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Koc ÖM, Menart C, Theodore J, Kremer C, Hens N, Koek GH, Oude Lashof AML. Ethnicity and response to primary three-dose hepatitis B vaccination in employees in the Netherlands, 1983 through 2017. J Med Virol 2019; 92:309-316. [PMID: 31621084 DOI: 10.1002/jmv.25610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/13/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS 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. METHODS 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). RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Özgür M Koc
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Charlotte Menart
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jemimah Theodore
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cécile Kremer
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-Biostat), Hasselt University, Hasselt, Belgium
| | - Niel Hens
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-Biostat), Hasselt University, Hasselt, Belgium.,Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ger H Koek
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Visceral Surgery and Transplantation, University Hospital of the RWTH, Aachen, Germany
| | - Astrid M L Oude Lashof
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
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Thomas RJ, Fletcher GJ, Kirupakaran H, Chacko MP, Thenmozhi S, Eapen CE, Chandy G, Abraham P. Prevalence of non-responsiveness to an indigenous recombinant hepatitis B vaccine: a study among South Indian health care workers in a tertiary hospital. Indian J Med Microbiol 2015; 33 Suppl:32-6. [PMID: 25657153 DOI: 10.4103/0255-0857.150877] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Health care workers (HCW) are at higher risk of contracting HBV infection. Non-response to HBV vaccine is one of the major impediments to prevent healthcare associated HBV infection (HAHI). We estimated the prevalence of non-responsiveness to initial 3-dose regimen of an indigenous recombinant HBV vaccine (GeneVac-B) among South Indian HCWs and typed the HLA in non-responders. STUDY DESIGN AND METHOD Of the 778 subjects screened over 1 year, 454 completed all three doses of the hepatitis B vaccination. Anti-HBs titers were estimated by microparticle enzyme immunoassay AxSYM AUSAB, (Abbott, Germany). HLA typing was done using SSP-PCR assay AllSet+™ Gold SSP (Invitrogen, USA). RESULTS The overall seroconversion rate (anti-HBs>10 mIU/mL) was 98.89% wherein 90.8% had titers>1000mIU/mL, 7.6% had titers 100-1000mIU/mL, 0.43% had titers<100 mIU/mL and 1.1% were non-responsive (<10 mIU/mL) to the initial 3-dose regimen. Antibody titers<1000 mIU/mL were significantly associated with the highest quartile of body mass index (BMI) (P<0.001). We found no significant difference in seroprotection rate between gender (P=0.088). There was no difference in seroprotection rates among various ethnic groups (P=0.62). Subjects who were non-responsive in our study had at least one HLA allele earlier known to be associated with non-responsiveness to the vaccine. CONCLUSION Our findings suggest that non-response to HBV vaccine is not a major impediment to prevent HAHI. Robust seroprotection rates can be achieved using this indigenous HBV vaccine. However, gender and BMI might influence the level of anti-HBs titers. We recommend the use of this cost effective HBV vaccine as well as postvaccination anti-HBs testing to prevent HAHI among HCWs.
