Received Hepatitis B Virus Vaccine Research Articles

Fixing a Hole: a retrospective cohort study evaluating HAV, HBV, tetanus screening, and vaccination during hospitalization in persons who use substances.

Rates of serious injection-related infections in persons who use drugs have increased. Resulting admissions are an opportunity for screening and vaccination of preventable infections such as hepatitis A virus (HAV), hepatitis B virus (HBV), and tetanus. We conducted a retrospective review of adults with documented substance use admitted for bacterial infection between July 2015 and March 2020. We evaluated HAV, HBV, and tetanus vaccination status at admission, along with screening for HAV and HBV infection and immunity. We identified the proportion of patients at risk for infection who received HAV, HBV, and tetanus vaccines during admission and patient-level factors associated with vaccination. We identified 280 patients who met our inclusion criteria. Of the 198 (70.7%) patients at risk for HAV, infectious disease providers recommended vaccination for 21 (10.6%) and 15 (7.6%) received HAV vaccine. Of the 174 (62.1%) patients at risk for HBV, infectious disease providers recommended vaccination for 32 (18.3%) and 25 (14.4%) received HBV vaccine. A large proportion of patients (31.4%, 88) had no documentation of prior tetanus vaccination, and infectious disease providers recommended tetanus vaccination for three (1.1%) and five patients (1.8%) received a tetanus booster. Infectious disease consult vaccine recommendations were statistically significantly associated with HAV or HBV vaccination prior to discharge. Over 70% of our population is at risk for one or more of these preventable infections. Efforts are needed to maximize inpatient screening and vaccination for HAV, HBV, and tetanus in patients with barriers to care.

Hepatitis B infection or reactivation after switch to two-drug antiretroviral therapy: A case series, literature review, and management discussion.

Two-drug antiretroviral therapy (ART) without hepatitis B virus (HBV) activity is prescribed for persons with HIV as simplified or salvage therapy. While two-drug regimens are not recommended for persons with chronic HBV infection, guidelines do not address use in those with HBV susceptibility and/or core antibody reactivity. We present a case series of individuals with HBV infection or reactivation following switch to two-drug, non-HBV-active ART. HIV primary care clinics of an academic medical center in New York, NY. Case surveillance was conducted to identify persons with HBV surface antigenemia and viremia following two-drug ART switch. Clinical characteristics and outcomes were ascertained through chart review. Four individuals with HBV infection or reactivation after ART switch were identified. Two had HBV susceptibility, one had core antibody reactivity, and one had surface antigen reactivity pre-switch. All eligible persons had received HBV vaccination, two with low-level antibody response and one with persistent nonresponse. Two presented with fulminant hepatitis, one requiring liver transplantation. Two-drug ART switch may pose risk of HBV infection or reactivation. We propose careful patient selection and monitoring through the following: 1) Assessment of HBV serologies before switch and periodically thereafter, 2) Vaccination and confirmation of immunity before switch, 3) Risk stratification and counseling about HBV reactivation for those with core antibody, 4) Preemptive HBV DNA monitoring for those at risk of reactivation, 5) Continuation of HBV-active prophylaxis when above measures are not feasible, 6) Continuation of HBV-active therapy and surveillance for chronic HBV infection.

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.

Hepatitis B virus infection among 5 493 migrant workers in Shenzhen city′s Luohu Demonstration Zone for comprehensive hepatitis B prevention and treatment

Objective To examine the prevalence of hepatitis B virus (HBV) infection among migrant workers in Luohu district of Shenzhen city for providing evidences to HBV infection prevention in the workers. Methods A questionnaire survey and serum hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) detections with enzyme-linked immunosobent assay (ELISA) were conducted among 5 493 migrant workers in Shenzheng city′s Luohu demonstration zone for comprehensive prevention and control of hepatitis B (HB) when the workers had their physical examinations between April 2019 and June 2020. Results For all the workers, the positive rate was 6.54% and 60.37% for serum HBsAg and anti-HBs; the positive rate of both HBsAg and anti-HBs differed significantly by age, education, occupation, registered residence, and history of HBV vaccination. The results of binary logistic regression analysis on significant influencing factors of serum HBsAg and anti-HBs identified with univariate analysis demonstrated that inoculation of HBV vaccine is a protective factor against HBsAg positive; while, with the education of junior high school and lower and aged 30 – 49 years are risk factors for HBsAg positive; the results also indicated that the workers having received HBV vaccination, aged less than 30 years, and with a registered residence in East China were more likely to be serum anti-HBs positive compared to other migrant workers. Conclusion The prevalence of HBV infection decreased in comparison to that ten years ago among migrant workers in Shenzhen city′s Luohu demonstration zone for comprehensive HBV infection prevention and treatment but the prevention of HBV infection still needs to be strengthened in the unvaccinated migrant workers younger than 20 years and in those from southwest, northeast and northwest region of China.

