Post-vaccination Serologic Testing Research Articles

Optimization of Mother-to-Child Hepatitis B Virus Prevention Program: Integration of Maternal Screening and Infant Post-vaccination Serologic Testing.

Evaluation of the impact on mother-to-child transmission (MTCT) of a HBV-prevention program that incorporates maternal antiviral prophylaxis is hindered by the limited availability of real-world data. This study analyzed data on maternal HBV screening, neonatal immunization, and post-vaccination serologic testing (PVST) for HBsAg among at-risk infants born to HBV carrier mothers from the National Immunization Information System during 01/01/2008-31/12/2022. Through linkage with the National Health Insurance Database, information of maternal antiviral therapy was obtained. Multivariate logistic regression was performed to explore MTCT risk in relation to infant-mother characteristics and prevention strategies. Totally, 2,460,218 deliveries with maternal HBV status were screened. Between 2008 and 2022, the annual HBsAg and HBeAg seropositivity rates among native pregnant women aged 15-49 years decreased from 12.2% to 2.6% and from 2.7% to 0.4%, respectively (p for both trends < 0.0001). Among the 22,859 at-risk infants undergoing PVST, the MTCT rates differed between infants born to HBsAg-positive/HBeAg-negative and HBeAg-positive mothers (0.75% and 6.33%, respectively; p < 0.001). The MTCT rate was 1.72% (11/641) for infants born to HBeAg-positive mothers with antiviral prophylaxis. MTCT risk increased with maternal HBeAg-positivity (OR 9.29, 6.79-12.73) and decreased with maternal antiviral prophylaxis (OR 0.28, 0.16-0.49). For infants with maternal HBeAg-positivity, MTCT risk was associated with mothers born in the immunization era (OR 1.40, 1.17-1.67). MTCT was related to maternal HBeAg-positivity and effectively prevented by maternal prophylaxis in the immunized population. At-risk infants born to maternal vaccinated cohorts might possibly pose further risk.

Implementation of Strategies to Prevent Mother-to-child Transmission of Hepatitis B Virus Infection, Thailand, 2016–2017

Mother-to-child transmission (MTCT) of hepatitis B virus can cause chronic liver disease. Thailand aimed to eliminate MTCT of hepatitis B virus by 2025. Strategies include hepatitis B surface antigen (HBsAg) screening for pregnant women, antiviral therapy for infected mother, hepatitis B birth dose vaccination (HepB-BD), HBV immunoglobulin (HBIG) administration and post-vaccination serologic testing (PVST) for infants born to HBsAg-positive mother. The objectives of this study were to assess the management of HBsAg-positive mothers and their infants. We reviewed medical records of HBsAg-positive pregnant women and their infants born during 1 Jan 2016–31 Dec 2017 at 14 hospitals in seven provinces to assess the percentage of women who were tested and treated for HBV and the percentage of infants born to them who received HepB-BD, HBIG and underwent PVST. All 69,303 pregnant women were screened for HBsAg and 1,179 (1.7%) were HBsAg positive. Of 1,179 HBsAg-positive women, 219 (18.6%) were tested for hepatitis B e-antigen (HBeAg) and 85 (38.8%) were HBeAg positive; 29 (2.5%) were tested for HBV DNA and 14 (48.3%) had viral load ≥200,000 IU/mL. Of 90 women eligible for antiviral therapy, 16 (17.8%) received treatment. Among 1,144 infants with available records, HepB-BD and HBIG coverage was 99.3% and 45.8%. Of 966 children with follow-up records, 12.2% underwent PVST and all were HBsAg negative. In conclusion, while the coverage of maternal HBsAg screening and infant HepB-BD was high, few women received follow-up testing and treatment. HBIG administration for infants was low and PVST rate still needed improvement.

