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Godono A, Clari M, Corgiat Loia R, Panero B, Noè S, Carena E, Mansour I, Dimonte V, Pira E, Charrier L. Serosusceptibility and hesitancy for booster HBV vaccination among health care workers in Italy: A cross-sectional study. J Infect Public Health 2024; 17:1095-1099. [PMID: 38705062 DOI: 10.1016/j.jiph.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Health care workers (HCWs) are at increased risk of exposure to hepatitis B virus (HBV). The most effective prevention measure is vaccination, with a serum hepatitis B surface antibody (HBsAb) titre > 10 mIU/ml considered protective. To date, the sociodemographic and occupational characteristics related to HBV serosusceptibility and factors associated with booster hesitancy remain unclear. Therefore, this study aimed to identify factors associated with maintaining a protective HBsAb titre in a large sample of HCWs and to evaluate factors potentially associated with hesitancy towards vaccine boosters. METHODS A cross-sectional study was conducted among HCWs who underwent a health surveillance visit between 2017 and 2022. If the serum HBsAb titre was < 10 MIU/ml, a vaccine booster dose was offered. Based on their willingness to be vaccinated, employees were classified into three groups: acceptance, hesitation, and refusal. Uni- and multivariable analyses were performed to assess the association of demographic and occupational characteristics with serosusceptibility and attitudes towards vaccination. RESULTS A total of 1632 (27%) employees were shown to be nonimmune. A lower median age and being a physician were significantly associated with a protective HBsAb titre. A total of 706 nonimmune employees (43.3%) accepted the vaccination, 865 (53%) hesitated, and 61 (3.7%) refused. The median age of those who refused vaccination was significantly higher than that of those who hesitated and those who were vaccinated. Acceptance of vaccination was significantly higher among nurses, while nurse aides hesitated more; among nonmedical graduate staff both hesitation and refusal were higher than expected. In the multivariable analysis, higher age, female sex, and employment as an allied health care professional were shown to be significantly associated with hesitation/refusal, while being born abroad turned out to be protective. CONCLUSIONS Our study showed that approximately a quarter of HCWs were not immune to HBV infection, and of these, more than half were hesitant towards or refused the booster dose. The risk of hesitation/refusal was higher with age in women and among allied health care staff. Based on these findings, further studies are needed to prospectively evaluate HBV seroprevalence, vaccination adherence, factors associated with hesitancy, and the effectiveness of health surveillance strategies in a high-risk population susceptible to infection.
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Affiliation(s)
- Alessandro Godono
- Department of Sciences of Public Health and Pediatrics, University of Torino, Italy
| | - Marco Clari
- Department of Sciences of Public Health and Pediatrics, University of Torino, Italy.
| | | | - Bruna Panero
- Department of Sciences of Public Health and Pediatrics, University of Torino, Italy
| | - Samuele Noè
- Department of Sciences of Public Health and Pediatrics, University of Torino, Italy
| | - Elisa Carena
- Department of Sciences of Public Health and Pediatrics, University of Torino, Italy
| | - Ihab Mansour
- Department of Sciences of Public Health and Pediatrics, University of Torino, Italy
| | - Valerio Dimonte
- Department of Sciences of Public Health and Pediatrics, University of Torino, Italy
| | - Enrico Pira
- Department of Sciences of Public Health and Pediatrics, University of Torino, Italy
| | - Lorena Charrier
- Department of Sciences of Public Health and Pediatrics, University of Torino, Italy
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Sayad B, Vazirian A, Bozorgomid A, Sayad N, Janbakhsh A, Afsharian M, Mansouri F, Vaziri S, Rezaeian S, Gholizadeh M. Effectiveness of oral levamisole as an adjuvant to hepatitis B vaccination in healthcare workers non-responsive to previous vaccination: A randomized controlled trial. New Microbes New Infect 2023; 53:101141. [PMID: 37255960 PMCID: PMC10225936 DOI: 10.1016/j.nmni.2023.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