Immunologic Response to Hepatitis B Virus Vaccination among Human Immunodeficiency Virus Thai Adults without Hepatitis B Virus Infection

Background: It is currently recommended that hepatitis B virus (HBV) vaccine be provided for every HIV-infected patient with no HBV immunity. HBV immunization program for HIV-infected patients was suggested to be given in three doses of vaccine at zero, one and six months. HBV vaccine has been included in the Thai immunization program for newborns for three doses, at birth, M2, and M6. Hence, one dose of vaccination might respond in complete protective immunity in some of the HIV patients. Objective: To evaluate HIV-infected patients’ response to one dose of vaccine and their associated factors. Materials and Methods: The present study was a Retrospective Cohort Study. It recruited patients who had come to Queen Savang Vadhana Memorial Hospital for their hepatitis B vaccination between January 1, 2018 and March 31, 2020. Eligible patients were infected with HIV, received ART, and had CD4 of more than 200 cells/mm³. The authors collected data from the patients having anti-HBs of less than 10 mIU/mL with negative anti-HBc who received HBV vaccine. From the medical records, the authors evaluated their anti-HBs titer after the first dose of vaccination, and the titer after a third dose, in cases the result of the first dose was negative. Results: Of the 88 HIV-infected patients who received HBV vaccination, 19 patients (21.6%) showed protective anti-HBs after the first dose of vaccination. Factors associated with the presence of anti-HBs after the first dose included age as the patients of 29 years or older had protective anti-HBs of 15% and the patients younger than 29 years old had protective anti-HBs of 43% (p=0.013), and anti-HBs titer before the vaccination as the patients with titer of less than 2 mIU/mL had protective anti-HBs of 17% and the patients with titer of 2 to less than 10 mIU/mL had protective anti-HBs of 44% (p=0.038). Conclusion: Some HIV-infected patients have developed protective anti-HBs after the first dose of HBV vaccination especially the younger age of less than 29 years old and with an anti-HBs titer before vaccination of 2 mlU/mL or above. Almost half of them required only one HBV booster to achieve protective anti-HBs. Keywords: Vaccine; Hepatitis B; HIV; Vaccination; Immunity

Uptake of Cost-Free Hepatitis B Vaccination among Healthcare Workers in Northern Tanzania

Background The World Health Organization and other global agencies recommend all healthcare workers (HCWs) to get vaccinated against hepatitis B virus before enrolment to clinical work. There are limited data in low-income countries on hepatitis B virus vaccination coverage among HCWs, which set back WHO Hepatitis B Elimination Strategy 2016-2021. The aim of this study was to determine the prevalence of hepatitis B virus vaccination uptake and associated factors among HCWs from a tertiary and teaching hospital in northern Tanzania. Methods A cross-sectional study was conducted among HCWs at Kilimanjaro Christian Medical Centre a referral and teaching hospital from August 2016 to June 2017. Questionnaire based interviews were used to obtain information about HCWs’ demographic characteristics, occupation risks and other invasive procedures such as intravenous, and intramuscular injections and knowledge of Hepatitis B Virus (HBV) infection. Multivariable logistic regression was used to determine factors associated with Engerex DNA-recombinant hepatitis B vaccine uptake. Results About two third 295 (67.4%) of 438 participants had received HBV vaccination. Among those who ever received HBV vaccination (n=295), 205 (70.5%) received 3 shots, 57 (19.5%) received 2 shots and 33 (10%) received 1 shot. HCWs working in clinical areas had 79% higher odds of vaccine uptake compared to those who were not (OR=1.79, 95%CI 1.11, 2.89). Ever having intravenous and intramuscular injections significantly increased the odds of vaccination uptake compared to those who never had (OR=2.21, 95%CI 1.33, 3.66) and (OR=2.42, 95%CI 1.36, 4.28) respectively. Also, HCWs with a fair and good knowledge on HBV infection had over three times higher odds of vaccine uptake compared to those with poor knowledge (OR=3.08, 95%CI 1.90, 5.01) and (OR=3.07, 95%CI 1.75, 5.40), respectively. After adjusting for other factors, those that remained to be significantly associated with HBV vaccine uptake were area of specialty and knowledge on HBV infection. Conclusion The current Engerex DNA-recombinant hepatitis B vaccine coverage among HCWs at KCMC, referral and teaching hospital in North-eastern Tanzania was only 67.4% despite of it been given free of charge. Factors that were associated with HBV vaccine uptake include area of specialty and knowledge of participants on HBV infection and vaccination. We encourage continuous medical education among HCWs about importance of hepatitis B vaccination. We also recommend hepatitis B vaccination as pre-employment requirement for HCWs as well as doing antibody titer determination post vaccination. Keywords: Cost-free hepatitis B vaccine, Prevention, Healthcare workers, vaccination coverage, Low income countries, Tanzania.

