A 3-week hepatitis B vaccination schedule provides rapid and persistent protective immunity: a multicenter, randomized trial comparing accelerated and classic vaccination schedules

Sero-prevalence of hepatitis B virus and compliance with hepatitis B vaccination schedules among outpatient clinic attendees in Nairobi

BACKGROUND

Hepatitis B is becoming a growing public health problem in Kenya. To combat the threat, HBV vaccination should be recommended, particularly for individuals who are not covered by the national immunization program. Vaccination provides sero-protection rates approaching 95% among healthy adults after completing the three-dose vaccination course, but decreases to 87% among those who receive only two doses, emphasizing the importance of completing the three-dose vaccination course. However, data on adult adherence to HBV multi-dose vaccines in Sub-Saharan Africa are limited, despite the fact that this information is critical for prevention. As a result, more research on HBV vaccine dose completion is required. The purpose of this study is to estimate the prevalence of hepatitis B virus infection among out-patient clinic attendees in Nairobi, Kenya, as well as to identify beneficiaries of free vaccination and barriers to completing the recommended vaccine doses.

METHODS

Between July 30th and September 30th, 2015, 2644 outpatient clinic attendees aged ≥ 4 were recruited from three hospitals in Nairobi County, Kenya: Mama Lucy, Riruta, and Loco. Self-administered questionnaires were used to collect socio-demographic information, and blood samples were tested for hepatitis B surface antigen (HBsAg) using the KEMRI HEPCELL Rapid® (Hepatitis B Detection kit) test kit. Individuals who tested negative for HBsAg were given a free course of three doses of HBV vaccine. The vaccination register provided information on the number of doses administered.

RESULTS

The average age of the study population was 31.4 years (range: 4-66), with females accounting for 59.2%. 1.82% (48/2644) of the participants tested positive for HBsAg. Among the 2596 individuals eligible for vaccination, 66% (1720/2596) received at least one dose, and 51.8% (1345/2596) received all three doses. Vaccination acceptance increased with age, with older patients more likely to return for subsequent dose (OR>1 for second and third dose). Unavailability and failure to contact client were cited as significant (p<0.0001) barrier to vaccination completion by 53.7% (666/1226, 95% CI 0.5-0.6) and 37% (454/1226, 95% CI 0.3-0.4) of respondents respectively.

CONCLUSION

The prevalence of HBV infection among outpatient clinic attendees highlights the importance of expanding HBV immunization programs in Kenya. However, given the low vaccination completion rate, there is a need for public awareness of the vaccine's importance in preventing HBV and HBV-related complications.

[Hepatobiliary complications following allogeneic hematopoietic cell transplantation: Recommendations of the Francophone Society of Bone Marrow transplantation and cellular Therapy (SFGM-TC)]

Hepatobiliary complications are frequent in the context of allogeneic hematopoietic cell transplantation (allo-HCT) and contribute largely to the morbidity and mortality after transplantation. Within the framework of the ninth workshops of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held in Lille in September 2018, diagnostic approaches and treatments of hepatobiliary dysfunctions prior to and following transplantation were reviewed according to the analysis of published studies.

Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7)

Infection is a main concern after haemopoietic stem cell transplantation (HSCT) and a major cause of transplant-related mortality. Some of these infections are preventable by vaccination. Most HSCT recipients lose their immunity to various pathogens as soon as the first months after transplant, irrespective of the pre-transplant donor or recipient vaccinations. Vaccination with inactivated vaccines is safe after transplantation and is an effective way to reinstate protection from various pathogens (eg, influenza virus and Streptococcus pneumoniae), especially for pathogens whose risk of infection is increased by the transplant procedure. The response to vaccines in patients with transplants is usually lower than that in healthy individuals of the same age during the first months or years after transplant, but it improves over time to become close to normal 2-3 years after the procedure. However, because immunogenic vaccines have been found to induce a response in a substantial proportion of the patients as early as 3 months after transplant, we recommend to start crucial vaccinations with inactivated vaccines from 3 months after transplant, irrespectively of whether the patient has or has not developed graft-versus-host disease (GvHD) or received immunosuppressants. Patients with GvHD have higher risk of infection and are likely to benefit from vaccination. Another challenge is to provide HSCT recipients the same level of vaccine protection as healthy individuals of the same age in a given country. The use of live attenuated vaccines should be limited to specific situations because of the risk of vaccine-induced disease.