Background Healthcare workers are at risk for HBV infection through percutaneous or mucosal contact with infected blood, body secretions, or blood products or via sharps injury. Hepatitis B vaccination, despite immunogenicity, may not induce a proper immune response in 5-10% of the general adult population. Increased immune response in healthcare providers that do not respond properly to conventional hepatitis B vaccination is an important health challenge. Therefore, the aim of the present study was to evaluate the effectiveness of hepatitis B vaccination plus oral levamisole as adjuvant in healthcare providers non-responsive to routine vaccination. Materials and methods The healthcare workers that were non-responsive to previous hepatitis B vaccination were enrolled in a double-blind randomized placebo-controlled clinical trial. The participants were then randomized to two groups including hepatitis B vaccination (as a three-dose series on a 0, 1, and 2-month schedule in the deltoid muscle) plus levamisole (levamisole group) and hepatitis B vaccination plus placebo (placebo group) at a 1:1 ratio. The outcome measure was the HBs antibody titer one month after receiving each dose as well as the seroprotection ratio. The side effects were also evaluated in all participants. Results In total, 22 subjects finished the trial (11 individual in per group). The median antibody titer one month after receiving the first and third doses increased more in the levamisole group compared to the placebo group but the difference was not significant (p = 0.34, p = 0.66, respectively).The seroprotection ratio after three doses was similarly high in both groups (90.9% in per group). Furthermore, the seroprotection ratio and median antibody titer had no significant correlation with age, sex, BMI, and history of smoking in intervention and control groups (p>0.05). No serious side effects were noted in both groups. Conclusions Re-vaccination can boost the immune response in healthcare professionals that were non-responsive to previous vaccination although the mean antibody titer was higher in the levamisole group.
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Affiliation(s)
- Babak Sayad
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Armin Vazirian
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arezoo Bozorgomid
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nazanin Sayad
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Janbakhsh
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mandana Afsharian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Feizollah Mansouri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Siavash Vaziri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Gholizadeh
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Soriano V, Aguilera A, Benito R, González-Díez R, Miró E, Liendo P, Rodríguez-Diaz JC, Cabezas T, Richart A, Ramos JM, Barea L, Álvarez C, Treviño A, Gómez-Gallego F, Corral O, de Mendoza C. Susceptibility to hepatitis B virus infection in adults living in Spain. Liver Int 2023; 43:1015-1020. [PMID: 36809581 DOI: 10.1111/liv.15548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/11/2023] [Accepted: 02/20/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND A protective hepatitis B virus (HBV) vaccine has been available for four decades. Universal HBV vaccination of infants is recommended by the WHO since the 1990s. Furthermore, HBV immunization is advised for all adults with high-risk behaviours and no seroprotection. However, HBV vaccine coverage remains globally suboptimal. The advent of new more efficacious trivalent HBV vaccines has renewed the interest in HBV vaccination. At present, the extent of current HBV susceptibility in adults remains unknown in Spain. METHODS HBV serological markers were assessed on a large and representative sample of adults in Spain, including blood donors and individuals belonging to high-risk groups. Serum HBsAg, anti-HBc and anti-HBs were tested in specimens collected during the last couple of years. RESULTS From 13 859 consecutive adults tested at seven cities across the Spanish geography, overall 166 (1.2%) had positive HBsAg. Past HBV infection was recognized in 14% and prior vaccine immunization in 24%. Unexpectedly, 37% of blood donors and 63% of persons belonging to high-risk groups had no serum HBV markers and therefore were potentially HBV susceptible. CONCLUSION Roughly 60% of adults living in Spain seem to be HBV susceptible. Waning immunity might be more common than expected. Hence, HBV serological testing should be performed at least once in all adults regardless of risk exposures. HBV vaccine full courses or boosters should be administered to all adults lacking serological evidence of HBV protection.
