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Persistence of antibody to hepatitis B surface antigen among vaccinated children in a low hepatitis B virus endemic area. World J Pediatr 2011; 7:358-60. [PMID: 21874619 DOI: 10.1007/s12519-011-0286-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 12/05/2010] [Indexed: 10/17/2022]
Abstract
BACKGROUND A potential problem of hepatitis B immunization is that vaccine-induced antibody to hepatitis B surface antigen (anti-HBs) declines to low levels with age. This study investigated the persistence of anti-HBs in vaccinated children in a low hepatitis B virus (HBV) endemic area. METHODS Plasma samples of 938 children between ages of 8 months and 15 years were tested for the presence of anti-HBs. RESULTS The seroprotection rate was 60%. Protective antibody level was detected in 65% of children one year after vaccination, and in 30%, 29% and 24% 5, 10 and 15 years after vaccination, respectively. The mean anti-HBs titer declined with post-vaccination time (to 66 mIU/mL in 1 year, 60 mIU/mL in 5 years, 40 mIU/mL in 10 years to 37 mIU/mL in 15 years after vaccination). CONCLUSIONS Children vaccinated against HBV during infancy may show low levels of antibody during adolescence. Our data suggest that a booster dose of vaccine may be required in low HBV endemic areas.
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Immunogenicity of recombinant hepatitis B vaccine: comparison of two different vaccination schedules. Infection 2010; 38:269-73. [PMID: 20512395 PMCID: PMC2910296 DOI: 10.1007/s15010-010-0031-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 05/03/2010] [Indexed: 10/29/2022]
Abstract
BACKGROUND Neonatal immunization with hepatitis B (HB) vaccine induces protective levels of antibody (anti-HBs > or =10 IU/L) in a majority of vaccines. However, the duration of protection after HB vaccination in infants is unknown. A smaller proportion of children vaccinated beginning at birth with three doses of HB vaccine were found to have protective titers 5-10 years after initial vaccination. Long-term efficacy of HB vaccine depends mainly on peak antibody levels after vaccination, and subjects were observed to have lower levels of antibodies if they received the first dose of vaccine immediately after birth. The aim of our study was to compare the immunogenicity of two different HB vaccine schedules in infants born to HB surface antigen-negative mothers. METHODS Anti-HBs titers in infants vaccinated with two different schedules were compared. Infants were vaccinated at 0, 2, and 9 months (group 1) or at 2, 4, and 9 months (group 2). In total, 267 blood samples were analyzed at a mean of 14.20 +/- 2.39 months after the third vaccine dose. Sera were tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core antibody (anti-HBc) using commercial enzyme immunoassay kits. RESULTS The geometric mean titers for anti-HBs were 95.00 and 379.51 IU/L and the rates of anti-HBs more than > or =100 IU/L were 57.7 and 94.9% in group 1 and 2 infants, respectively. CONCLUSION Delaying the first dose of the HB vaccine until 2 months after birth produces a higher immune response and can provide longer term protection.
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Challenge with hepatitis B vaccine in children previously vaccinated with a hepatitis B-containing combination vaccine. Adv Ther 2010; 27:28-38. [PMID: 20182924 DOI: 10.1007/s12325-010-0005-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: 12/28/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The World Health Organization (WHO) recommends universal infant hepatitis B virus (HBV) vaccination as the most effective preventive measure against HBV-induced disease in endemic areas. More than 160 countries have followed the WHO recommendations to incorporate HBV vaccination in their national infant immunization programs. While antibodies to hepatitis B surface antigen (anti-HBs) concentrations progressively decrease following vaccination in infancy, protection persists, probably due to lasting immune memory. Hence, it is thought that future exposure to wild-type virus or HBV vaccine will induce a protective secondary immune response. METHODS Children aged 7-8 years old who had been vaccinated in infancy with a hexavalent DTacP-IPV-HB-Hib vaccine (Hexavac(R); Sanofi Pasteur MSD, Lyon, France) and children aged 7-9 years vaccinated in infancy with a DT-HB vaccine (Primavax(R); Sanofi Pasteur MSD), whose anti-HBs concentrations had fallen below the seroprotective threshold of 10 mIU/mL at age 4.5-6 years, received a challenge dose of monovalent HBV vaccine (HBVAXPRO(R); Sanofi Pasteur MSD) to assess persistence of protection. RESULTS One month postchallenge, 54 of 61 (88.5%) Hexavac-primed seronegative children and 34 of 40 (85.0%) Primavax-primed seronegative children had anti-HBs concentrations > or =10 mIU/mL. The percentage of protected children would have been even higher if the children who still had protective antibody levels (who were not included in this challenge study) had been assessed (42.1% with Hexavac, 55.4% with Primavax). CONCLUSION Vaccination with a HBV-containing multivalent vaccine during infancy induces a lasting immune memory that can be boosted, even in children with a decline in anti-HBs concentrations. The present results confirm that the full primary vaccination schedule in infancy seems to confer long-term protection via immune memory and that an additional HBV dose is not generally required.