Eliminating mother-to-child transmission of hepatitis B virus: practice and progress in Baoan, a national pilot district of China

BackgroundWhile mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains a significant challenge in China, research investigating the effectiveness of the September 2017 pilot program to eliminate MTCT of HIV, syphilis, and HBV is limited. Baoan district, which has a higher-than-average rate of hepatitis B infection among pregnant women and strong support from the government, was one of six national pilot districts selected for the program. Therefore, this study aims to assess the progress and implementation of the elimination of MTCT of HBV in Baoan district over a period of 5 years.MethodsData was collected from the national information system for the prevention of MTCT, registration forms, and follow-up forms of pregnant women and their live births from 2018 to 2022. Joinpoint models were used to analyze changing trends over time, calculating annual percentage change (APC) and the corresponding 95% confidence interval (95%CI). Multivariate logistic regression models were used to analyze risk factors for HBV MTCT.ResultsFrom 2018 to 2022, the coverage of HBV screening during pregnancy increased from 98.29 to 99.55% (APC = 0.30, P = 0.012). The coverage of HBV early screening within 13 gestational weeks increased from 40.76 to 86.42% (APC = 18.88, P = 0.033). The prevalence of maternal HBV infection declined by an APC of − 3.50 (95% CI -6.28 ~ − 0.63). The coverage of antiviral therapy among high-risk pregnant women increased from 63.59 to 90.04% (APC = 11.90, P = 0.031). Coverage for timely administration of hepatitis B immunoglobulin, hepatitis B birth dose vaccine, and three-dose hepatitis B vaccination remained consistently above 97.50%. The coverage of post-vaccination serological testing (PVST) in high-risk infants was 56.15% (1352/2408), and the MTCT rate of HBV was 0.18%. Mothers with high-school education or below (OR = 3.76, 95% CI 1.04 ~ 13.60, P = 0.04) and hepatitis B e antigen (HBeAg) positivity (OR = 18.89, 95% CI 1.98 ~ 18.50, P = 0.01) had increased MTCT risk.ConclusionsThe implementation of comprehensive prevention strategies in Baoan district, including screening, treatment, and immunoprophylaxis, has proven effective in maintaining the MTCT of HBV at an extremely low level. However, it remains crucial to raise public awareness, specifically on the importance of improving the coverage of PVST for infants exposed to HBV.

Seroconversion and Prevalence of Hepatitis B Surface Antigen among Vaccinated Health Care Workers in Ashanti Region, Ghana.

Health care workers (HCWs) constantly stand at a high risk of exposure to the hepatitis B virus because of the nature of their work. Hence, it is mandatory for HCWs to undergo hepatitis B vaccination. However, most HCWs in Ghana do not check their HBsAb titre after completion of their primary vaccination. This study assessed the prevalence of HBsAg and the seroconversion rate among vaccinated health care workers in the Ashanti Region, Ghana. A semistructured open-ended questionnaire was pretested and administered to 424 HCWs. Two (2) ml of blood was drawn and qualitative analyses (HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb) were done on the blood samples. Samples that tested positive to HBsAb were quantified using ELISA. Data obtained were analysed using GraphPad Prism 9. Out of the 424 study participants, 271 (63.9%) were females and 153 (36.1%) were males. Seroconversion (≥1 mIU/mL) and seroprotection (≥10 mIU/mL) through vaccination only among study participants were 67.5% (n/N = 286/424) and 58.0% (n/N = 246/424), respectively. Prevalence of hepatitis B viral infection was 2.4% (n/N = 10/424). Anti-HBc seropositivity was 13.2%, and anti-HBs seronegativity was 24.1%. 2.4% (n/N = 10/424) of study participants were negative to HBsAg but positive to HBcAb. In addition, 8.5% (n/N = 36/424) of the study participants were seroprotected due to exposure and recovery from previous HBV infection. Age, the number of doses received, taking a booster dose, and keeping a vaccination record card were significant factors influencing seroconversion status. This study reaffirms the need for HCWs to undergo a supervised primary hepatitis B vaccination course. Postvaccination serological testing should be done for all HWCs to confirm immunity and reduce their chances of contracting HBV infection.

Adherence to the three-component Hepatitis B virus vaccination protocol among healthcare workers in hepatitis B virus endemic settings in Ghana