The Delayed Immune Response of Infants of Diabetic Mothers to Hepatitis B Vaccine: A Prospective Case-Control Study

Background: Infants of diabetic mothers (IDMs) have a significantly greater risk for perinatal morbidity, mortality, and altered immune response. Aim of work: To assess the immune response of IDMs for hepatitis B virus (HBV) vaccine and to compare them with infants of non-diabetic mothers as a control group. Patients and Methods: 150 neonates met the inclusion criteria; 100 IDMs and 50 infants’ non-diabetic mothers as controls. All neonates who met the inclusion criteria received HBV vaccine during the first 24 hours of age and at 1 and 6 months of age according to the WHO guidelines. Furthermore, hepatitis B surface antigen (HBsAg), hepatitis B virus surface antibodies (anti-HBs), and hepatitis B virus core antibodies (anti-Hbc) were measured at 9, 12, and 24 months of age. Results: IDMs had significantly higher birth weight when compared to infants of the non-diabetic mothers (3.6 ± 0.4 kg and 3.03 ± 0.5 kg, P-value 0.01). There was a significant difference between the response to anti-HBs between case group and control group at 9 months 7±12 mIU/dL versus 20±23 mIU/dL (P-value < 0.0001). However, anti-HBs antibodies levels follow-up at 12 and 24 months showed no significant differences between the case and control groups. Conclusion:At 9 months of age, post HBV vaccination, there was a delayed immune response for HBV vaccine was present in IDM compared to infants of non-diabetic mothers. However, IDM became immune at follow-up at 12 and 24 months of age.

How knowledge of hepatitis B disease and vaccine influences vaccination practices among parents in Ho Chi Minh City, Vietnam

Objective: To assess the influences of the knowledge of parents about hepatitis B virus (HBV) infection and the benefit of HBV vaccination on the practice of HBV vaccination among children.Methods: A prospective cross-sectional study recruited parents whose children, aged 12-24 months, received HBV vaccination at Commune Health Centers (CHCs) in Ho Chi Minh City from Feb. 2016 to Jul. 2017. Parents were interviewed using a questionnaire that included 11-item binary knowledge questions and checked their children's vaccination cards.Results: A total of 768 parents had a mean age of (30.8±5.1) years. The mean knowledge score of the 11- item questions was (7.0±2.4). The knowledge score was positively associated with full and timely HBV vaccination. In addition, children who received complete and timely HBV vaccination were significantly more likely to live in rural areas (Adjusted OR 4.02, 95% CI 2.79-5.79, P<0.001). Also, children whose parents received vaccination information from health care providers, and had knowledge about HBV risk, had a higher rate of full and timely HBV vaccination (Adjusted OR 1.60, 95% CI 1.13-2.29, and Adjusted OR 1.47, 95% CI 1.01-2.13, P all<0.05).Conclusions: Parents possessed a great deal of incorrect knowledge about HBV. More health education from health care providers should target parents living in specific locations and focus on the benefits of HBV vaccine.