Short-term immunogenicity of standard and accelerated hepatitis B virus vaccination schedules in healthy adults: a comparative field study in China

World Health Organization recommends hepatitis B virus (HBV) immunization at 0, 1, and 6 months. However, studies have suggested that shortening the interval between the first and last HBV immunization can improve completion rates. Less clear is whether accelerated immunization is as immunogenic as standard immunization. Thus, the present study aimed to compare the short-term immunogenicity of yeast-derived hepatitis B vaccine in healthy adults immunized on an accelerated or standard schedule. Between June 2013 and March 2014, individuals from Jinfeng and Longmen, China were randomly assigned to receive the vaccine on an accelerated schedule (at 0, 1, and 2 months; n=201) or a standard schedule (at 0, 1, and 6 months; n=206). Subjects filled out a questionnaire asking about demographic and other health data, and they underwent physical examination. Blood was assayed for HBV surface antigen and HBV surface antibody (HBsAb) at 1–2 months after the three-dose schedule. Multivariate binary logistic regression was used to determine whether the rate of anti-HBs seroconversion differed with immunization schedule. Covariance analysis was used to compare geometric mean HBsAb concentration between the two schedules. The anti-HBs seroconversion rate was 84.6% in the accelerated group and 90.3% in the standard group. After controlling for several potential confounders, the accelerated schedule was associated with significantly lower anti-HBs seroconversion rate (OR: 0.560, 95% CI: 0.318–0.988). Similarly, the accelerated schedule was associated with significantly lower geometric mean HBsAb concentration. These results suggest that the standard schedule is more likely to lead to anti-HBs seroconversion and higher HBsAb levels in adults.

Management of chronic viral hepatitis in the hematological patient

INTRODUCTION

Infection with HBV and HCV represents a growing challenge in the management of patients with hematological malignancies. Recently, hepatitis E (HEV) was recognized as an endemic infection in developed countries and as an emerging health problem in immunocompromised patients. Areas covered: We reviewed the current knowledge on the impact of chronic viral hepatitis in the hematological setting. Epidemiological features, screening strategies and indications for treatment and monitoring have been explored and commented. Expert commentary: Knowing patient's complete HBV serostatus is mandatory in order to choose between treatment, prophylaxis or a pre-emptive approach. Recent guidelines favor treatment with high barrier molecules in all patients with chronic HBV infection and long lasting prophylaxis with those with inactive or resolved one. With regard to HCV, the new direct-acting antiviral agents have been safely administered in the hematological setting. Their use as first-line single treatment in indolent lymphomas, and combined with chemotherapy in aggressive ones, should be considered. Due to the existing risk of chronic HEV infection in the immunocompromised, screening with serum HEV-RNA should be performed in case of signs and symptoms indicative of hepatitis. In the event of HEV infection, reduction of immunosuppression and, if not feasible or unsuccessful, ribavirin treatment should be prescribed.

Management of viral hepatitis in patients with haematological malignancy and in patients undergoing haemopoietic stem cell transplantation: recommendations of the 5th European Conference on Infections in Leukaemia (ECIL-5)

Viral hepatitis affects millions of people worldwide, and host immunity is the key determinant of patient outcome. Viral hepatitis can be life threatening in patients with haematological malignancy, including haemopoietic stem cell transplant recipients, because of the virus itself, or through a need to decrease the dose of chemotherapy. A past or currently infected haemopoietic stem cell donor could also transmit viral hepatitis. The burden of viral hepatitis in patients with haematological malignancies and the weak evidence on which previous guidelines are based has prompted the European Conference on Infection in Leukaemia (ECIL-5) to convene a group of experts in the fields of viral hepatitis and of haematological malignancy to specifically address previously unconsidered issues and grade the available quality of evidence according to the Infectious Diseases Society of America grading system. The group recommends that all patients should be screened for hepatotropic viruses before haematological treatment and that patients or haemopoietic stem cell donors with markers of past or current viral hepatitis should be assessed by an expert. Screening, vaccination, and treatment rules are reported in this Review.