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Affiliation(s)
| | | | | | | | | | | | | | - P Abraham
- Department of Clinical Virology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Ribner BS, Hall C, Steinberg JP, Bornstein WA, Chakkalakal R, Emamifar A, Eichel I, Lee PC, Castellano PZ, Grossman GD. Use of a Mandatory Declination Form in a Program for Influenza Vaccination of Healthcare Workers. Infect Control Hosp Epidemiol 2015; 29:302-8. [DOI: 10.1086/529586] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To evaluate the utility and impact of using a declination form in the context of an influenza immunization program for healthcare workers.Methods.A combined form for documentation of vaccination consent, medical contraindication(s) for vaccination, or vaccination declination was used during the 2006-2007 influenza season in a healthcare system employing approximately 9,200 nonphysician employees in 3 hospitals; a skilled nursing care facility; a large, multisite, faculty-practice plan; and an administrative building. Responses were entered into a database that contained files from human resources departments, which allowed correlation with job category and work location.Results.The overall levels of influenza vaccination coverage of employees increased from 43% (3,892 of 9,050) during the 2005-2006 season to 66.5% (6,123 of 9,214) during the 2006-2007 season. Of 9,214 employees, 1,898 (20.6%) signed the declination statement. Among the occupation groups, nurses had the lowest rate of declining vaccination (13.2% [393 of 2,970]; P < .0001), followed by pharmacy personnel (18.1% [40 of 221]), ancillary personnel with frequent patient contact (21.9% [169 of 771), and all others (24.7% [1,296 of 5,252]). Among the employees who declined vaccination, nurses were the least likely to select the reasons “afraid of needles” (3.8% [15 of 393], vs. 9.1% [137 of 1,505] for all other groups; P < .001) and “fear of getting influenza from the vaccine” (13.5% [53 of 393], vs. 20.5% [309 of 1,505]; P = .002). Seven pregnant nurses had been advised by their obstetricians to avoid vaccination. When declination of influenza vaccination was analyzed by age, 16% of personnel (797 of 4,980) 50 years of age and older declined to be vaccinated, compared with 26% of personnel (1,101 of 4,234) younger than 50 years of age {P < .0001).Conclusions.Implementing use of the declination form during the 2006-2007 influenza season was one of several measures that led to a 55% increase in the acceptance of influenza vaccination by healthcare workers in our healthcare system. Although we cannot determine to what degree use of the declination form contributed to the increased rate of vaccination, use of this form helped the vaccination program assess the reasons for declination and will help to focus future vaccination campaigns.
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Lithgow D, Cole C. A reinvestigation of seroconversion rates in hepatits B-vaccinated individuals. Biol Res Nurs 2014; 17:49-54. [PMID: 25504950 DOI: 10.1177/1099800414524619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine whether the hepatitis B seroconversion rates in a small sample of subjects reflected that of the published rates, regardless of HIV status, after a hepatitis B vaccination series was completed while following strict vaccine protocols. The study, which had a nonexperimental, correlational cross-sectional design, took place at a community clinic in Laguna Beach, CA. Participants comprised 100, predominantly White, men aged 18-65 years (mean 39.2 years) who were hepatitis B naive, regardless of immune status. After receiving a primary vaccine series for hepatitis B, participants were tested for seroconversion to immune status. Seroconversion to the immune state occurred in 78.6% of the non-immunocompromised, HIV-negative participants (n = 50), who had received the standard three-dose regimen of the vaccine, and in 77% of the immunocompromised, HIV-positive participants (n = 48), who had received the recommended modified three-double-dose regimen. The manufacturer-published rates of seroconversion are 90-100%, depending upon the population. These findings highlight a need for further study to validate or reveal deficits in current vaccine protocols for individuals who are vaccinated against hepatitis B, including health care workers, the immune-compromised and other high-risk populations.
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Affiliation(s)
- Diana Lithgow
- College of Graduate Nursing, Western University of Health Sciences, Huntington Beach, CA, USA
| | - Casey Cole
- College of Graduate Nursing, Western University of Health Sciences, Huntington Beach, CA, USA
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A model program for hepatitis B vaccination and education of schoolchildren in rural China. Int J Public Health 2011; 57:581-8. [PMID: 21845405 DOI: 10.1007/s00038-011-0289-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/12/2011] [Accepted: 08/01/2011] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Incomplete hepatitis B virus (HBV) vaccine coverage and poor HBV-related knowledge in China leave millions of children unprotected from this life-threatening infection. To address these gaps, a pilot program for HBV education and vaccination was launched in rural China. METHODS In 2006, public and private organizations in the US and China collaborated to provide HBV education and vaccination to 55,000 school-age children in the remote, highly HBV-endemic area of Qinghai Province. The impact of the educational program on HBV-related knowledge was evaluated among more than 2,800 elementary school students. RESULTS Between September 2006 and March 2007, the three-shot hepatitis B vaccine series was administered to 54,680 students, with a completion rate of 99.4%. From low pre-existing knowledge levels, classroom educational sessions statistically significantly increased knowledge about HBV risks, symptoms, transmission, and prevention. CONCLUSIONS This program offers an effective and sustainable model for HBV catch-up vaccination and education that can be replicated throughout China, as well as in other underserved HBV-endemic regions, as a strategy to reduce chronic HBV infection, liver failure, and liver cancer.