Hepatitis B vaccination status among medical students at a tertiary institution in North-East Nigeria

Background: Hepatitis B virus (HBV) infection is ranked among the top ten killers by the World Health Organisation. It is a public health problem, highly infectious and an occupational hazard for Health care workers. Nigeria is endemic for HBV with an estimated 20 million people infected. Though vaccine preventable, medical students are outside the age group which benefits from the introduction of HBV vaccine into the National immunization schedule and are a high risk group for HBV infection. We studied the HBV vaccination status of medical students who commenced clinical training to determine their risk of infection. Methods and materials: A cross sectional study was conducted among medical students who commenced clinical training at a tertiary institution in north-western Nigeria. All consenting students were recruited into the study. Those less than 18 years of age and students infected with HBV were excluded. Data was collected using a structured self-administered questionnaire with sections on demography, knowledge of HBV and HBV vaccination status. Data was analysed using Epi Info version 7.1.06. Results: Overall, 176 consenting students were recruited. Of these, 118 (67%) respondents were male, 172 (97.7%) were single and mean age of respondents was 22 ± 2 years. Most respondents, 172 (97.7%) had heard of HBV and common sources of information were lectures 146 (84.9%) and literature 51 (29.7%). Most respondents, 169 (96%) knew their training predisposed them to HBV infection though more than half, 94 (53.4%) were not vaccinated against HBV. The commonest reason for non-vaccination was lack of access 53 (56.4%). Of all respondents, majority, 142 (80.7%) had not received HBV vaccine before commencement of clinical training. Conclusion: Medical students in training at this institution are exposed to infection with HBV. We recommend the School authority develop policies on HBV vaccination for medical students before commencement of clinical training.

Hepatitis B Virus Infection in Pregnancy: An Update on Evidence-Based Management.

Vertical hepatitis B virus (HBV) transmission is the important route of chronic HBV infection. Although infant immunoprophylaxis is effective, a significant number of infants still become infected, most are associated with intrauterine infection. New evidences support intrauterine treatment in cases of high risk. The aim of this study was to review the current evidences and recommendations for management of HBV infection in pregnancy. Original research articles, review articles, and guidelines were reviewed. The management can be summarized as follows: (1) all pregnant women should be screened for hepatitis B surface antigen (HBsAg) and antibody to HBsAg. High-risk HBsAg-negative pregnant women without immunity should be vaccinated during pregnancy. (2) HBsAg-positive pregnant women should undergo further workup for liver status and indicative factors for immunoprophylaxis failure. (3) Pregnant women should be treated with HBV DNA levels greater than 200,000 IU/mL or 6 log copies/mL. (4) Antiviral drug should be started around 28 to 32 weeks. The first-line drug is tenofovir disoproxil fumarate. (5) Delivery route should be chosen based only on obstetric indications. (6) Breastfeeding is not contraindicated because it does not increase the risk of transmission in neonates with HBV vaccine and immunoglobulin administration. (7) Neonates born to HBsAg-positive mothers should receive HBV vaccine and immunoglobulin after birth as soon as possible. (8) Follow-up of the mothers and neonates is important. Beware of hepatitis flare after birth and after antiretroviral drug discontinuation; alanine transaminase assessment every 1 to 3 months until 6 months is suggested. Also, the schedule of infant vaccination and follow-up of serologic testing at 9 to 12 months old is needed.

Prevalence of Viremic hepatitis C, hepatitis B, and HIV infection, and vaccination status among prisoners in Stockholm County