Factors associated with hepatitis B vaccine series completion in a randomized trial for injection drug users reached through syringe exchange programs in three US cities

Background

Hepatitis B virus (HBV) is a vaccine preventable infection yet vaccination rates are low among injection drug users (IDUs) despite the high risk of infection and longstanding recommendations to promote vaccination. We sought to improve vaccination rates by reaching IDUs through syringe exchange programs (SEPs) in three U.S. cities.

Methods

IDUs were randomized in a trial comparing the standard HBV vaccination schedule (0, 1, and 6 months) to an accelerated schedule (0, 1, and 2 months) and participation data were analyzed to identify determinants of completion of the three-dose vaccine series. Independent variables explored included sociodemographics, injection and syringe access behaviors, assessment of health beliefs, HBV-associated knowledge, and personal health status.

Results

Covariates associated with completion of the three-dose vaccine series were accelerated vaccine schedule (aOR 1.92, 95% CI 1.34, 2.58, p = <0.001), older age (aOR 1.05, 95% CI 1.03, 1.07, p = <0.001), and poorer self-rated health score (aOR 1.26, 95% CI 1.05, 1.5, p = 0.02). Completion was less likely for those getting syringes from SEP customers than for SEP customers (OR 0.33, 95% CI 0.19, 0.58, p = <0.001).

Conclusions

SEPs should offer hepatitis vaccination in a manner that minimizes time between first and last visits by accelerating the dosing schedule. Public health interventions should target younger, less healthy, and non-SEP customer participants. Other health interventions at SEPs may benefit from similar approaches that reach out beyond regular SEP customers.

A randomised controlled trial of financial incentives to increase hepatitis B vaccination completion among people who inject drugs in Australia

OBJECTIVE

This study aimed to investigate the efficacy of modest financial incentives in increasing completion of an accelerated 3-dose hepatitis B virus (HBV) vaccination schedule (0, 7, 21days) among people who inject drugs (PWID).

METHODS

Randomised controlled trial. Participants were randomly allocated to receive $30 Australian Dollars cash following receipt of vaccine doses two and three ('incentive condition'), or standard care ('control condition'). Serologically confirmed HBV-susceptible PWID. Two inner-city health services and a field study site in Sydney, Australia. The primary outcome was completion of the vaccination series. Additional assessments included self-reported demographic, drug use and treatment, and risk-taking histories.

RESULTS

Compared to the control condition, significantly more participants in the incentive condition received all three vaccine doses, under intention-to-treat analyses (n=139; 87% versus 66%; p=.004); and within the specified window periods under per protocol analyses (n=107 received three vaccine doses; 92% versus 67%; p=.001). Multivariate analysis indicated that the incentive condition and longer injecting histories significantly increased the likelihood of series completion. Aboriginal/Torres Strait Islanders were significantly less likely to complete the series.

CONCLUSIONS

Modest financial incentives, per-dose, increased adherence to the accelerated HBV vaccination schedule among PWID. Results have implications for increasing HBV and, potentially, other vaccine-preventable infections, among PWID.

Rapid immunization scheme for spouses of individuals estabilished as hepatitis B carriers during premarital tests

BACKGROUND

The aim of this study was to monitor the cases identified as hepatitis B carriers during premarital tests, to vaccinate their prospective spouses with a rapid vaccination scheme, and to compare the anti-HBs responses with the traditional vaccination scheme.

METHODS

Blood samples of 1250 couple spouses were tested for HBsAg and anti-HBs. HBsAg positive cases' fiancées which were found HBV negative were administered a rapid three-dose vaccination scheme on days 0, 7, and 21. Forty controls with similar age and gender were also were administered three doses of the same vaccine.

RESULTS

Out of 1250 cases (625 couples), 46 (3.6%) were HBsAg positive, and 40 of them aged between 18 and 39 were admitted to the rapid vaccination program.

CONCLUSION

Upon determination of HBsAg positivity in premarital tests, a rapid vaccination program provides early protection, but the 6th and 12th month vaccinations are also required. Anti-HBs response should be monitored.

Accelerated hepatitis B vaccination schedule among drug users: a randomized controlled trial

BACKGROUND

Hepatitis B vaccine provides a model for improving uptake and completion of multidose vaccinations in the drug-using community.