BackgroundThe WHO and CDC recommend that HCWs who are at risk of HBV infection should vaccinate as adults early in their career by receiving 3 doses of HB vaccine at a schedule of months 0,1,6 and perform post-vaccination serological testing 1–2 months after vaccination. This study assessed adherence to all three components of the HBV vaccination program. MethodsThe study was a hospital-based analytical cross-sectional study involving 340 HCWs who were randomly selected. A pretested questionnaire was used to collect data which was analyzed using SPSS version 21. The proportion of HCWs adhering to the three components of the HBV vaccination protocol was computed. The multivariable analysis procedure identified the factors associated with overall adherence. Odds ratios were estimated with corresponding confidence intervals with the level of significance set at 0.05. ResultsHBV vaccination coverage was 60.9 % and adherence to 3-doses, 0,1,6 vaccination schedules and post-vaccination serological testing were 46.8 %, 38 % and 13 % respectively. Overall adherence was intermediate at the population level with only 6.2 % of the study participants adhering to all three components of the HBV vaccination protocol. HCWs who had low-risk perception for HBV had the lowest odds of completely adhering to all three indicators recommended for HBV vaccination (aOR = 0.15; 95 %CI = 0.04–0.58). Also, male HCWs have lower odds of adhering to all three components of HBV vaccination compared to their female counterparts (aOR = 0.65; 95 %CI = 1.17–2.50). ConclusionAdherence to the three components of HBV vaccination recommended for HCWs is low in this study. Failure to receive the recommended three-dose series of HBV vaccine at the recommended 0,1,6 schedule has implications for achieving seroprotection or development of antibodies against HBV. Failure to perform post-vaccination testing 1–2 months after HBV vaccination has implications for timely PEP management following occupational exposures. All three components of an ideal HBV vaccination program are important and should be used collectively to guide facility led HCW vaccination programs. Occupational health and safety programs, Infection prevention and control, as well as health promotion campaigns in health facilities, should promote adherence to all three components of HBV vaccination programs.

Hepatitis B virus vaccination post serological testing and antibody levels of vaccinated health care workers in Accra, Ghana

IntroductionHepatitis B Virus (HBV) infection is an important occupational hazard to Health Care Workers (HCWs) all over the world. International health organizations have strongly recommended the use of the HBV vaccine, especially among individuals at risk of HBV infection. A laboratory test aimed at measuring Anti-HBs concentration (titer) 1–2 months following a 3-dose vaccination schedule is the most reliable approach for diagnosing seroprotection against HBV. This study sought to assess post-vaccination serological testing, seroprotection against HBV, and associated factors among vaccinated HCWs in Ghana. MethodsA hospital-based analytical cross-sectional study involving 207 HCWs. Pretested questionnaires were used to collect data. 5mls of venous blood were collected from consenting HCWs under strict aseptic conditions and quantitatively analyzed for Anti-HBs using ELISA procedures. SPSS Version 23 was used to analyze data with the level of significance set at 0.05. ResultsMedian age; 33, IQR of 29–39. The post-vaccination serological testing rate was 21.3 %. HCWs with high-risk perception and working at the regional hospital had lower odds of adherence to post-vaccination serological testing (aOR = 0.2; 95 % CI = 0.1–0.7) and (aOR = 0.1; 95 % CI = 0.1–0.6) p < 0.05. The seroprotection rate was 91.3 % (95 % CI = 87 %-95 %). Minority, 18 (8.7 %) of the 207 vaccinated HCWs had antibody titers below 10mIU/mL and were not seroprotected against HBV. Geometric Mean Titers (GMTs) were higher in those who received three doses, took a booster, and were less than 25 kg/m2. ConclusionThe post-vaccination serological testing practice was sub-optimal. The seroprotection rate was higher with higher GMTs in those who adhered to the 3-dose vaccination regimen, took a booster dose, and had BMI < 25 kg/m2. It may be inferred that those with Anti-HBs below 10 IU/ml had their antibodies diminishing or waning off with time or they are true vaccine non-responders. This observation calls for strict adherence to post-vaccination serological testing, especially for HCWs who are at high risk of percutaneous and mucocutaneous exposures that could result in HBV infection.

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

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

A booster hepatitis B vaccine for children with maternal HBsAg positivity before 2 years of age could effectively prevent vaccine breakthrough infections