BackgroundIdentification and knowledge of settings with high prevalence of hepatitis C virus (HCV) infection is important when aiming for elimination of HCV. The primary aim of this study was to estimate the prevalence of viremic HCV infection among Swedish prisoners. Secondary aims were to estimate the prevalence of hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV), and the proportion who have received hepatitis B virus (HBV) vaccination.MethodsA cross-sectional study of all incarcerated persons (n = 667) at all prisons (n = 9) in Stockholm County was conducted. All prisoners are routinely offered opt-in screening for HCV antibodies (anti-HCV), HCV RNA, HBsAg, anti-HBs, anti-HBc and HIV Ag/Ab at prison in Sweden. Data on the results of these tests and the number of received HBV vaccine doses were collected from the prison medical records. The parameters of HCV RNA, anti-HCV, and occurrence of testing for HCV were analysed in multiple logistic regression models in relation to age, sex and prison security class.ResultsThe median age was 35 (IQR 26–44) years, and 93.4% were men. Seventy-one percent (n = 471) had been tested for anti-HCV, 70% (n = 465) for HBsAg and 71% (n = 471) for HIV. The prevalence of anti-HCV, HCV RNA, HBsAg and HIV Ag/Ab was 17.0, 11.5, 1.9, and 0.2%, respectively among tested persons. The proportion of prisoners who had received full HBV vaccination was 40.6% (n = 271) among all study subjects.ConclusionsThe prevalence of viremic HCV infection among Swedish prisoners in Stockholm County was 11.5%, which is high in comparison to the general population. Therefore, when aiming for the WHO goal of HCV elimination, prisons could suit as a platform for identification and treatment of HCV infection. There is a need to increase testing for blood-borne viruses and to improve vaccination coverage against HBV in Swedish prisons.

Ethnicity and response to primary three-dose hepatitis B vaccination in employees in the Netherlands, 1983 through 2017.

Hepatitis B virus (HBV) vaccination is recommended to all employees who have an occupational risk in the Netherlands. This study assessed the determinants of the immune response to primary standard three-dose HBV vaccination (0, 1, 6 months), with the main focus on ethnicity. Out of 76 239 individuals who received HBV vaccination between April 1983 and December 2017, 11 567 persons with a known country of birth and complete vaccination schedule were included in this study. Weighted multiple logistic regression with Firth's bias adjustment was used to assess the determinants of nonresponse (anti-HBs < 10 mIU/mL) and low response (anti-HBs 10-99 mIU/mL). Baseline characteristics of the study population (n = 11 567) were as follows: mean age 27.5 years (95% confidence interval [CI], 27.23-27.72), 99.4% born in the Netherlands and 93.5% of Western European origin. Of all identified subjects, 180 (1.6%) were HBV vaccine nonresponders and 549 (4.8%) were low responders. When compared with individuals aged <40 years, the rate of nonresponse (4.3% vs 0.8%; P < .001) and low response (11.9% vs 2.9%; P < .001) was higher in those aged 40 years or older. The height of anti-HBs levels were lower in those subjects aged >40 years in comparison with those younger than 40 years, P < .001. All nonresponders were born in the Netherlands. Although no significant association was found between nonresponse and individuals of Western European origin (adjusted odds ratio [aOR] = 1.20; 95% CI, 0.66-2.44; P = .163), low response to HBV vaccination was significantly associated with Western European origin (aOR = 2.21; 95% CI, 1.41-3.86; P = .001). Significant determinants for nonresponse were older age at vaccination (aOR = 1.06; 95% CI, 1.06-1.07; P < .001) and male gender (aOR = 2.51; 95% CI, 1.97-3.22; P < .001). The nonresponse rate was low in our study population. Our findings suggest that the vaccines being used for the primary vaccination are probably less immunogenic for older individuals, males, and persons of Western European origin.

Vertically acquired occult hepatitis B virus infection may become overt after several years

To study the frequency of vertically acquired occult hepatitis B virus (HBV) infection (OBI). We investigated 44 children born to hepatitis B surface antigen (HBsAg) positive mothers. They received HBV vaccine directly after birth and at 2, 6 and 52 weeks of age; eight with HBeAg-positive mothers also received hepatitis B immunoglobulin (HBIG). HBV DNA was analyzed in blood collected at 6 weeks and 12 months of age, and HBV antibodies at 12 and 18 months of age. HBV DNA, but not HBsAg or anti-HBc, was detected at 12 months of age in three children. The viral sequences were almost identical with HBV DNA from their mothers who all were HBeAg-positive and had received tenofovir during pregnancy. Follow-up at 5-7 years age showed that one of the three children had become seropositive for HBsAg and anti-HBc. This child and one of the other two had detectable HBV DNA at the follow-up, with whole genome sequences identical to those in HBV from their mothers. Mothers-to-child transmission of HBV can, despite adequate prophylaxis, lead to OBI which may later develop into overt HBV infection. Whether such infections are of clinical importance needs to be further investigated.