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Affiliation(s)
| | - Antonio Aguilera
- Hospital Clínico Universitario de Santiago & GI-1209 USC, Santiago de Compostela, Spain
| | - Rafael Benito
- Hospital Universitario Lozano Blesa & Universidad de Zaragoza, Zaragoza, Spain
| | | | | | | | | | | | - Alberto Richart
- Centro de Transfusión de la Comunidad de Madrid, Madrid, Spain
| | | | - Luisa Barea
- Centro de Transfusión de la Comunidad de Madrid, Madrid, Spain
| | - Carmen Álvarez
- Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Ana Treviño
- Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | | | - Octavio Corral
- Universidad Internacional de La Rioja (UNIR), Madrid, Spain
| | - Carmen de Mendoza
- Puerta de Hierro University Hospital & Research Institute, Majadahonda, Spain
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Bianchi FP, Stefanizzi P, Migliore G, Martinelli A, Vimercati L, Germinario CA, Tafuri S. Prevalence of healthcare workers fully vaccinated against hepatitis B without circulating antibodies in Italy and role of age at baseline cycle vaccination: a systematic review and meta-analysis. Expert Rev Vaccines 2023; 22:139-147. [PMID: 36564923 DOI: 10.1080/14760584.2023.2162507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Healthcare workers (HCWs) susceptible to hepatitis B represent an important public health concern. National and international guidelines recommend assessing the hepatitis B immune status of all HCWs and possibly vaccinating those found to be seronegative (non-responders). We conducted a meta-analysis to estimate the rate of hepatitis B sero-susceptibility among HCWs in Italy and to explore possible options for the management of non-responders. AREAS COVERED Nineteen studies, selected from scientific articles available in the Scopus, MEDLINE/PubMed and ISI Web of Knowledge databases between 1 January 2016 and 22 April 2022, were included. The prevalence of HBV-susceptible HCWs was 27.1% (95%CI = 23.2-31.7%). In a comparison by sex (males vs. females) the RR was 1.16 (95%CI = 1.03-1.31), and by full-cycle vaccination period (adolescence vs. infancy) the RR was 0.30 (95%CI = 0.25-0.37). Occupational health screenings for hepatitis B, with subsequent vaccination of non-responders, and exclusion of susceptible HCWs from high-risk settings have been common management strategies. EXPERT OPINION It is highly probable that a proportion of the next generation of medical students and HCWs will not show circulating IgG on serologic evaluation. Therefore, more targeted efforts are needed to identify these individuals and actively immunize them.
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Affiliation(s)
| | - Pasquale Stefanizzi
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | | | - Andrea Martinelli
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
| | | | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro University of Bari, Bari, Italy
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Rahmani A, Montecucco A, Kusznir Vitturi B, Debarbieri N, Dini G, Durando P. Long-Term Effectiveness of Hepatitis B Vaccination in the Protection of Healthcare Students in Highly Developed Countries: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:1841. [PMID: 36366350 PMCID: PMC9695994 DOI: 10.3390/vaccines10111841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 09/05/2023] Open
Abstract
Hepatitis B virus represents an important global health problem. In highly developed countries, mass vaccination campaigns of newborns in recent decades have drastically reduced the proportion of carriers. However, workers exposed to blood and body fluids, including healthcare students, can be at risk of exposure. In order to assess the proportion of susceptible individuals in the specific population of healthcare students in highly developed countries, a systematic review and meta-analysis was performed to summarize the evidence on the persistence of humoral immune protection induced by the primary cycle of hepatitis B vaccination, as well as the proportion of true non-responders. Forty-six studies were included in the final analysis (52,749 participants). Overall, the seroprotection prevalence at the pre-exposure assessment was equal to 73.8% (95% CI 69.1-78.0); the prevalence of anamnestic response following the administration of a challenge dose was 90.9% (95% CI 87.7-93.3), demonstrating a high proportion of persistence of vaccination-induced immunity. Among those without evidence of anamnestic response, 5.0% (95% CI 2.1-11.5) were non-responders following the completion of a secondary immunization cycle. These findings demonstrate that the majority of healthcare students vaccinated with the complete HBV primary cycle maintain an effective humoral immunity against this pathogen for over two decades.