BackgroundThe long-term protective effect of hepatitis B vaccine (HepB), the incidence of hepatitis B virus (HBV) vaccine breakthrough infections (VBIs), and whether a booster HepB is necessary remain to be clarified in children born to mothers with chronic HBV infection.MethodsBased on a long-term follow-up prospective cohort of 1177 hepatitis B surface antigen (HBsAg)-positive mothers and their paired infants which was established from 2009 to 2011, total 454 children with immunoprophylaxis success as determined by postvaccination serologic testing (PVST) at 7 months old were included in this study. Among the 454 children, 246 never had a booster HepB, and 208 children received a booster HepB from 1 to 5 years of age. Multivariate logistic regression analysis was used to analyse the risk factors for HBV VBIs.ResultsThe hepatitis B surface antibody (anti-HBs) levels declined sharply from 7 months to 2 years old, and the anti-HBs seronegative rate in the children increased significantly from 2 years old. A total of 31 (6.83%) of the 454 children experienced VBIs, of which 7 had overt and 7 had occult HBV infections. Notably, 14 (45.16%) of the 31 children with VBIs were diagnosed at 2 years old, and all of them had anti-HBs positivity (> 10 mIU/mL) at 1 year old. Maternal hepatitis B e antigen (HBeAg) positivity, higher HBV DNA and HBsAg levels, lower initial infant anti-HBs levels and not receiving a booster HepB were independent risk factors for VBIs. The incidence of VBIs was significantly lower in children with a booster HepB than in nonboosted children (0.50 vs. 11.90%, P < 0.001), and none of the boosted children developed overt or occult HBV infection. The anti-HBs levels of 76.67% for the children with VBIs in the nonboosted group indicated positivity before VBIs was detected.ConclusionsAfter the primary full immunization with HepB, children born to mothers with chronic HBV infection, especially the children with maternal HBeAg positivity, high HBV DNA levels, high HBsAg levels and/or low initial infant anti-HBs levels, were at a high risk of VBIs, and a booster HepB for these children before 2 years old, instead of when their anti-HBs level is < 10 mIU/mL, could reduce the incidence of VBIs.

Timing of primary three-dose hepatitis B vaccination and postvaccination serologic testing among a large cohort of healthy adults.

This study evaluated the optimal timing of a primary three‐dose hepatitis B vaccination and postvaccination serologic testing (PVST) among a large group of healthy naïve adults in the Netherlands. Data were collected from the Ease Travel Clinic hepatitis B vaccination database. The study population consisted of 22,997 adults who received three hepatitis B vaccinations. Seroprotection was attained in 97.3% individuals. When compared with PVST performed at 1–2 months (98.2%) after the final dose, lower seroprotection rates were observed with <1 (97.3%, p = 0.128), 3–6 (90.6%, p < 0.001), and ≥7 (88.4%, p < 0.001) months after vaccination. Among the subpopulation with a PVST 1–2 months, no statistically significant difference was observed for the various intervals between the first and second vaccination (<1, 1–2, 3–4, or ≥5 months). When compared with 4–5 months between the second and third vaccine dose, lower seroprotection rates were observed with <4 (odds ratio [OR]: 0.29, p = 0.020) and ≥12 (OR: 0.22, p < 0.001) months, although comparable rates were observed with 6–11 months interval (OR: 0.85, p = 0.262). Our data indicate that PVST should be obtained 1–2 months after the last vaccination and a delayed PVST was the major determinant of a lower seroprotection rate after primary three‐dose hepatitis B vaccination schedule. Based on our data, the hepatitis B vaccination also leaves room for flexibility for the second dose and the third dose without the necessity of restarting the vaccination series or confirmation of the immune response to the vaccine.

Post‐vaccination serologic testing of infants born to hepatitis B surface antigen‐positive mothers is more cost‐effective in Zhejiang Province, China: A Markov chain analysis

To evaluate the cost-effectiveness of the post-vaccination serologic testing (PVST) plus active-passive immunoprophylaxis of infants born to hepatitis B surface antigen (HBsAg)-positive mothers, a Markov model was constructed by R 4.0.1 to compare the current strategy (three-dose HepB plus HBIG) and the PVST strategy (post-vaccination serologic testing plus the current strategy) for infants of HBsAg-positive mothers. Costs and utility scores were assessed from a field survey. Other model inputs were extracted from published literature and unpublished data from the Zhejiang provincial center for disease control and prevention (Zhejiang CDC). We calculated the incremental cost-effectiveness ratio (ICER) as the main result within 1-year cycle length with a 81horizon among 50,000 infants and performed one-way sensitivity analysis and probabilistic sensitivity analysis to explore the reliability of outcome. The ICER was -4130.18 yuan/quality-adjusted life year (QALY) for the PVST strategy compared with the current strategy from the societal perspective. It was estimated that the PVST strategy would save about 3,809,546 yuan and prevent loss of 922.37 QALYs within 81 cycles among 50,000 infants. ICER was most sensitive to the discount rate, and the cost-effectiveness acceptability curves showed that the PVST strategy reached a probability of being 100% cost-effective below willing to pay (107,624 yuan). In conclusion, the PVST strategy had increased the utility and reduced cost among infants born to HBsAg-positive mothers. The PVST strategy is a more cost-effective choice for infants born to HBsAg-positive mothers than the current strategy, and further promotion of the PVST project is recommended.