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Development of up-converting phosphor technology-based lateral-flow assay for rapidly quantitative detection of hepatitis B surface antibody. Diagn Microbiol Infect Dis 2009; 63:165-72. [PMID: 19150709 DOI: 10.1016/j.diagmicrobio.2008.10.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 10/28/2008] [Accepted: 10/28/2008] [Indexed: 01/05/2023]
Abstract
An up-converting phosphor technology-based lateral-flow (UPT-LF) assay system was developed for rapid and quantitative detection of hepatitis B surface antibody (HBsAb). To evaluate its performance, we compared it with the Abbott Axsym AUSAB (ABBOTT Diagnostics Division, Wiesbaden, Germany) assay and conventional ELISA (Wantai Biological Pharmacy Enterprise, Beijing, China) using 13 standard positive sera and 306 clinical sera. In both laboratory evaluation and clinical application, UPT-LF assay showed the best sensitivity (99.19%) and detection agreement (97.43% for the adjusted agreement) with true results. The concordance rate between UPT-LF and ELISA, as shown by correlative regression analysis, was the highest (R(2)=0.6389), whereas that between UPT-LF and AUSAB was the lowest (R(2)=0.5702). In conclusion, UPT-LF assay for quantitative detection of HBsAb is sensitive and rapid, promising this new assay a bright future.
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Chang ET, Sue E, Zola J, So SK. 3 For Life: a model pilot program to prevent hepatitis B virus infection and liver cancer in Asian and Pacific Islander Americans. Am J Health Promot 2009; 23:176-81. [PMID: 19149422 DOI: 10.4278/ajhp.071025115] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE 3 For Life aims to increase hepatitis B virus (HBV) awareness and reduce the high prevalence of undiagnosed chronic HBV infection and susceptibility among Asian/Pacific Islander (API) adults. DESIGN This pilot program offered low-cost HBV vaccination with free HBV testing targeted primarily at foreign-born Chinese adults. SETTING Semimonthly screening and vaccination clinics were held in San Francisco, California, for 1 year. SUBJECTS A total of 1206 adults accessed the program. INTERVENTION Participants paid a discounted fee for a full vaccine series against HBV, hepatitis A virus (HAV), or both. Participants also provided blood samples for HBV serologic testing. Test results, recommendations, and appointment reminders were provided by mail. MEASURES We compared the probability of completing a recommended vaccine series by HBV serologic status and sociodemographic characteristics. ANALYSIS Proportions were compared using multivariate logistic regression models. RESULTS Nine percent of adults were chronically infected with HBV, and 53% were unprotected. In the latter group, 85% completed the HBV vaccine series. The probability of completing a recommended hepatitis vaccine series was similar across most sociodemographic groups, with slightly higher completion rates among middle-aged and Chinese participants. CONCLUSIONS Lessons learned from this pilot program have been used toward successful replication in other cities, demonstrating that 3 For Life is an accessible, affordable, reproducible, and sustainable model to increase HBV awareness, testing, and prevention among API adults.
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Affiliation(s)
- Ellen T Chang
- Asian Liver Center, Stanford University, Stanford, California 94305, USA.