Detection of Occult Hepatitis B Virus Among Iranian HCV-Infected Patients with Hemophilia Treated with Direct-Acting Antiviral Agents

Background: One of the challenges to treat hepatitis C virus (HCV) infection is the activation of hepatitis B virus (HBV) that occurs during treatment of HCV infection with direct-acting antivirals (DAAs) in some patients. The detection of serum or liver HBV DNA in the absence of serum HBsAg (HBV surface antigen) is described as occult HBV infection (OBI). Objectives: The current study aimed at determining the prevalence of OBI in Iranian DAA-naive HCV-infected patients with hemophilia. Methods: The current study was conducted on 100 patients with hemophilia receiving DAAs. The sera obtained from these patients were tested for the presence of HBsAg. Then, the presence of the HBV DNA was detected in peripheral blood mononuclear cell (PBMC) and also plasma samples using nested polymerase chain reaction (PCR). Results: Among the 100 study subjects, 81 (81%) were male and 19 (19%) female. The mean age of the patients was 37 ± 10.50 years. All patients had previously received HBV vaccine. In the current study, HBV DNA was observed in 1% of plasma and in 3% of PBMC samples. In addition, none of the patients who had positive result for HBV detection test previously had markers of HBV infection (anti-HBc (HB core antigen) antibodies, anti-HBs antigens, and positive result of DNA PCR) and all had negative results for HCV RNA after treatment. Conclusions: Generally, the prevalence of OBI was low, but however, HBsAg negativity was not sufficient to completely exclude the presence of HBV DNA. Thus, the serological markers of HBV infection should be confirmed by molecular tests for the presence of possible occult infection.

Prevention of mother-to-child transmission of hepatitis B virus in Burkina Faso: Screening, vaccination and evaluation of post-vaccination antibodies against hepatitis B surface antigen in newborns

The low rate of screening for hepatitis B virus (HBV) in pregnant women is a highrisk factor for its vertical transmission. The objectives of this study were: i) to screen pregnant women for HBV infection; ii) vaccinate all children from birth against HBV regardless their mother HBV status; and iii) evaluate after 7 months of birth the level of their AbHBs among babies who received HBV vaccine at birth. Serological markers of HBV (HBsAg, HBeAg, AbHBs, AbHBe, and AbHBc) were determined on venous blood samples from 237 pregnant women and their children using the Abon Biopharm Kit. One hundred and two (102) children received the three doses of the EUVAX B® vaccine respectively at birth, two months and four months of life. Seven months after delivery, venous blood samples were collected from mothers and their children. Antibodies against hepatitis B surface antigen (AbHBs) were measured in vaccinated children using the ELISA Kit AbHBs Quantitative EIA. DNA extraction was performed on samples from HBV-seropositive mothers and their children using the Ribo Virus (HBV Real-TM Qual) Kit and for Real Time PCR, the HBV Real-TM Qual Kit was used. Serological diagnosis in pregnant women revealed 22 (9.28%) hepatitis B surface antigen (HBsAg) positive samples of which 21 were positive for viral DNA by real-time PCR. Among the 22 HBsAg+ women, five (05) transmitted the virus to their children with a vertical transmission rate of 22.73%. A transmission rate of 23.81% (5/21) was found with the PCR method. Analysis of AbHBs levels revealed that 98.31% of the children had an average concentration of 218.07 ± 74.66 IU/L, which is well above the minimum threshold for protection (11 IU/L). This study has confirmed that vertical transmission of HBV is a reality in Burkina Faso and that vaccination at birth would significantly reduce this transmission.

2195. Effectiveness of a Dual-Test Strategy and Software Modifications for Mitigating and Preventing Hepatitis B Virus (HBV) Exposures in a Dialysis Unit