METHODS

The Drugs, AIDS, STDs, and Hepatitis (DASH) project conducted a randomized controlled trial among not-in-treatment current drug users in 2 urban neighborhoods. Neighborhoods were cluster-randomized to receive a standard behavioral intervention (which provided information on human immunodeficiency virus [HIV]) or an enhanced behavioral intervention (designed to increase acceptance of or adherence to the hepatitis B vaccination protocol). Participants within clusters were randomized to a standard vaccination schedule (vaccines at 0, 1, and 6 months) or an accelerated vaccination schedule (vaccines at 0, 1, and 2 months). The outcomes were completion of the 3-dose vaccine and seroprotection against hepatitis B virus (HBV).

RESULTS

Of participants with negative screening results for HIV and HBV, 77% accepted hepatitis B vaccination, and 75% of vaccinees received all 3 doses. Injection drug users (IDUs) on the accelerated schedule were significantly more likely to receive 3 doses (76%) than those on the standard schedule (66%; P = .04), although for drug users as a whole the corresponding adherence rates were 77% and 73%, respectively. No difference in adherence was observed between the behavioral intervention groups. Predictors of adherence were older age, African American race, stable housing, and alcohol use. Cumulative HBV seroprotection (≥10 mIU/mL) was gained within 12 months by 65% of those completing the schedule. Seroprotection at 6 months was greater for those on the accelerated schedule.

CONCLUSION

The accelerated vaccination schedule improves hepatitis B vaccination adherence among IDUs.

Use of an accelerated immunization schedule for combined hepatitis A and B protection in the corporate traveler

Increased international business travel to moderate or high endemic areas of hepatitis A and B may leave many business travelers at risk for infection if not vaccinated. Many international business travelers depart for hepatitis A and B endemic areas within 2 months of the decision to travel. Many of these travelers do not seek pretravel medical advice and are unaware of the risks and modes of acquiring hepatitis A and B. Monovalent vaccines and a combined hepatitis A and B vaccine are available and can be administered on an accelerated schedule. Because many areas endemic for hepatitis A are also endemic for hepatitis B, accelerated administration of the combined vaccine can offer protection for many international business travelers destined for areas endemic for both diseases and should be part of corporate travel immunization programs.

Schedules for hepatitis B vaccination of risk groups: balancing immunogenicity and compliance

INTRODUCTION

Vaccination is an important tool in hepatitis B prevention. However, several vaccine doses are required to induce long-term protection. Several at-risk groups have difficulties in adhering to the standard vaccination schedule.

OBJECTIVES

This paper aims to review the use of accelerated hepatitis B vaccination schedules, in terms of immunogenicity and compliance.

RESULTS

Accelerated schedules (0.1.2.12 months) or super-accelerated schedules (0.7.21.360 days) have been shown to result in higher proportions of healthy vaccinees reaching anti-HBs antibody levels >or=10 IU/l more rapidly. A fourth completing dose is required to lift antibody levels to an equal height, as does a standard (0.1.6 months) schedule. Accelerated schedules do also increase the uptake of hepatitis B vaccine, that is the proportion of vaccinees who receive three doses. However, completing the schedule with a fourth dose is usually more difficult than completing a standard 0.1.6-month schedule. Several additional tools can help to increase the compliance (eg, reminder systems, outreach services and incentive schemes).

CONCLUSION

For rapid seroconversion and almost immediate protection in the short term, a (super)accelerated schedule could be used in at-risk groups. As long-term protection data with these (super) accelerated schedules have not been documented yet, a fourth dose at month 12 is still required. A shortened schedule (0.1.4 months) might be an alternative worth considering compared with the standard 0.1.6, as it convenes to internationally accepted minimum dose intervals and offers earlier protection. There is a clear need to study the long-term protection and effectiveness of the primary part of (super)accelerated schedules.