The optimal interval for post-vaccination serological test in infants born to mothers with positive hepatitis B surface antigen

ABSTRACT Postvaccination serologic testing (PVST) is utilized to monitor the success or failure of vaccination against hepatitis B virus (HBV) infection in infants of hepatitis B surface antigen (HBsAg) positive mothers. This secondary analysis of 1255 infants of HBsAg-positive mothers at 7–14 months age included in two prospective studies aimed to determine the optimal interval for PVST after three hepatitis B vaccine doses. HBsAg and anti-HBs were quantitatively tested with microparticle enzyme immunoassay. The average PVST interval was 3.8 ± 2.2 months. Overall, 1.7% (21/1255) infants had anti-HBs <10 mIU/mL. The non-response rates were 1.6%, 1.1%, 0.9%, 0.7%, 1.1%, 0.7%, and 5.7% when PVST was performed at an interval of 1, 2, 3, 4, 5, 6, and 7–8 months after the third vaccine dose, respectively. Compared with 1 month of PVST interval, the non-response rate in infants who underwent PVST 7–8 months was significantly higher (χ2 = 4.616, P = .032). Anti-HBs titers were significantly declined in infants with medium responses when PVST was performed with longer intervals (χ2 = 27.592, P < .001), actually declined from interval of 6, and 7–8 months (Z = −3.177, P = .001 and Z = −3.715, P < .001), respectively. These results indicate that PVST may be performed at the age of 7–12 months for infants vaccinated on 0, 1, and 6-month schedule. To identify non-responders as early as possible, we suggest that PVST is performed at 7 months age or 1 month after the final vaccine dose.

S3389 Identifying Barriers to Vaccination in Veteran Patients With Advanced Liver Disease

Introduction: Patients with advanced fibrosis and cirrhosis are at high risk for vaccine-preventable conditions such as Hepatitis A/B. Despite Center for Disease Control (CDC) recommendations, many patients with liver disease remain unvaccinated. The goal of our project was twofold: (1) to identify barriers to vaccination at a Veterans Affairs Medical Center (VAMC), and (2) to formulate process improvement strategies to improve vaccination rates among our veterans. Methods: An ad-hoc multidisciplinary quality improvement team was assembled to evaluate and improve upon vaccination efforts in the VAMC Gastroenterology (GI) and Liver clinics. Data was collected through a 10-item questionnaire consisting of multiple choice, free response, and Likert scale questions that was distributed electronically to clinic providers. Results: Twenty providers participated in the survey: 8 attendings (40%), 9 GI fellows (45%), 1 nurse practitioner (5%), 1 physician assistant (5%), and 1 pharmacist (5%). Six providers (30%) reported almost always addressing vaccination status with patients during an encounter in clinic. Data also revealed that 50% of providers rarely or never undergo post vaccination serological testing (Figure 1). Thirteen (65%) providers currently have a note template related to vaccinations, but 19 providers (95%) reported an interest in implementing a standardized template. A majority of providers believed that the most effective and opportune time to address vaccinations during an encounter was during patient intake with the clinic nurse (13, 65%) as opposed to during the encounter with the provider (4, 20%) or during check-in with the medical support assistant (3, 15%). Moreover, there was variability amongst providers in prioritizing vaccinations during patient encounters (Table). Qualitative data was obtained regarding perceived barriers to vaccination. Common themes elicited were lack of time (65%), patients declining vaccinations (55%), and overlap of responsibility with primary care providers (35%). Providers also expressed difficulty determining vaccination history for patients. Conclusion: Significant room for improvement remains in vaccination rates of VAMC patients. Addressing opportunities and barriers such as provider education, standardizing a template for vaccination status and immunity in provider documentation, and engaging veterans during clinic intake could prove to be beneficial interventions improving the rates of vaccination in the future.Figure 1.: Addressing Vaccination Status and Post-Vaccination Serological Testing During Patient Encounters.Table 1.: Priority of Addressing Vaccinations During Clinic Encounters.

Influencing factors and necessity of post-vaccination serologic testing follow-up for HBsAg-positive mothers and their infants: A 5-year prospective study in Zhejiang Province, China (2016-2020).