BackgroundYearly, the number of U.S. patients needing dialysis increases by 5%. Unlike patients infected with Hepatitis C or HIV who require only standard precautions during dialysis, patients with HBV infection must be segregated. Given the prevalence of HBV, first time dialysis patients could be infected with HBV and inadvertently dialyzed in a nonsegregated setting, especially if dialysis is urgent. Following such an event, we sought to minimize subsequent exposure risk to roommates of the exposed patients if/when they seroconverted before their serology and HBV-DNA results were available. The high volume of patients needing dialysis, and limited resources, made segregating all exposed for 6 months logistically impossible. We also optimized a widely used electronic medical software program to prevent future incidents.MethodsAn exposure was defined as any non-immune patient concurrently dialyzed in the same room with the index case (horizontal; n = 4) or dialyzed on the same machine that was cleaned (but not bleached and heat treated) immediately after the index patient (vertical; n = 1). All received HBV vaccine and immunoglobulin, and all of the dialysis machines were sequestered, bleached, and heat treated after each dialysis. All patients were monitored for seroconversion (SCV) with weekly HBSAg and DNA. The dialysis position of the vertical exposure was moved to last of the day. Root causes of a patient’s serologic status escaping verification included: (1) having only a single manual verification step; (2) gaps in a popular medical software (Epic Verona, WI); (3) urgent initiation of the first dialysis session; and (4) automatic importing of lab results. A highly visible “HBV” column on the dialysis census and a”hard stop’ in electronic ordering were added.ResultsAt 1-year follow-up, there were no questions of false-positives, no HBV DNA detections, SCVs, or further incidents.ConclusionWe used both DNA and HBSAg for monitoring the exposed, because using only DNA would have risked missing an inter-dialysis SCV due to its 4-day turnaround time. Although HBSAg can be falsely positive from vaccination, results were available in ≤ 24 hours. As there are no specific recommendations for optimum SCV monitoring and mitigating this type of event, others may find our approach useful.Disclosures All authors: No reported disclosures.

2475. Hepatitis B Vaccination Coverage Amongst Asian-American Adults: A Population-Based Study of the Role of Race and Gender

BackgroundAn estimated 257 million individuals are living with hepatitis B Virus (HBV) worldwide. While the aggregate rate of HBV infection has been firmly decreasing in the United States, Asian males continue to experience the highest risk of infection. This study aims to investigate the racial and gender disparities in HBV vaccination coverage among Asian American adults using the 2012–2015 National Health Interview Survey (NHIS).MethodsThe study sample included 125,399 adults aged 18 to 85 who participated in the 2012–2015 NHIS. The main outcome was HBV vaccination status. Race/ethnicity was categorized into White-non-Hispanics, Black-non-Hispanics, Hispanics, Other, Asian-Indian, Chinese, Filipino, and Other-Asian (Korean, Vietnamese, Japanese, and other Asian subgroups). Complex survey methods were applied to all models to provide statistical estimates that are representative of US adults. Multivariable logistic regression models adjusting for age, education, region of residence, survey year, health insurance access, chronic liver disease, influenza vaccination, marital, employment and health status were fit to examine the associations between gender, race/ethnicity and HBV vaccinations status.ResultsAn estimated 39.66% (95% CI; 38.07%, 41.25%) of Asian adults living in the US received HBV vaccination. Vaccination prevalence among male Asian adults was lower than their female counterparts 38.05% (95% CI; 35.66%, 40.44%) vs. 41.09% (95% CI; 38.96%, 43.21%). Among Asian adults, the adjusted odds ratio (AOR) of HBV vaccination for females were 1.20 (95% CI; 1.04, 1.39) times higher than males. The AORs of HBV vaccinations were significantly higher when compared with white 1.21 (95% CI; 1.03, 1.41), 1.29 (95% CI; 1.10, 1.51), respectively for Chinese and Filipino Adults. We observed significant gender disparities in HBV vaccination AOR for Asian-Indian and Chinese adults. In both groups, females had higher AOR of HBV vaccination when compared with males, Asian-Indian 1.42 (95% CI; 1.04, 1.94) and Chinese 1.39 (95% CI; 1.07, 1.80).ConclusionAmong Asian-Indian and Chinese adult residents of the United States, the association between race and HBV vaccination status differs by gender, with males having lower vaccination rates than females. Healthcare resources should be directed to these target populations to improve these rates.Disclosures V. Rustgi, Genfit: Grant Investigator and Investigator, Research support. Gilead: Speaker’s Bureau, Speaker honorarium. Abbvie: Speaker’s Bureau, Speaker honorarium.