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Calderon M, Feja KN, Ford P, Frenkel LD, Gram A, Spector D, Tolan RW. Implementation of a pertussis immunization program in a teaching hospital: an argument for federally mandated pertussis vaccination of health care workers. Am J Infect Control 2008; 36:392-8. [PMID: 18675144 DOI: 10.1016/j.ajic.2007.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2007] [Revised: 10/26/2007] [Accepted: 10/30/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND As pertussis disease becomes more common, health care-associated outbreaks have been reported with increasing frequency. Often, these clusters are costly and labor intensive to investigate and contain. It is clear that health care workers are among the adults who transmit pertussis to susceptible infants. Recent focus on patient safety, together with a concern for protecting employees in the workplace and those they expose elsewhere, has spurred interest in optimizing measures to prevent infection and disease transmission. Shortly after a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine adsorbed booster was licensed and became available, we designed, launched, and analyzed a campaign to immunize the employees of our institution against pertussis. METHODS To optimize acceptance of a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine adsorbed booster by employees, we adopted a program consisting of a 3-phase publicity and educational model and a 3-phase vaccine delivery approach. RESULTS Despite extraordinary resources dedicated to this program, and our institution's better than average annual uptake of influenza vaccine, less than one third of our eligible employees were immunized. A significant number of employees declined to be vaccinated for inappropriate reasons. CONCLUSION A campaign of this kind is quite labor intensive and expensive, yet limited overall vaccine uptake was achieved. A federal mandate to require pertussis immunization of all health care workers appears to be a more effective way to protect our patients, employees, families, and society.
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Dinelli MIS, Moraes-Pinto MID. Seroconvertion to hepatitis B vaccine after weight reduction in obese non-responder. Rev Inst Med Trop Sao Paulo 2008; 50:129-30. [DOI: 10.1590/s0036-46652008000200013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 11/27/2007] [Indexed: 11/22/2022] Open
Abstract
Decreased responses to hepatitis B vaccine have been associated with some host conditions including obesity. Susceptible non-responders to a primary three-dose vaccine series should be revaccinated. Those who maintain a non-responder condition after revaccination with three vaccine doses are unlikely to develop protection using more doses. This is a description of an obese woman who received six doses of hepatitis B vaccine and persisted as a non-responder. She was submitted to a vertical banded gastroplasty Roux-en-Y gastric bypass Capellas's technique. After weight reduction, she received three additional doses of vaccine and seroconverted. Further studies should help clarify the need to evaluate antibody levels and eventually revaccinate the increasing population of individuals who undergo weight reduction.
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Evaluation of immune response to Hepatitis B vaccine in health care workers at a tertiary care hospital in Pakistan: an observational prospective study. BMC Infect Dis 2007; 7:120. [PMID: 17961205 PMCID: PMC2228304 DOI: 10.1186/1471-2334-7-120] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 10/25/2007] [Indexed: 12/13/2022] Open
Abstract
Background Seroconversion rates reported after Hepatitis B virus (HBV) vaccination globally ranges from 85–90%. Health care workers (HCWs) are at high risk of acquiring HBV and non responders' rates after HBV vaccination were not reported previously in Pakistani HCWs. Therefore we evaluated immune response to HBV vaccine in HCWs at a tertiary care hospital in Karachi, Pakistan. Methods Descriptive observational study conducted at Aga Khan University from April 2003 to July 2004. Newly HBV vaccinated HCWs were evaluated for immune response by measuring serum Hepatitis B surface antibody (HBsAb) levels, 6 weeks post vaccination. Results Initially 666 employees were included in the study. 14 participants were excluded due to incomplete records. 271 (41%) participants were females and 381(59%) were males. Majority of the participants were young (<25–39 years old), regardless of gender. Out of 652 HCWs, 90 (14%) remained seronegative after six weeks of post vaccination. The percentage of non responders increased gradually from 9% in participants of <25, 13% in 25–34, 26% in 35–49, and 63% in >50 years of age. Male non responders were more frequent (18%) than female (8%). Conclusion Seroconversion rate after HBV vaccination in Pakistani HCWs was similar to that reported in western and neighboring population. HCWs with reduced immune response to HBV vaccine in a high disease prevalent population are at great risk. Therefore, it is crucial to check post vaccination HBsAb in all HCWs. This strategy will ensure safety at work by reducing nosocomial transmission and will have a cost effective impact at an individual as well as at national level, which is very much desired in a resource limited country.