In 2016, China officially proposed for the first time that infants born to HBsAg-positive mothers should be tested for HBsAg and anti-HBs 1-2months after their third dose of HepB, also known as the post-vaccination serological testing programme. This study aimed to systematically evaluate the implementation and influencing factors of PVST to further reduce HBV infection risk in infants and improve the protective effect of HepB to the greatest extent. A prospective observational study was conducted to investigate the interruption of MTCT of hepatitis B. Univariate and multivariate analyses were applied to explore factors associated with the PVST follow-up rate among HBsAg-positive mothers and their infants. Additionally, bivariate analysis was performed on HBsAg and anti-HBs results in infants born to HBsAg-positive mothers. Here, the participation rate of PVST was 67.08% among 2120 pairs of positive mothers and infants. The HBsAg-positive rate among participants was 0.77%, whereas the anti-HBs positive rate was 96.84%, and both negative rates were 2.39%. Among infants with double negative results (34), only 15 completed three doses of HepB and PVST again, and 14 (93.33%) of which the antibody test results turned positive. Older mothers with high educational levels who reside in the local area were the most likely to PVST follow-up. The PVST programme is necessary to evaluate the HepB response status of newborns after vaccination. Moreover, revaccination for susceptible infants can effectively improve the MTCT-blocking rate of hepatitis B. Therefore, the scope of PVST projects in Zhejiang and China should be expanded.

English

BACKGROUND Hepatitis B virus (HBV) has long been recognized as a work-related hazard for health-care personnel (HCP). HCPs are all paid and unpaid persons giving health care or working or training in health-care settings, who have reasonably expected risks for exposure to infectious materials. Post-vaccination serological testing is suggested 4 to 8 weeks after completion of the primary course in all health care workers. If the anti - HBs levels are less than 10 mIU / ml 4 - 8 weeks after the third dose of vaccine, the person's serum has to be tested for markers of HBV. The objective of the study was to evaluate the immune response after hepatitis B vaccination in health care workers. METHODS This study was a cross-sectional study that was conducted for a period of one year (January 2016 – December 2016). In this study, blood samples of 211 HCP were collected and sera were tested for quantitative anti - HBs level using anti - HBs EIA kit (Diapro, Italy). RESULTS 75. 83 % of HCP were completely vaccinated and 24.17 % did not complete the three-dose regimen. 91.87 % of completely vaccinated HCP had an anti- HBs titre of more than 10mIU/ml while 80.39 % of incompletely vaccinated HCP had protective antibody levels. 71.42 % of males and 90.35 % of females had protective antibody titre. The housekeeping staff were the most protected (100 %) while doctors were the least protected (54.54 %). Among the different vaccine, compliant subgroups 85.96 % of HCP who were completely vaccinated and had not taken booster dose had protective antibody titre even after five years where as 90.47 % of HCP who were completely vaccinated and had taken a booster dose and had protective antibody titre even after 5 years. It was also noted that 95.23 % of HCP who were vaccinated before the age of 20 had a protective antibody titre while only 70.58 % of those who got vaccinated after the age of forty had a protective antibody titre. CONCLUSIONS The records, if possible retrievable electronic records, should be maintained in health care centers as a reference in case of occupational exposure or for other purposes. KEYWORDS Hepatitis B, Anti HBs, Health Care Personnel

Correlation between BNT162b2 mRNA Covid-19 vaccine-associated hypermetabolic lymphadenopathy and humoral immunity in patients with hematologic malignancy.

PurposeVaccine-associated hypermetabolic lymphadenopathy (VAHL) is frequently observed on [18F]FDG PET-CT following BNT162b2 administration. Recent data suggest a prominent B cell germinal-center (GC) response elicited by mRNA vaccines in draining lymph nodes. Thus, in this study we aimed to explore the correlation between VAHL and humoral immunity as reflected by post-vaccination serologic testing and by comparing the incidence of VAHL between lymphoma patients treated recently with B cell depleting therapy and those that were not.MethodsA total of 137 patients with hematologic malignancy that had post-vaccination [18F]FDG PET-CT were included (All-PET group), 86 received both vaccine doses before imaging (PET-2 group). Their VAHL status and grade on imaging were recorded. Among 102 lymphoma patients, 34 (33.3%) were treated during the year prior vaccination with anti-CD20 antibody containing therapy. A subgroup of 54 patients also underwent serologic testing 2–3 weeks after the booster dose, and their anti-spike titers were recorded and graded as well.ResultsThe overall incidence of VAHL in patients with hematologic malignancy was 31.4%. The 34 lymphoma patients treated during the year prior vaccination with anti-CD20 antibody containing therapy had significantly lower rates of VAHL comparted with all other lymphoma patients (8.8 versus 41.2% in all-PET patients, Pv < 0.01). VAHL rates were 10% in patients with negative serology, 31.3% in patients with low anti-spike titers, and 72.2% in patients with high anti-spike titers. The positive predictive values of VAHL were 90 and 93.3% in all-PET and PET-2 patients, respectively. A positive statistically significant correlation was found between VAHL and serology ranks in All-PET patients (rs = 0.530, Pv < 0.001), and stronger correlation was found in PET-2 patients (rs = 0.642, Pv < 0.001).ConclusionVAHL on [18F]FDG PET-CT of patients with hematologic malignancy may reflect GC B cell proliferation and an effective humoral response elicited by BNT162b2 vaccine.