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Affiliation(s)
- Alborz Rahmani
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Alfredo Montecucco
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | | | - Nicoletta Debarbieri
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Paolo Durando
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
- Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Huang Y, Zhang Y, Seaton KE, De Rosa S, Heptinstall J, Carpp LN, Randhawa AK, McKinnon LR, McLaren P, Viegas E, Gray GE, Churchyard G, Buchbinder SP, Edupuganti S, Bekker LG, Keefer MC, Hosseinipour MC, Goepfert PA, Cohen KW, Williamson BD, McElrath MJ, Tomaras GD, Thakar J, Kobie JJ. Baseline host determinants of robust human HIV-1 vaccine-induced immune responses: A meta-analysis of 26 vaccine regimens. EBioMedicine 2022; 84:104271. [PMID: 36179551 PMCID: PMC9520208 DOI: 10.1016/j.ebiom.2022.104271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/27/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The identification of baseline host determinants that associate with robust HIV-1 vaccine-induced immune responses could aid HIV-1 vaccine development. We aimed to assess both the collective and relative performance of baseline characteristics in classifying individual participants in nine different Phase 1-2 HIV-1 vaccine clinical trials (26 vaccine regimens, conducted in Africa and in the Americas) as High HIV-1 vaccine responders. METHODS This was a meta-analysis of individual participant data, with studies chosen based on participant-level (vs. study-level summary) data availability within the HIV-1 Vaccine Trials Network. We assessed the performance of 25 baseline characteristics (demographics, safety haematological measurements, vital signs, assay background measurements) and estimated the relative importance of each characteristic in classifying 831 participants as High (defined as within the top 25th percentile among positive responders or above the assay upper limit of quantification) versus Non-High responders. Immune response outcomes included HIV-1-specific serum IgG binding antibodies and Env-specific CD4+ T-cell responses assessed two weeks post-last dose, all measured at central HVTN laboratories. Three variable importance approaches based on SuperLearner ensemble machine learning were considered. FINDINGS Overall, 30.1%, 50.5%, 36.2%, and 13.9% of participants were categorized as High responders for gp120 IgG, gp140 IgG, gp41 IgG, and Env-specific CD4+ T-cell vaccine-induced responses, respectively. When including all baseline characteristics, moderate performance was achieved for the classification of High responder status for the binding antibody responses, with cross-validated areas under the ROC curve (CV-AUC) of 0.72 (95% CI: 0.68, 0.76) for gp120 IgG, 0.73 (0.69, 0.76) for gp140 IgG, and 0.67 (95% CI: 0.63, 0.72) for gp41 IgG. In contrast, the collection of all baseline characteristics yielded little improvement over chance for predicting High Env-specific CD4+ T-cell responses [CV-AUC: 0.53 (0.48, 0.58)]. While estimated variable importance patterns differed across the three approaches, female sex assigned at birth, lower height, and higher total white blood cell count emerged as significant predictors of High responder status across multiple immune response outcomes using Approach 1. Of these three baseline variables, total white blood cell count ranked highly across all three approaches for predicting vaccine-induced gp41 and gp140 High responder status. INTERPRETATION The identified features should be studied further in pursuit of intervention strategies to improve vaccine responses and may be adjusted for in analyses of immune response data to enhance statistical power. FUNDING National Institute of Allergy and Infectious Diseases (UM1AI068635 to YH, UM1AI068614 to GDT, UM1AI068618 to MJM, and UM1 AI069511 to MCK), the Duke CFAR P30 AI064518 to GDT, and National Institute of Dental and Craniofacial Research (R01DE027245 to JJK). This work was also supported by the Bill and Melinda Gates Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the funding sources.