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Jacob M, Bradley J, Barone MA. Human papillomavirus vaccines: what does the future hold for preventing cervical cancer in resource-poor settings through immunization programs? Sex Transm Dis 2005; 32:635-40. [PMID: 16205306 DOI: 10.1097/01.olq.0000179892.78342.79] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Yen YH, Chen CH, Wang JH, Lee CM, Changchien CS, Lu SN. Study of hepatitis B (HB) vaccine non-responsiveness among health care workers from an endemic area (Taiwan). Liver Int 2005; 25:1162-8. [PMID: 16343067 DOI: 10.1111/j.1478-3231.2005.01157.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To evaluate the etiology of non-responsiveness to hepatitis B (HB) vaccination in adults from an endemic area. METHODS A total of 250 subjects who were HBsAg negative and anti-HBs<10 mIU/ml received three-dose HB-vaccine series. Anti-HBs 'negative' was defined as a level<1.5 mIU/ml. 'Weakly' positive was defined as 1.5-10 mIU/ml at pre-vaccination testing. Anti-HBs response was defined as a level >10 mIU/ml at post-vaccination testing. Among non-responders who were anti-HBc positive, serum anti-HBe and hepatitis B virus (HBV) DNA were tested. RESULTS Three variables were associated with non-responsiveness by univariate analysis: anti-HBc positive, male gender, and age >40 years. Multivariate analysis additionally showed that anti-HBs negative was associated with non-responsiveness. Among 23 non-responders in anti-HBc positive subjects, post-vaccination serum was available in 16 subjects. HBV-DNA in all subjects was under detectable level by PCR assay. Anti-HBe positive were found in 13 of 16 subjects and were assumed to be occult HBV infection. CONCLUSION Male gender, age >40 years and anti-HBc positive are associated with non-responsiveness to HB vaccination. Most of non-responders among anti-HBc positive subjects were assumed to be occult HBV infection. Subjects with weakly positive anti-HBs were associated with responsiveness which may be the effect of immune memory.
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Affiliation(s)
- Yi-Hao Yen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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McEwen M, Farren E. Actions and Beliefs Related to Hepatitis B and Influenza Immunization Among Registered Nurses in Texas. Public Health Nurs 2005; 22:230-9. [PMID: 15982196 DOI: 10.1111/j.0737-1209.2005.220306.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Studies indicate that roughly half of health care workers are not immunized against hepatitis B and influenza. Findings from a survey of 1,000 registered nurses (RNs) conducted to analyze their beliefs and actions related to immunization recommendations are reported. Only 8% of the responding RNs chose not to receive vaccination against hepatitis B. The primary reasons that nurses declined hepatitis B vaccination were because they were not working in nursing or did not believe they were at risk of exposure. Similarly, 86% of the RNs reported they had ever received a flu shot, and 69% reported of being immunized during 2 of the previous 4 years. Rationale for receiving immunization included belief in its effectiveness, belief that they were at risk of exposure, and that it was provided free of charge. Reasons for declining included concerns about side effects, lack of concern about getting the illness, and doubts about effectiveness. The nurses who responded to the survey appear to value immunizations and generally adhere to immunization recommendations. Further study needs to be conducted on related issues, including follow-up for assessment of long-term protection of hepatitis B immunization and adherence to guidelines for postexposure prophylaxis. Ongoing monitoring and further study of serious complications of hepatitis B immunizations are also needed.