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

National Perinatal Hepatitis B Prevention Program: 2009-2017.

To assess trends and programmatic outcomes among infants born to hepatitis B surface antigen (HBsAg)-positive women from 2009 to 2017 and case-managed by the Centers for Disease Control and Prevention's national Perinatal Hepatitis B Prevention Program (PHBPP). We analyzed 2009-2017 annual programmatic reports submitted by 56 US jurisdictions funded through the Centers for Disease Control and Prevention's PHBPP to assess characteristics of maternal-infant pairs and achievement of objectives of infant hepatitis B postexposure prophylaxis, vaccine series completion, and postvaccination serologic testing (PVST). We compared the number of maternal-infant pairs identified by the program with the number estimated born to HBsAg-positive women from 2009 to 2014 and 2015 to 2017 by using a race and/or ethnicity and maternal country of birth methodology, respectively. The PHBPP identified 103 825 infants born to HBsAg-positive women from 2009 to 2017, with a range of 10 956 to 12 103 infants annually. Births estimated annually to HBsAg-positive women increased nonsignificantly from 24 804 in 2009 to 26 444 in 2014 (P = .0540) and 20 678 in 2015 to 20 832 in 2017 (P = .8509). The proportion of infants identified annually increased overall from 48.1% to 52.6% (P = .0983). The proportion of case-managed infants receiving postexposure prophylaxis, at least 3 vaccine doses, and PVST increased overall from 94.7% to 97.0% (P = .0952), 83.1% to 84.7% (P = .5377) and 58.8% to 66.8% (P = .0002), respectively. The PHBPP has achieved success in managing infants born to HBsAg-positive women and ensuring their immunity to hepatitis B. Nonetheless, strategies are needed to close gaps between the number of infants estimated and identified, increase vaccine series completion, and increase ordering of recommended PVST for all case-managed infants.

Maternal hepatitis B e antigen can be an indicator for antiviral prophylaxis of perinatal transmission of hepatitis B virus

ABSTRACT As a high-risk factor of perinatal HBV transmission, the potential role of maternal hepatitis B e antigen (HBeAg) to guide antiviral prophylaxis has not yet been fully reported. This large prospective cohort study enrolled 1177 hepatitis B surface antigen (HBsAg)-positive pregnant women without antiviral treatment and their newborns. HBeAg, HBsAg, and viral load in maternal serum collected before delivery were measured. All the newborns were given standard passive–active immunoprophylaxis within 12 h after birth, and post-vaccination serologic testing was performed at 7 (±7d) months of age. The results revealed that 20 of the 1177 infants (1.70%) were immunoprophylaxis failure, and all their mothers were HBeAg positive. Maternal quantitative HBeAg was positively correlated with viral load (r = 0.83; P < .0001) and quantitative HBsAg (r = 0.68; P < .0001). The area under the receiver operating characteristic curve (AUC) for predicting immunoprophylaxis failure by maternal HBeAg was comparable to that by maternal viral load (0.871 vs 0.893; P = .441) and HBsAg (0.871 vs 0.871; P = .965). The optimal cutoff value of maternal quantitative HBeAg to predict perinatal infection was 2.21 log10 PEI U/mL, and the sensitivity and specificity was 100.0% and 74.5%, respectively. According to maternal viral load >2 × 105 IU/mL, the sensitivity and specificity of maternal qualitative HBeAg to identify the risk of HBV MTCT for pregnant women and determine the necessity for antiviral prophylaxis was 95.5% and 92.6%, respectively. This study showed that maternal HBeAg can be a surrogate marker of HBV DNA for monitoring and evaluating whether antiviral prophylaxis is necessary for preventing perinatal HBV transmission.