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Mu SC, Lin YM, Jow GM, Chen BF. Occult hepatitis B virus infection in hepatitis B vaccinated children in Taiwan. J Hepatol 2009; 50:264-72. [PMID: 19070923 DOI: 10.1016/j.jhep.2008.09.017] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 08/31/2008] [Accepted: 09/15/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIMS Presence of occult HBV infection in HBV vaccinated children remains largely unknown. The aim of this study was to investigate the prevalence of occult HBV infection among HBV vaccinated children in Taiwan. METHODS Forty-six HBsAg negative sera from vaccinated children were enrolled randomly. HBV serum markers were detected by ELISA, and the titers of HBV DNA were determined by quantitative real-time PCR. Pre-S, S and pre-core/core genes were amplified by nested PCR and analyzed. RESULTS Anti-HBs was detected in 23 (50%) children, and the positivity decreased according to age. Five (10.9%) children were classified into occult HBV infection by positivity of nested PCR in at least two regions; they had a low titer (mean titer 1.60x10(4)copies/ml). Sequence analyses of S gene showed occult isolates were variants; no G145R but C139S vaccine escape mutant was found. Variation and deletion were found in pre-S region; pre-S deletion was more frequent in 3' terminus of pre-S1 which leads to loss of immune epitopes and function sites. CONCLUSIONS This pilot study indicates that the prevalence of occult HBV infection is 10.9% in HBV vaccinated children. Since this is a small study, a study of a large population is needed to confirm the findings herein.
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Affiliation(s)
- Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Thompson SC, Oman K. Why should Australia adopt universal infant hepatitis B vaccination? Aust N Z J Public Health 2008. [DOI: 10.1111/j.1467-842x.1996.tb01061.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Immunization is the most effective way to prevent transmission of HBV and, hence, the development of acute or chronic hepatitis B. The national strategy to eliminate transmission of the virus in the United States includes vaccination of all newborn infants, children, adolescents, and high-risk adults. Postexposure prophylaxis is also advocated, depending on the vaccination and anti-HBs status of the exposed person. Seroprotection after vaccination, defined as anti-HBs > or = 10 mIU/mL, is achieved in over 95% of all vaccinees. The hepatitis B vaccines are very well tolerated with usually minimal adverse effects. Predictors of non-response include increasing age, male gender, obesity, tobacco smoking, and immunocompromising chronic dis-ease. For those who remain nonresponders after the second series of vaccination, adjuvants such as GM-CSF may be considered, but their results are variable.
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Affiliation(s)
- Andy S Yu
- Pacific Gastroenterology, 2101 Forest Avenue, Suite 106, San Jose, CA 95128, USA
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Huang ML, Liao WL, Ho MS. HBV serological markers of vaccinated children in remote areas of Taiwan: Emphasis on factors contributing to vaccine failure. Vaccine 2007; 25:6326-33. [PMID: 17629600 DOI: 10.1016/j.vaccine.2007.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 06/10/2007] [Accepted: 06/11/2007] [Indexed: 01/05/2023]
Abstract
A serosurvey targeting Hepatitis B virus (HBV)-vaccinated children born between 1986 and 1998 was conducted in 2001 in remote Taiwanese villages where a 1993 serosurvey indicated high vaccine failure. The HBV S antigen (HBsAg) seropositive rate among vaccinees of 3-6-year-old children in 2001 was significantly lower than that of 1993 and was higher among children who had a delayed vaccination schedule and received the plasma-derived vaccine. Vaccine escape variants were more prevalent among recipients of recombinant HBV vaccine residing in Hualien. Our study highlights the importance of continued monitoring of vaccinees for incidence of HBV infection in order to refine future vaccination policy.