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Affiliation(s)
- Melanie McEwen
- School of Nursing, Nursing Systemsand Technology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
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Jacobs RJ, Gibson GA, Meyerhoff AS. Cost-effectiveness of hepatitis A-B vaccine versus hepatitis B vaccine for healthcare and public safety workers in the western United States. Infect Control Hosp Epidemiol 2004; 25:563-9. [PMID: 15301028 DOI: 10.1086/502440] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of substituting hepatitis A-B vaccine for hepatitis B vaccine when healthcare and public safety workers in the western United States are immunized to protect against occupational exposures to hepatitis B. PARTICIPANTS A cohort of 100,000 hypothetical healthcare and public safety workers from 11 western states with hepatitis A rates twice the national average. DESIGN A Markov model of hepatitis A was developed using estimates from U.S. government databases, published literature, and an expert panel. Added costs of hepatitis A-B vaccine were compared with savings from reduced hepatitis A treatment and work loss. Cost-effectiveness was expressed as the ratio of net costs to quality-adjusted life-years (QALYs) gained. RESULTS Substituting hepatitis A-B vaccine would prevent 29,796 work-loss-days, 222 hospitalizations, 6 premature deaths, and the loss of 214 QALYs. Added vaccination costs of $5.4 million would be more than offset by $1.9 million and $6.1 million reductions in hepatitis A treatment and work loss costs, respectively. Cost-effectiveness improves as the time horizon is extended, from $232,600 per QALY after 1 year to less than $0 per QALY within 11 years. Estimates are most sensitive to community-wide hepatitis A rates and the degree to which childhood vaccination may reduce future rates. CONCLUSION For healthcare and public safety workers in western states, substituting hepatitis A-B vaccine for hepatitis B vaccine would reduce morbidity, mortality, and costs.
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Affiliation(s)
- R Jake Jacobs
- Capitol Outcomes Research, Inc., Alexandria, Virginia 22310, USA
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Fisman DN, Agrawal D, Leder K. The effect of age on immunologic response to recombinant hepatitis B vaccine: a meta-analysis. Clin Infect Dis 2002; 35:1368-75. [PMID: 12439800 DOI: 10.1086/344271] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2002] [Accepted: 08/08/2002] [Indexed: 01/16/2023] Open
Abstract
Hepatitis B vaccine is a key tool for the prevention of hepatitis B infection. Age-associated changes in immune function may contribute to decreased vaccine efficacy in older individuals, although research related to this topic has yielded contradictory findings. We performed a meta-analysis of 24 published trials and studies that evaluated the association of age with response to hepatitis B vaccine, using a random-effects model. Pooling of study results suggested a significantly increased risk of nonresponse to hepatitis B vaccine among older individuals (relative risk [RR], 1.76; 95% confidence interval [CI], 1.48-2.10). An elevated risk of nonresponse persisted even after exclusion of poor-quality studies (RR, 1.63; 95% CI, 1.23-2.15) and adjustment for publication bias (RR, 1.52; 95% CI, 1.26-1.83), and it was present even when "older" individuals were defined as being as young as 30 years. These findings have important implications for individuals at risk for hepatitis B infection, including health care workers and travelers.
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Affiliation(s)
- David N Fisman
- City of Hamilton Social and Public Health Services Department, Hamilton, Ontario, Canada.
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Tele SA, Martins RM, Lopes CL, dos Santos Carneiro MA, Souza KP, Yoshida CF. Immunogenicity of a recombinant hepatitis B vaccine (Euvax-B) in haemodialysis patients and staff. Eur J Epidemiol 2002; 17:145-9. [PMID: 11599688 DOI: 10.1023/a:1017918218784] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hepatitis B vaccine is the most effective strategy for preventing the transmission of hepatitis B virus (HBV) in haemodialysis centers. Nevertheless, lower vaccine responses have been reported in haemodialysis patients as compared with healthy subjects. This study examines the response to Euvax-B in Brazilian haemodialysis patients and staff. A total of 102 eligible patients (n = 42) and staff members (n = 60) consented to be studied. Patients were immunized intramuscularly with four doses of 40 microg of Euvax-B vaccine at 0, 1, 2 and 6 months. In staff members, the vaccine was administered in three doses of 20 microg at 0, 1, and 6 months. Post-vaccine samples were taken from all subjects I month after each dose. The vaccine response was determined by measuring antibody to the hepatitis B surface antigen (anti-HBs) levels using ELISA. Subjects with anti-HBs titres equal to or higher than 10 UI/L were considered immune protected. Of the haemodialysis patients who received four doses of hepatitis B vaccine, 89.5% responded to Euvax-B vaccine. The geometric mean of anti-HBs titres was 322.8 IU/L (95% CI: 317.7-328). Among staff members, 93.3% reached anti-HBs protective titres after the third vaccine dose. The geometric mean of anti-HBs titres was 2,209 IU/L (Cl: 2,198-2,219). Age, male gender and body mass index were not associated with vaccine response in either group. This study showed a good immunogenicity response to Euvax-B in haemodialysis patients and staff.