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Affiliation(s)
- Yunda Huang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America; Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America; Department of Global Health, University of Washington, Seattle, WA, United States of America.
| | - Yuanyuan Zhang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Kelly E Seaton
- Center for Human Systems Immunology, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Stephen De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Jack Heptinstall
- Center for Human Systems Immunology, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Lindsay N Carpp
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - April Kaur Randhawa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Lyle R McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MN, Canada; JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, MN, Canada; Centre for the AIDS Program of Research in South Africa (CAPRISA), Durban, South Africa
| | - Paul McLaren
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MN, Canada; JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, MN, Canada
| | - Edna Viegas
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Glenda E Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council, Cape Town, South Africa
| | - Gavin Churchyard
- Aurum Institute, Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, United States of America; Department of Medicine and Department of Epidemiology, University of California, San Francisco, CA, United States of America
| | - Srilatha Edupuganti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Michael C Keefer
- Department of Medicine, Infectious Diseases Division, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - Mina C Hosseinipour
- University of North Carolina Project, Lilongwe, Malawi; Department of Medicine, Institution for Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Paul A Goepfert
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kristen W Cohen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Brian D Williamson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - M Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Georgia D Tomaras
- Center for Human Systems Immunology, Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Juilee Thakar
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America
| | - James J Kobie
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
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Sticchi L, Iavarone IG, Durando P, Di Biagio A, Schiavetti I, Murgia F, Icardi G. The role of hepatitis B vaccine challenge dose in patients with underlying health conditions. Hum Vaccin Immunother 2021; 17:575-579. [PMID: 32614653 PMCID: PMC7899643 DOI: 10.1080/21645515.2020.1777058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 02/08/2023] Open
Abstract
We have evaluated the immunological response to Hepatitis B virus (HBV) booster vaccine dose in 129 adults with underlying diseases in comparison with 694 subjects at occupational risk of infection, who have previously completed the primary series and resulted with anti-HBs <10 mIU/mL. After booster dose, 60.5% of the patients with underlying diseases and 14.8% of the subjects at occupational risk resulted seronegative. By comparing two groups, rate of subjects with anamnestic response was higher in at occupational risk group respect to that at risk for medical conditions (OR: 5.99 [95%IC, 3.81-9.41], p < .001). This difference was associated to gender (males/females: OR: 0.619 [95%IC, 0.421-0.910], p = .015) and age (better response for younger people, p = .011).
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Affiliation(s)
- L. Sticchi
- Department of Health Sciences (Dissal), University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - I. G. Iavarone
- Department of Health Sciences (Dissal), University of Genoa, Genoa, Italy
| | - P. Durando
- Department of Health Sciences (Dissal), University of Genoa, Genoa, Italy
- Occupational Medicine Unit, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - A. Di Biagio
- Department of Health Sciences (Dissal), University of Genoa, Genoa, Italy
- Infectious Diseases, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - I. Schiavetti
- Department of Health Sciences (Dissal), University of Genoa, Genoa, Italy
| | - F. Murgia
- Healthcare Profession Direction Operational Unit, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - G. Icardi
- Department of Health Sciences (Dissal), University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS Policlinico San Martino Hospital, Genoa, Italy
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Bechini A, Bonanni P, Grazzini M, Paolini D, Arcangeli G, Mucci N, Bini C, Tiscione E, Zanella B, Boccalini S. Need to take special care of non-responders to hepatitis B vaccination among health-care workers, students and chronic patients. Hum Vaccin Immunother 2020; 17:580-582. [PMID: 33270480 DOI: 10.1080/21645515.2020.1810495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Both our research and that published by Sticchi et al. on immunological memory against hepatitis B virus (HBV) in health-care workers (HCWs) vaccinated as infants or adolescents confirm that in those testing negative after the primary course, one additional (fourth) booster dose is able to elicit an anti-HBs response in >85% subjects. The fifth and the sixth doses further contribute substantially to a high overall response rate. The rate of subjects showing an anamnestic response after the booster dose was almost six-fold higher in HCWs compared to chronic patients. Since universal vaccination in Italy resulted in a significant decrease in HBV infections, special attention and testing should be addressed to those affected by chronic diseases.