Comparison of accelerated and rapid schedules for monovalent hepatitis B and combined hepatitis A/B vaccines in children with cancer

The aim of this study was to determine the efficacy of immunization against hepatitis A and B infections with "rapid" or "accelerated" schedules in children with cancer receiving chemotherapy. Fifty-one children were recruited to receive either vaccination schedule, in the "rapid vaccination schedule"; hepatitis B (group I) or combined hepatitis A/B vaccines (group III) were administered at months 0, 1, 2, and 12; in the "accelerated vaccination schedule," hepatitis B (group II) or combined hepatitis A/B (group IV) vaccines were administered on days 0, 7, 21, and 365 intramuscularly. The seroconversion rates at months 1 and 3 were 35.7 and 57.1% in group I and 25 and 18.8% in group II, respectively. Group I developed higher seroconversion rates at month 3. In group III the seroconversion rates for hepatitis B at months 1 and 3 were 54.5 and 60% and in group IV 50 and 70%, respectively. For hepatitis A, the seroconversion rates at months 1 and 3 were 81.8 and 90% in group III and 80 and 88.9% in group IV, respectively. The accelerated vaccination schedule seems to have no advantage in children receiving cancer chemotherapy except for high antibody levels at month 1. In conclusion, the accelerated vaccination schedules are not good choices for cancer patients. The combined hepatitis A/B vaccine is more effective than monovalent vaccine in cancer patients, which probably can be explained by an adjuvant effect of the antigens. The seroconversion of hepatitis A by the combined hepatitis A/B vaccination is very good in cancer patients.

An accelerated hepatitis B vaccination schedule for young drug users

OBJECTIVE

To determine completion rates for an accelerated hepatitis B vaccine (HBV) program among a population of young drug users.

DESIGN

Between January 2001 and May 2002, a three-dose course of HBV vaccine (0, 7 and 21 days) was offered free to all drug users (aged 22 years or younger) accessing two outreach sites of a youth-focused support and drug treatment service in metropolitan Melbourne, Australia. Clients were offered vaccination in any safe environment of their choice. An audit was conducted on the health records of participating clients.

MAIN OUTCOME MEASURES

Number of completed vaccinations; settings in which vaccinations were completed.

RESULTS

Ninety young people accepted vaccination, with 71% completing the full course. The majority preferred to receive vaccination at drug treatment outreach sites (53%).

CONCLUSIONS

An accelerated vaccination schedule appears acceptable to young drug users, suggesting that vaccination programs can be successful when barriers to immunisation are appropriately identified and addressed.

Twinrix®vaccination schedules among injecting drug users

Twinrix is the only licensed vaccine that provides dual protection against infection with hepatitis A virus (HAV) and hepatitis B virus (HBV). The standard vaccination schedule for Twinrix is 0, 1 and 6 months. However, many high-risk populations, such as injecting drug users (IDUs), do not complete the vaccination series and, thus, do not acquire sufficient immunity against HAV and HBV. Twinrix can be administered using an accelerated vaccination schedule of 0, 7 and 21 days, with a booster recommended at 12 months. This manuscript reviews the available literature on vaccinating IDUs against HAV and HBV. The authors conclude that there is insufficient evidence regarding whether the accelerated Twinrix HAV/HBV vaccination schedule would yield a greater number of IDUs protected against both HAV and HBV.

The use of the super accelerated hepatitis B vaccination regimen in a north London sexual assault referral centre (SARC)

The super accelerated hepatitis B vaccination regimen was offered to survivors of sexual assault, attending the Haven Paddington, who were at possible risk of contracting the virus [Clinical Effectiveness Group. National Guideline on the Management of Adult Victims of Sexual Assault. Sex Trans Inf 2001;(Suppl. 1):S82-S84]. The uptake and completion rates of the vaccination over two time periods from March 2004 and January 2005 were audited, using 150 clients in each group. More clients accepted the initial vaccination at the time of the forensic medical examination in the second audit when compared with the first [80 clients (73%) and 73 clients (71%), respectively]. Similar numbers of clients completed the course during both study periods [34 clients (47%) and 30 clients (38%), respectively]. Of 65% of clients who had their hepatitis B surface antibody titre checked at three months during the first audit, 77% had protective levels [>10 mIU/ml]. There was little difference following the second audit, where 75% of those who had their antibody checked were found to have protective levels. Our study has shown that this client group accepted the super accelerated hepatitis B vaccination regimen. Early serological response compares well with published data for this vaccination regimen in other settings.