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Affiliation(s)
- Mei-Liang Huang
- College of Public Health, National Taiwan University, Taipei, Taiwan
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Wang CW, Wang LC, Chang MH, Ni YH, Chen HL, Hsu HY, Chen DS. Long-term follow-up of Hepatitis B Surface antibody levels in subjects receiving universal Hepatitis B vaccination in infancy in an area of hyperendemicity: correlation between radioimmunoassay and enzyme immunoassay. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2006; 12:1442-7. [PMID: 16339069 PMCID: PMC1317070 DOI: 10.1128/cdli.12.12.1442-1447.2005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aims of the present study were to determine (i) the long-term immunogenicity and the decay rate of hepatitis B virus (HBV) surface antibody (anti-HBs) from universal hepatitis B vaccination at infancy for a healthy population in an area of hyperendemicity and (ii) whether the anti-HBs levels measured by enzyme immunoassay (EIA) were closely correlated with those assayed by radioimmunoassay (RIA) methods during long-term monitoring. A total of 1,337 apparently healthy children (696 boys and 641 girls) who were vaccinated against HBV at infancy and monitored for anti-HBs annually from 7 to 16 years of age entered the study. Serum samples were analyzed for anti-HBs by RIA at 7 to 15 years of age and were also analyzed by EIA at 13 to 16 years of age. Antibody titers were quantified in mIU/ml by EIA as well as by the ratio of the count in the sample to the count for a negative control (S/N) by RIA. In non-boosted children, the average decay of anti-HBs from 7 to 16 years of ages indicated that approximately 20% of the geometric mean titer decays per year. There was a good correlation between serum anti-HBs levels measured by the RIA and the EIA methods (r=0.91; P<0.0001). An equation for RIA to EIA level conversion was established: log EIA titer=-0.12+ (1.31 . log RIA S/N). The anti-HBs titers measured by EIA correlate well with the S/N assayed by RIA. The annual decay rate of the log anti-HBs level may help in planning booster immunizations for hypo-responders or individuals at risk in adolescence.
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Affiliation(s)
- Ching-Wen Wang
- Department of Pediatrics, Hepatitus Research Center, National Taiwan University Hospital, College of Medicine, Taipei 100, Taiwan
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An YW, Chung EH, Rheem I. A study of the current(2003-2005) prevalence of anti-HBs and immunologic memory of hepatitis B vaccine in children from the central area of Korea. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.6.630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Young Won An
- Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea
| | - Eun Hee Chung
- Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea
| | - Insoo Rheem
- Department of Laboratory Medicine, College of Medicine, Dankook University, Cheonan, Korea
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Zuckerman J, Langer B. Hepatitis B vaccination in a school age population: a feasibility study. J Med Virol 2005; 76:47-54. [PMID: 15778966 DOI: 10.1002/jmv.20335] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There remains no consensus on whether to adopt a universal hepatitis B vaccination strategy in the United Kingdom, where the endemicity of hepatitis B virus (HBV) is considered to be very low in the general population. To assess the feasibility and acceptance of a school-based adolescent vaccination approach, 11-13 years old pupils in local secondary schools in the London Borough of Camden and Islington were contacted and offered a three-dose hepatitis B vaccination course using a 0, 1, and 12 months schedule. The adult dose of hepatitis B vaccine (Engerix B GlaxoSmithKline) containing 20 mug recombinant hepatitis B surface antigen (HBsAg) in 1 ml suspension was administered. This dosage is normally intended for adults and children older than 15 years of age, but can be administered in 10-15 years old children when compliance may be low, since a higher proportion of those vaccinated develop protective antibody levels following administration of only two doses of vaccine. Overall, a total of 528 pupils were contacted, with 122 (23%) consenting to be vaccinated. Of these, 117 (96%) received the complete three-dose regimen according to the schedule (four did not receive vaccine: three were non-attendees and one was previously vaccinated; one withdrew following a flu-like adverse event). The results of this study show that it is feasible and practical to administer hepatitis B vaccination to adolescents in a school setting, and that it is possible to achieve high rates of uptake for the complete three-dose course among adolescents. However, in order to attain and sustain high coverage rates among pupils, this would require additional general health promotion, including health education and provision of information, targeting of teachers, pupils, and parents in order to increase participation in a school-based hepatitis B vaccination programme. A further requirement includes the availability of good local health support within schools so as to allow for an efficient vaccine delivery system to maximize vaccination in this setting.
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Affiliation(s)
- Jane Zuckerman
- Academic Centre for Travel Medicine and Vaccines, WHO Collaborating Centre for Reference, Research and Training in Travel Medicine, Royal Free and University College Medical School, London, United Kingdom.