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Affiliation(s)
- Angela Bechini
- Department of Health Sciences, University of Florence , Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence , Florence, Italy
| | | | - Diana Paolini
- Department of Health Sciences, University of Florence , Florence, Italy
| | - Giulio Arcangeli
- Department of Experimental and Clinical Medicine, University of Florence , Florence, Italy
| | - Nicola Mucci
- Department of Experimental and Clinical Medicine, University of Florence , Florence, Italy
| | - Costanza Bini
- Department of Experimental and Clinical Medicine, University of Florence , Florence, Italy
| | - Emilia Tiscione
- Department of Health Sciences, University of Florence , Florence, Italy
| | - Beatrice Zanella
- Department of Health Sciences, University of Florence , Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence , Florence, Italy
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Discrepancies between Vaccine Documentation and Serologic Status for Diphtheria, Tetanus, and Hepatitis B in Internationally Adopted Children. Vaccines (Basel) 2020; 8:vaccines8030489. [PMID: 32872676 PMCID: PMC7563378 DOI: 10.3390/vaccines8030489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/04/2022] Open
Abstract
Internationally Adopted Children (IAC) often show suboptimal immunisation coverage, but available data are discordant. Data at the first evaluation of 2073 IAC (median age: 6 years) referred to the Meyer Children’s University Hospital (Florence, Italy) in 2009–2019 were analysed in order to evaluate their immunisation status against diphtheria, tetanus, and hepatitis B. Negative antibody titres were observed in 11.5% of the IAC for diphtheria, 18.6% for tetanus, and 39.0% for hepatitis B. At multivariate analysis, originating from Africa was an independent risk factor for seronegativity for the three diseases (p < 0.001), while age below four years was an independent factor associated with protective immunity, only considering hepatitis B (p < 0.001). Vaccine documentation was an additional factor independently associated with protective immunity. However, a discrepancy between documentation (indicating previous vaccinations) and serology (showing negative antibody titres) was evidenced in 3.8% of the children for diphtheria, 12.6% for tetanus, and 29.6% for hepatitis B. This finding suggests that although vaccine documentation may reflect the presence of protective antibody titres, it should not be accepted as absolute evidence of protective immunity, underlining the importance of a complete assessment of immunisation status in IAC, particularly in those originating from Africa and aged over four years.
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Kinetics of Anti-Hepatitis B Surface Antigen Titers in Nurse Students after a Two-Year Follow-Up. Vaccines (Basel) 2020; 8:vaccines8030467. [PMID: 32839391 PMCID: PMC7563960 DOI: 10.3390/vaccines8030467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022] Open
Abstract
Infection caused by hepatitis B virus (HBV) can be prevented through a safe and effective vaccine. This study analysed the kinetics of serum antibodies against hepatitis B surface antigen (HBsAg) (anti-HBs) titers in relation to previous vaccine boosters in Italian nursing students who were followed up for two years. Serum anti-HBs titers were evaluated at the first visit, after vaccine booster (if required) and at visit after two years. Overall, 483 students (mean age = 21.7 years; SD = 3.7) with median anti-HBs IgG titer of 6 mUI/mL (interquartile range (IQR) = 0–34) were enrolled. A total of 254 (52.5%) students with a titer lower than 10 mIU/mL were offered an anti-HBV booster at the first visit. Among these students, an exponential relation between anti-HBs IgG titer, one month after HBV booster and anti-HBs IgG titer two years later was found (y = 3.32 exp (0.0045x); R2 = 0.48; p < 0.001). Students with anti-HBV titer higher than 10 mIU/mL (N = 229) were followed up, and anti-HBs IgG titers at follow-up visit linearly correlated with anti-HBV baseline titers (y = 0.86x + 26.2; R2 = 0.67; p < 0.001). A decrease in anti-HBs titers can be expected a few years after the anti-HBV booster dose. This reduction is more pronounced than that observed in students not administered the booster dose and is exponential with respect to basal titers assessed after the booster dose.
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