Hepatitis A and B Booster Recommendations: Implications for Travelers

Hepatitis A and B are serious vaccine-preventable diseases with a predominantly overlapping epidemiological distribution. Travelers, a term encompassing a range of individuals, are at risk of contracting these diseases if they are unvaccinated. Although the benefits of the primary vaccination course of hepatitis A and B vaccines are clear, the administration of hepatitis A and B boosters varies worldwide. Recommendations on the need for booster vaccinations have recently been published, and the implications of these recommendations for travelers are discussed in this review. Until a greater understanding is reached on the immunogenicity of hepatitis A and B vaccines in certain special groups (e.g., immunocompromised persons), there will be a need to monitor antibody levels to assess whether booster vaccinations are required. However, for the majority of immunocompetent travelers, the full primary vaccination course will provide protection from both hepatitis A and B infection in the long term, without the need for boosters.

Comparison of the accelerated and classic vaccination schedules against Hepatitis B: three-week Hepatitis B vaccination schedule provides immediate and protective immunity

Background

Hepatitis B virus infection although preventable by vaccination remains an important health issue throughout the world due to its morbidity, mortality and economical losses. Early seroprotection is desirable for people at high risk of exposure. The aim of this study was to determine whether three-week hepatitis B vaccination (on days 0, 10 and 21) provide seroprotection or not.

Methods

The 120 subjects enrolled into the study were divided into two groups and vaccinated by the classic (months 0, 1, and 2) or the accelerated (days 0, 10, and 21) schedules and antibody response determined on days 30, 60, and 90 and, if below 10 mIU/ml^-1, again on day 180. For each individual in the classic group (B) three subjects were enrolled in the accelerated group (A). Recombinant hepatitis B vaccine (Gen-Hevac B, Pasteur) was given as 20 micrograms intramuscular injections via the deltoid muscle. A booster dose on day 365 was administered for each group. Family members of hepatitis B carriers and volunteer health personnel were enrolled into group A. To the B group only volunteers who wanted vaccination against hepatitis B were included.

Results

After three doses of vaccine, Anti-HBs titers reached protective levels in both groups. The number of vaccinees with seroprotective levels of Anti-HBs (≥10 mIU/ml^-1) on day 30 was 53 (58.9%) in group A and 9 (30.0%) in group B (p < 0.05). On day 60, there was no difference between group A and B, with response rates of 84.4% (n = 76) and 80.0% (n = 24) respectively (p > 0.05). On day 90 there was no difference between group B and group A; with 26 (86.7%) and 79 (87.7%) responders respectively. In both groups those with Anti-HBs levels <10 mIU/ml^-1 attained protective levels by day 180.

Conclusion

In this study, the three-week vaccination provided protective antibody titers within a shorter time compared to the classic schedule. Therefore, in order to provide rapid antibody production against hepatitis B virus, the accelerated vaccination schedule seems to be a good preference.

Vaccination options for last-minute travellers in need of travel-related prophylaxis against hepatitis A and B and typhoid fever: a practical guide

Last-minute travellers represent a particular challenge to travel healthcare professionals, as standard vaccination schedules can take a few months to complete. This has led researchers to investigate the value of alternative accelerated schedules and existing schedules among this group, particularly with respect to time taken for an individual to seroconvert, duration of protection and multiple vaccination requirements. This paper reviews the available options for the three most common vaccine preventable diseases among travellers-hepatitis A, hepatitis B and typhoid fever. Studies suggest that even if the first dose of hepatitis A vaccine is given on the day of travel, this will provide adequate protection, and that immunity to typhoid fever can be provided in over 70% of travellers following vaccination 1 week prior to departure. For hepatitis B, an accelerated schedule of 0, 7 and 21-days has been shown to induce early protection, and is considered to be of benefit to the last-minute traveller. Practical guidelines on vaccination options from one week up to one month, as well as one month or more prior to travel are presented. This should provide guidance for travel healthcare professionals, and reassure last-minute travellers that they need not begin their journey unprotected against these three serious infectious diseases.

A novel hepatitis B vaccination regimen for adolescents: two doses 12 months apart

BACKGROUND

Two- and three-dose hepatitis B vaccinations for adolescents are usually administered using dosing schedules of 6 months duration. This does not suit all circumstances. A 12-month schedule would be useful in schools and settings where only annual vaccination is the most practical option.

AIM

To examine the efficacy of a 12-month dosing interval for two-dose hepatitis B vaccination of adolescents.