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Petersen KM, Bulkow LR, McMahon BJ, Zanis C, Getty M, Peters H, Parkinson AJ. Duration of hepatitis B immunity in low risk children receiving hepatitis B vaccinations from birth. Pediatr Infect Dis J 2004; 23:650-5. [PMID: 15247604 DOI: 10.1097/01.inf.0000130952.96259.fd] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The duration of protection after hepatitis B vaccination of infants is unknown. METHODS We determined antibody to hepatitis B surface antigen (anti-HBs) at 4-13 years of age in 363 low risk children who had been vaccinated starting at birth with hepatitis B vaccine. Those with nonprotective titers (<10 mIU/mL) received a booster dose. We similarly followed 16 children of hepatitis B surface antigen (HBsAg)-positive mothers. RESULTS Of low risk infants receiving a plasma-derived vaccine, 41% (42 of 102) of those whose primary response was unknown and 24% (4 of 17) who had initially responded retained protective titers (> or = 10 mIU/mL) of anti-HBs at 9 and 13 years, respectively. Of those who did not have protective antibody titers, 61% (33 of 54) and 67% (8 of 12), respectively, responded to a booster dose. In children of HBsAg-positive mothers, 31% retained protective anti-HBs at 12 years, and 90% (9 of 10) with nonprotective titers responded to a booster. In low risk children initially receiving a recombinant vaccine, 12.5% (26 of 208) and none (0 of 36) retained protective anti-HBs titers at 5 and 7 years of age, respectively. Of those who did not have protective titers, 90% (120 of 134) and 91% (32 of 35), respectively, responded to a booster. CONCLUSIONS Anti-HBs disappeared by 5 years of age in most children who were vaccinated with hepatitis B vaccine from birth. Although most children showed immunologic memory, one-third failed to demonstrate an anamnestic response to a booster dose. Additional long term studies of low risk infants are needed to determine duration of protection and the necessity for or timing of booster doses.
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Affiliation(s)
- Kenneth M Petersen
- Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Alaska Native Tribal Health Consortium, Anchorage, AK 99508, USA
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12
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Abstract
Immunization is the most effective way to prevent transmission of HBV and, hence, the development of acute or chronic hepatitis B. The national strategy to eliminate transmission of the virus in the United States includes vaccination of all newborn infants, children, adolescents, and high-risk adults. Postexposure prophylaxis is also advocated, depending on the vaccination and anti-HBs status of the exposed person. Seroprotection after vaccination, defined as anti-HBs > or = 10 mIU/mL, is achieved in over 95% of all vaccinees. The hepatitis B vaccines are very well tolerated with usually minimal adverse effects. Predictors of non-response include increasing age, male gender, obesity, tobacco smoking, and immunocompromising chronic disease. For those who remain nonresponders after the second series of vaccination, adjuvants such as GM-CSF may be considered, but their results are variable.
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Affiliation(s)
- Andy S Yu
- Liver Transplant Program, Stanford University Medical Center, 750 Welch Road, Suite 210, Stanford, CA 94305, USA
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Affiliation(s)
- Peter Karayiannis
- Department of Medicine A, Faculty of Medicine, Division of Medicine, St Mary's Campus, Imperial College, London W2 1NY, UK.
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Pichichero ME, Blatter MM, Reisinger KS, Harrison CJ, Johnson CE, Steinhoff MC, Senders SD, Rothstein EP, Willems P, Howe BJ. Impact of a birth dose of hepatitis B vaccine on the reactogenicity and immunogenicity of diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b combination vaccination. Pediatr Infect Dis J 2002; 21:854-9. [PMID: 12352809 DOI: 10.1097/00006454-200209000-00014] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the impact of a birth dose of hepatitis B vaccine (HepB) on the reactogenicity and immunogenicity of a novel diphtheria-tetanus-acellular pertussis (DTaP)- HepB-inactivated poliovirus (IPV)/ type b (Hib) combination vaccine administered subsequently at 2, 4 and 6 months of age. METHODS Neonates ( = 550) were randomized into two groups with regard to receipt of HepB at birth. All subjects in both groups received DTaP-HepB-IPV/Hib at 2, 4 and 6 months of age. Solicited local and general adverse events were recorded for 8 days after each dose. Antibodies to hepatitis B surface antigen were measured 1 month after the third dose of DTaP-HepB-IPV/Hib in a subset of 170 infants; titers of at least 10 mIU/ml were considered protective. RESULTS The DTaP-HepB-IPV/Hib combination vaccine was well-tolerated in both groups. Of the infants who received a birth dose of HepB, 22.6% had severe (Grade 3) reactions after any of the three doses of DTaP-HepB-IPV/Hib combination vaccine compared with 23.2% of subjects who did not receive a birth dose of HepB (difference, -0.5%; 90% confidence interval, -7.4 to 6.1). Antibody to hepatitis B surface antigen titers were > or =10 mIU/ml for all tested infants. Geometric mean titers were 2996.2 and 1240.1 mIU/ml with and without a birth dose of HepB, respectively. CONCLUSIONS A HepB birth dose does not increase the reactogenicity of a combination DTaP-HepB-IPV/Hib vaccine administered at 2, 4 and 6 months of age, and all tested subjects achieved protective anti-HBs titers (> or =10 mIU/ml), although geometric mean titers were higher when a birth dose of HepB was given.