Anti-Hepatitis B Antibody status in children with coeliac disease

Objective: This study aimed to compare the antibodies response to hepatitis B virus (HBV) vaccine between Libyan children with coeliac disease (CD) and healthy control. Subjects and Methods: A total of 66 children with CD on a gluten-free diet (GFD) and 31 randomly allocated healthy children who received HBV vaccination according to the standard immunization schedule were included. Hepatitis B virus surface antigen (HBsAg) and the production of specific anti-HBs antibodies were evaluated in all patients and control participants using standard techniques. Patients with &lt;10 IU/L anti-HBs antibodies were considered nonresponses to the vaccination. Results: None of the participants were HBsAg reactive. Forty-one of the 66 patients (62%) were female, and 25 (37.8%) were male. The mean age of the CD patients was 8.2 years (range, 22 months-15 years). Anti-HBs titers were positive in 40 (60.6%) patients and negative in 26 (39.3%) patients, whereas they were positive in 19 (61.2%) of the children in the control group and negative in 12 (38.7%).There was no significant difference in response to vaccine between the two groups (P = 0.83), the study revealed a statistically significant relation between negative anti-HBs titers and duration from the last dose of HBV vaccine (P = 0.004). Conclusion: In the present study, the response rate in Libyan children with CD on GFD was not different from healthy control. However, not all children need booster dose; only nonresponders need an intradermal test-booster dose to reassess the state of their memory cell before considering revaccination.

Follow-up of hepatitis b virus vaccine response in healthy individuals

Background The long-term protective effect of hepatitis B virus (HBV) vaccine and the need for booster dose vaccination remain unclear. Detection of nonresponders to HBV vaccine and search for factors that lead to nonresponse will help in prevention of HBV infection, hepatocellular carcinoma related to hepatitis B infection and hepatitis D virus infection. Aim The aim of this study was to assess the benefit of follow-up of hepatitis B vaccine response and evaluate the persistence of seroprotection after HBV vaccination to determine the necessity of a booster dose in healthy individuals after 5 and 10 years of vaccination. Patients and methods Serum samples were tested for quantitative detection of hepatitis B surface antibodies (HBsAb) using ELISA for 30 individuals who received HBV vaccine of less than or equal to 5 years (group I) and 30 individuals who received HBV vaccine for more than or equal to 10 years (group II), and if the results were negative or less than 10 IU/ml, evaluations of hepatitis B surface antigen and hepatitis B core antibodies (total) were done. Results HBsAb was positive among 66.7% of each group, and the median HBsAb level was 59.73 and 51.21 in groups I and II, respectively. Conclusion Approximately 33% of the studied groups were nonresponders of HBV vaccine regardless of postvaccination years (5–10). Hepatitis B infection and occult hepatitis B infection results were negative in all of nonresponders. Recommendations Follow-up of HBsAb levels in vaccinated individuals after having completed three doses of hepatitis B vaccination on a large scale is important to detect nonresponses and revaccinate them.

Hepatitis B vaccine and the need for a booster dose after primary vaccination.

Protective antibodies levels, induced by Hepatitis B virus (HBV) vaccine, persist for long-term after primary immunization, but there is evidence that, as the time since vaccination increases, there is a reduced ability to maintain immune memory. The study aim was to determine the prevalence and the duration of persistence of an anti-HBs titer with ≥10mIU/mL and eventual predictors of reduced seroprotection. The study was conducted among students attending medical and healthcare professions schools from January 2014 to June 2016. Data were collected through the review of medical records completed during the medical surveillance visit. All subjects had received HBV vaccine according to the Italian Ministry of Health indications. The results are reported for 722 subjects. Positive anti-HBs titer was found in 72.6% (95% CI=69-76). The mean age of the subjects was 25.5years. Subjects vaccinated during adolescence and students that had received an adult vaccine dose were significantly more likely to be seroprotected. The longer the time interval since vaccination the lower the probability of being seroprotected; however if the role of time since vaccination was considered after stratification by vaccine dose, a statistically significant association with a lower percentage of seroprotected remains only in the subgroup of subjects who received the pediatric dose. The findings of the multivariate regression analysis partially confirmed those of the univariate analysis. In conclusion, our findings show that over 25% of HBV vaccine recipients had an antiHBs titer <10mIU/ml after 18years of more from the primary vaccination. Furthermore, in the case a booster dose would be needed, our results suggest that the vaccination strategy should prefer administration of a vaccine adult dose during early adolescence, since it might offer longer-term protection through adulthood.