SUBJECTS

Four hundred and fifty-eight healthy first-year high school (Year 7) students. VACCINATION REGIMEN: Engerix-B (GlaxoSmithKline Biologicals) 20 micro g: two doses, 12 months apart. SERUM COLLECTION: #1, same day as first vaccine dose given; #2, >1 month after second vaccine dose.

RESULTS

Of the 458 children: 15 did not provide serum #1, 17 had prior vaccination, 2 had prior infection, 18 moved, 7 failed to provide serum #2, 12 withdrew (only 1 cited vaccine adverse reactions as the reason). Three hundred and eighty-seven (210 males, 177 females) aged 11.8-14.2 years (mean: 12.9+/-0.42 years) at entry completed both injections 321-381 days (mean: 359+/-10.7 days) apart and supplied serum #2, 30-57 days (mean: 41+/-5.6 days) after the second vaccine dose.Anti-HBs responses: 379 of the 387 subjects (97.9%; 95% CI: 95.9-99.1%) achieved anti-HBs > or =10 mIU/ml (range 10-170,460 mIU/ml, geometric mean concentration (GMC) 4155 mIU/ml-95% CI of mean: 3381-5106 mIU/ml). Sex was the only determinant of anti-HBs concentration (206 males: GMC 3073 mIU/ml-95% CI: 2285-4134 mIU/ml; 173 females: GMC 5944 mIU/ml-95% CI: 4508-7851 mIU/ml; P=0.001).

CONCLUSION

A high seroprotection rate and GMC were achieved using two 20 micro g doses of Engerix-B administered 12 months apart. These results are similar to those achieved by others using 6-month three- and two-dose regimens in adolescents.

Hepatitis B vaccine -- do we need boosters?

This review analyses the cumulated data from a number of long-term follow-up studies among infants, children and adults vaccinated against hepatitis B in industrialised and developing countries. Despite low or undetectable antibody responses years after vaccination, the development of HBsAg was a rarity and, if present, only transient. Some vaccinees developed anti-HBc responses but none developed an HB carrier state or clinical manifestations of disease. Studies demonstrating anamnestic responses among those with low or undetectable anti-HBs levels following challenge with HB vaccine, together with the production of anti-HBs in circulating B-cells by spot ELISA, confirmed the presence of immune memory among vaccinees. Anamnestic anti-HBs responses all correlate close in kinetics and magnitude with proliferative T-cell responses. The accumulated data from studies assessed in this Review indicate that protection is dependent on immune memory, rather than declining anti-HBs responses and add additional weight to the European Consensus recommendations (12) that following a complete course of vaccination, booster doses are unnecessary in immunocompetent persons. If implemented, this recommendation will have considerable cost benefits world-wide.

Accelerated hepatitis B vaccination schedule in childhood

BACKGROUND

For children travelling to a hepatitis B virus (HBV) endemic area or before a treatment by blood or blood productions, the conventional HBV vaccination schedule takes too long to be completed. There may be problems in the completion of the whole vaccination schedule in developing countries because of particular problems. In these situations an accelerated schedule may be useful for HBV vaccination.

METHODS

In this study, 40 children were randomly divided into two groups. Groups were vaccinated according to two different schedules; schedule A: one dose at 0, 1, and 6 months and schedule B: one dose at 0, 10, and 21 days (Engerix B, 10 mcg/0.5 ml, GlaxoSmithKline). Follow-up blood samples were obtained at 1, 6 and 12 months after the first vaccine injection.

RESULTS

Seroconversion rates were 35 and 80% 1 month after the first vaccine injection, 95 and 80% at 6 months, 95 and 100% at 12 months, in groups A and B respectively. Seroprotection rates were 20 and 65% 1 month after the first vaccine injection, 85 and 70% at 6 months, 95 and 95% at 12 months, in groups A and B respectively. Seroconversion and seroprotection rates was significantly different at day 28 in accelerated vaccination schedule (P < 0.005).

CONCLUSIONS

In conclusion, an accelerated vaccination course against HBV (three doses at 0, 10, and 21 days) elicited protective levels of anti-HBs antibodies more rapidly than a classic course (three doses at 0, 1, and 6 months) and without a difference in the rate of seroprotection after 1 year. The accelerated 3-week recombinant HBV vaccination schedule should be recommended for HBV prophylaxis when children, such as hurried travellers, who have to have blood and blood productions, or an estimated irregular vaccination, where they have < 1 month to complete the standard HBV vaccination schedule before travelling to HBV endemic areas.

