

動物細胞由来遺伝子組換えHBワクチンとヒト血漿由来HBワクチンの接種効果の比較

Chinese Hamster Ovary Cell derived HB vaccine (CDV) and plasma derived HB vaccine (PDV) were separately given to two groups of 131 and 112 medical stuff subjected, and both the anti-HBs responses were observed for 24 months from the time of first injection. The anti-HBs positive rate at the 7th month was 97% (mean geometric anti-HBs concentration 588 IU/L) in CDV group and 78% (83 IV/L) in PDV group, and the positive rate and mean titer of anti-HBs were always higher for 24 months in CDV group. The differences were remarkable between both the subjects aged over 40 years. The decreasing curves of the anti-HBs titer in the two groups were almost parallel; accordingly, the protective efficacy was estimated to be far longer in CDV. Also, the rate of non-responder was less lower (2.8%) in CDV group than that (15.2%) in PDV group. Above results show that CDV has a higher immunogenicity than PDV.

Immune Response to a Recombinant Hepatitis B Vaccine in Hemodialysis Patients

A 20-microgram dose of a recombinant hepatitis B vaccine was given at 0, 1, 2 and 6 months to 24 hemodialysis patients. From month 7 (i.e., 1 month after the fourth injection), 58.3% (14/24) of the patients had developed protective levels of antibodies against hepatitis B surface antigen (anti-HBs). In patients responding to vaccination, the fourth injection led to an abrupt rise of the anti-HBs titres which reached their maximum 2 months later, that is, in month 8. At that time, the geometric mean titre of anti-HBs was 145.79 mlU/ml. Eighteen months after the start of vaccination, 50% (12/24) of the patients were maintaining protective levels of anti-HBs antibodies. It is noteworthy that these results could be obtained with a considerably lower dosage than previously recommended.

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

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

Is There any Difference in Antibody Titer Between Children and Adults after Recombinant Hepatitis B Vaccination?

Hepatitis B virus infection is an important public health problem with significant morbidity and mortality. Recombinant hepatitis B vaccine for the prevention of hepatitis B virus infection is in practice in different parts of the world since its availability in 1986. Government of Bangladesh has also included hepatitis B vaccine in EPI schedule since 2005. This study was carried out to assess the seroconversion status among hepatitis B vaccinated individuals. A total of 190 individuals including 150 vaccinated persons and 40 non-vaccinated apparently healthy individuals were included as study population. Sources of vaccinated persons were from both EPI and non-EPI schedule of vaccination. Age and sex matched non-vaccinated individuals served as controls for the study. All individuals constituting the study population were screened for HBsAg by Immunochromatographic strip test and only HBsAg-negative persons were included for estimation of their anti-HBs titer. Out of 150 vaccinated individuals, 133(88.67%) were found to have anti-HBs titer in the protective level (≥10 IU/L), while 17(11.33%) individuals had anti-HBs titer below the protective level (&lt;10 IU/L). All non-vaccinated controls had anti-HBs titers below the protective level. Regarding immune response developed among vaccinated individuals, 67.78%, 23.33% and 8.89% were good-responders, hypo-responders and nonresponders respectively. Mean titer of anti-HBs was found significantly higher among recipients who received booster dose than those who received 3 doses schedule (863.39 IU/L vs. 262.40 IU/L), indicating high antibody titer develops after booster dose. Vaccinated group included 85 (56.67%) men and 65 (43.33%) women with protective level of anti-HBs titer found in 85.88% male and 92.31% female individuals. Vaccinated individuals from lower socioeconomic condition have had comparatively low rate of protective antibody than people from middle and upper classes. Recombinant HB vaccine induces good level of protective immunity among vaccinated persons. The present study showed that the proportion of adults (93.33%) developed level of protective antibody titer was higher than that of children (83.33%). It indicates that there is difference of antibody titer between children and adults after recombinant Hepatitis B vaccination. doi: 10.3329/taj.v21i1.3210 TAJ 2008; 21(1): 1-11