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Affiliation(s)
- S A Tele
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
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Villasís-Keever MA, Peña LA, Miranda-Novales G, Alvarez y Muñoz T, Damasio-Santana L, López-Fuentes G, Girón-Carrillo JL. Prevalence of serological markers against measles, rubella, varicella, hepatitis B, hepatitis C, and human immunodeficiency virus among medical residents in Mexico. Prev Med 2001; 32:424-8. [PMID: 11330992 DOI: 10.1006/pmed.2001.0825] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vaccination programs among health care workers are based on seroprevalence studies, which seldom include medical residents or students. The objective of this study was to determine the seroprevalence of antibodies against measles, rubella, varicella, hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) among medical residents. METHODS This study was designed as a prospective survey. A self-reported questionnaire was used to obtain the information. Serum samples were tested for antibodies by commercial immunoenzymatic assays. Statistical analysis was descriptive; history of exposure was evaluated as a diagnostic test and sensitivity, specificity, and predictive values were calculated according to Bayes theorem. RESULTS Eighty-nine residents were included, the median age was 27 years, and 58 (65.2%) were female. Seventy-two (79.7%) had been vaccinated against HBV, but vaccination was complete in only 30/72 (41.6%). All were positive for measles and varicella, with the exception of one case for each. The serology for rubella was negative in 12 residents (10 women). Three residents had anti-core against HBV, with negative surface antigen. One positive case for HCV was confirmed by Western blot. All were negative for HIV. A history of prior varicella had a 100% positive predictive value; in contrast, the negative predictive value was quite low (7%). CONCLUSIONS Negative serology for rubella among women and incomplete vaccination against HBV support the implementation of vaccination programs in medical schools in Mexico.
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Affiliation(s)
- M A Villasís-Keever
- Clinical Epidemiology Research Unit, Pediatric Hospital, XXI Century National Medical Center and Social Security Medical Institute, Avenida Cuauchtémoc No. 330, Col. Doctores, CP 06720 México, D.F., Mexico
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Helcl J, Cástková J, Benes C, Novotna L, Sepkowitz KA, DeHovitz JA. Control of occupational hepatitis B among healthcare workers in the Czech Republic, 1982 to 1995. Infect Control Hosp Epidemiol 2000; 21:343-6. [PMID: 10823572 PMCID: PMC2925678 DOI: 10.1086/501771] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Occupational hepatitis B remains a threat to healthcare workers (HCWs) worldwide, even with availability of an effective vaccine. Despite limited resources for public health, the Czech Republic instituted a mandatory vaccination program for HCWs in 1983. Annual incidence rates of acute hepatitis B were followed prospectively through 1995. Despite giving vaccine intradermally from 1983 to 1989 and intramuscularly as half dose from 1990 to 1995, rates of occupational hepatitis B decreased dramatically, from 177 cases per 100,000 workers in 1982 (before program initiated) to 17 cases per 100,000 in 1995. Among high-risk workers, the effect was even more dramatic (from 587 to 23 per 100,000). We conclude that strong public-health leadership led to control of occupational hepatitis B among HCWs in the Czech Republic, despite limited resources that precluded administering full-dose intramuscular vaccine for much of the program. Application of a similar program should be considered for other countries in regions that currently do not have a hepatitis B vaccination program.
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Affiliation(s)
- J Helcl
- National Institute of Public Health, Prague, Czech Republic
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