The effect of late doses on the achievement of seroprotection and antibody titer levels with hepatitis b immunization among adolescents

OBJECTIVE

To determine the effect of varying dosing schedules and predictor variables on the seroprotection rates and geometric mean titer levels resulting from the hepatitis B vaccination series among adolescents.

METHODS

Adolescents received the hepatitis B vaccination series at varying schedules according to their natural adherence patterns. Data collected included participants' medication use; chronic illness; use of cigarettes, alcohol, and marijuana; age; race/ethnicity; and body mass index. Participants' dates of vaccinations were recorded and titer levels for hepatitis B surface antibody were drawn ~12 and 24 months after study enrollment. The data for 498 participants were analyzed using chi(2) tests, Student t tests, logistic regression models, and analysis of variance.

RESULTS

Seroprotection rates among adolescents were not affected by late vaccinations. The only factors affecting the achievement of seroprotection ~12 and 24 months after the first vaccination were body mass index and the number of immunizations received. Increased time between doses 1 and 2 and doses 2 and 3 showed a trend toward correlating with increasing titer levels.

CONCLUSIONS

Although adolescents at risk of acquiring hepatitis B should receive the hepatitis B vaccination series in a timely fashion, late doses are not detrimental, and may be beneficial, to achieving high antibody levels against the hepatitis B virus.

School-based adolescent hepatitis B immunization programs in the United States: strategies and successes

BACKGROUND

To increase hepatitis B vaccination coverage of adolescents, a public/private partnership was organized in the greater Baton Rouge area of Louisiana in 1992 to fund and implement school-based vaccination programs.

METHODS

Initial programs utilized schools with existing school-based clinics and administered 2 to 3 doses of hepatitis B vaccine to up to 76% of eligible students. During 1996 to 1997, expansion from 4 schools to 68 schools was facilitated by the use of temporary clinics set up in open school space. This multifaceted program administered 3 doses of hepatitis B vaccine to 3232 students (75%) and 2 doses to 171 students (4%). Administration of the 3-dose regimen of hepatitis B vaccine was aided by the use of a dosing schedule at 0, 2 and 4 months. This accelerated dosing has been shown to provide seroprotection for greater than 95% of healthy adolescents.

RESULTS

In the Baton Rouge area, the hepatitis B adolescent vaccination program has immunized approximately 5000 adolescents during a 5-year period with minimal use of financial and personnel resources.

CONCLUSIONS

The success and growth of this program demonstrate that school-based vaccination programs can be highly efficient and effective.

A week in the life of a travel clinic

International travel has increased enormously in recent years. With the greater movement of people have come increased encounters with a wide variety of diseases: malaria, dengue, cholera, typhoid fever, Ebola virus, and many more. The need for greater scope, consistency, and knowledgeability in pretravel health care to meet these challenges has been met by the emergence of the discipline of travel medicine. Travelers are well advised to become informed of the risks they face and to take steps to minimize those risks. After reviewing a traveler's medical history and a detailed itinerary, a travel medicine practitioner can offer expert advice on behavioral modifications, immunizations, and chemoprophylaxis regimens which will increase the traveler's margin of safety. The issues most frequently addressed in a travel clinic include treatment of traveler's diarrhea, malaria chemoprophylaxis, and immunizations, for hepatitis A, typhoid fever, tetanus/diphtheria, influenza, pneumococcus, hepatitis B, polio, meningococcus, measles, mumps, rubella, varicella, and rabies. Pretravel consultation must consider the age and underlying health problems of the traveler, the nature of the trip (wilderness, jungle, rural, urban, resort, or cruise), the duration of travel, and the latest available information on the site in terms of disease outbreaks, terrorism, and natural calamities.

What is new in clinical research of viral diseases of the skin

Viral diseases of the skin have become a much more serious problem with the increasing number of patients immunosuppressed by either AIDS or cancer chemotherapy. The emphasis in research on the diagnosis and treatment of these diseases is similar to that on the bacterial diseases several decades ago.