High level of vaccination and protection against hepatitis B with low rate of HCV infection markers among hospital health care personnel in north of Iran: a cross-sectional study

Backgroundhepatitis B virus (HBV) and C virus (HCV) are among the leading causes of mortality worldwide. Health care personnel (HCP) are subjected to increased risk of these infections. Therefore, HBV vaccination and post-vaccination serologic testing (PVST) are recommended for them. Our objectives in this study were investigate how well the vaccination guidelines for hospital HCPs were implemented. Moreover, the prevalence rates of HBV and HCV infections were calculated. To determine the presence of immunological memory, vaccinated personnel negative to antibody against HB surface antigen with one dose of HB vaccine were boosted.MethodsFrom 1 July to 30 November 2017, a cross-sectional study among HCPs working in public hospitals were conducted. All HCPs from various professional categories potentially at risk of exposure to contaminated sources were included. The information was gathered via interview and self-administered questionnaire. The questions were focused on the demographic characteristics, HB vaccination and immunity status and time elapsed since initial vaccination series, and frequency of needelstick injuries during the past 12 months of their work. Moreover, the prevalence rate of HBV and HCV infections were calculated. To determine the presence of immunological memory, subjects negative to HBV seromarkers received a booster dose of the vaccine.ResultsA total of 186 out of 766 participants were male and nurses comprised 71% of personnel. Although all HCP were vaccinated, 84% of them completed the course and less than 5% of them received PVST. According to the results, 0.78, 4.6, and 83% were serologically positive to HBV surface antigen, antibodies against HBV core, and S antigens, respectively. Approximately, 91% of seronegative participants responded to a booster dose and only 0.91% of the personnel was anti-HCV positive.ConclusionMost HCP received full HBV vaccination course. Although a minority did PVST, the HBV vaccine-induced long-term protection and HB vaccine booster were not required. Therefore, policies should be made to increase the rate PVST after immunization. According to the results, the HCV infection rate was low and thus pre-recruitment screening was not necessary.

Compliance among infants exposed to hepatitis B virus in a post-vaccination serological testing program in four provinces in China

BackgroundMother to child transmission of hepatitis B virus (HBV) remains the most common form of HBV infection in China. Prevention of HBV vertical transmission involves timely administration of the complete hepatitis B vaccine (HepB) series and hepatitis B immunoglobulin. Post-vaccination serological testing (PVST) is utilized to determine an infant’s outcome after HBV exposure and completion of HepB series. We aim to determine the frequency of compliance with a PVST testing cascade for HBV infected mothers and analyze factors associated with infant lost to follow up (LTFU).MethodsWe conducted a retrospective cohort review of previously collected data in Fujian, Jiangxi, Zhejiang and Chongqing provinces in China from 1 June 2016–31 December 2017. The study population included all HBV-exposed infants and their mothers. SAS software was used for statistical analyses. Bivariate and multivariate regression analyses (presented in odds ratio [OR] with 95% confidence intervals [CI]) were used to compare the proportional differences of factors associated with PVST not being completed.ResultsAmong enrolled 8474 target infants, 40% of them transferred out of the study provinces without further information and 4988 were eligible for PVST. We found 20% (994) of infants were not compliant with the testing cascade: 55% of LTFU occurred because parents refused venous blood sample collection or failure of sample collection in the field, 16% transferred out after 6 months of age, and 10% of families chose to have independent, confidential PVST completed without reporting results. High PVST noncompliance rates were more likely to be from Fujian (aOR = 17.0, 95% CI: 9.7–29.9), Zhejiang (aOR = 5.7, 95% CI: 3.2–10.1) and Jiangxi (aOR = 1.9, 95% CI: 1.0–3.4), and from HBV e antigen positive mother (aOR = 1.2, 95% CI: 1.1–1.4).ConclusionsThis study found that the LTFU rate reached 20% in PVST program, which was a significant problem. We recommend implementing a national electronic information system for tracking HBV at risk mother-infant pairs; encourage further research in developing a less invasive means of completing PVST, and take effective measures nationally to reduce HBV stigma. Without reducing the loss to follow up rate among infants eligible for PVST, elimination of vertical HBV transmission will be impossible.