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Abstract
In a healthy cohort of 462 subjects in which hepatitis B vaccine was administered between 1990 and 1992 a follow-up study was carried out to determine the duration of protection. Individuals with antibody against the hepatitis B virus surface antigen (anti-HBs) titer lower than 100 mIU/ml were administered a booster dose and antibodies determined 30 days later. The proportion of protection 6.5 years after vaccination was 85% (95% CI: 82-88). Only nine vaccinees seroconverted to anti-HBc positivity without becoming carrier or ill. In 125 subjects in which a booster dose was administered a significant increase in geometric mean of anti-HBs titer was observed (609 mIU/ml) as compared to late (13 mlU/ ml) and early post-vaccination antibody levels (256 mIU/ml, Wilcoxon's test, p < 0.001) suggesting the existence of an anamnestic response. We conclude that in immunocompetent population it is not necessary to administer a booster dose 6.5 years after hepatitis B vaccination.
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Affiliation(s)
- M C Ayerbe
- Department of Public Health Service, Gerencia Atención Primaria Area Sanitaria 8 of Madrid, Spain.
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Abstract
Exposure to blood-borne pathogens poses a serious risk to health care workers (HCWs). We review the risk and management of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections in HCWs and also discuss current methods for preventing exposures and recommendations for postexposure prophylaxis. In the health care setting, blood-borne pathogen transmission occurs predominantly by percutaneous or mucosal exposure of workers to the blood or body fluids of infected patients. Prospective studies of HCWs have estimated that the average risk for HIV transmission after a percutaneous exposure is approximately 0.3%, the risk of HBV transmission is 6 to 30%, and the risk of HCV transmission is approximately 1.8%. To minimize the risk of blood-borne pathogen transmission from HCWs to patients, all HCWs should adhere to standard precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. Employers should have in place a system that includes written protocols for prompt reporting, evaluation, counseling, treatment, and follow-up of occupational exposures that may place a worker at risk of blood-borne pathogen infection. A sustained commitment to the occupational health of all HCWs will ensure maximum protection for HCWs and patients and the availability of optimal medical care for all who need it.
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Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and management of blood-borne infections in health care workers. Clin Microbiol Rev 2000; 13:385-407. [PMID: 10885983 PMCID: PMC88939 DOI: 10.1128/cmr.13.3.385] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Exposure to blood-borne pathogens poses a serious risk to health care workers (HCWs). We review the risk and management of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections in HCWs and also discuss current methods for preventing exposures and recommendations for postexposure prophylaxis. In the health care setting, blood-borne pathogen transmission occurs predominantly by percutaneous or mucosal exposure of workers to the blood or body fluids of infected patients. Prospective studies of HCWs have estimated that the average risk for HIV transmission after a percutaneous exposure is approximately 0.3%, the risk of HBV transmission is 6 to 30%, and the risk of HCV transmission is approximately 1.8%. To minimize the risk of blood-borne pathogen transmission from HCWs to patients, all HCWs should adhere to standard precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. Employers should have in place a system that includes written protocols for prompt reporting, evaluation, counseling, treatment, and follow-up of occupational exposures that may place a worker at risk of blood-borne pathogen infection. A sustained commitment to the occupational health of all HCWs will ensure maximum protection for HCWs and patients and the availability of optimal medical care for all who need it.
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Affiliation(s)
- E M Beltrami
- HIV Infections Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia 30333, USA.
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Abstract
Long-term protection against clinically significant breakthrough hepatitis B (HB) virus infection and chronic carriage depends on immunological memory, which allows a protective anamnestic antibody response to antigen challenge. Memory seems to last for at least 15 years in immunocompetent individuals. To date there are no data to support the need for booster doses of HB vaccine in immunocompetent individuals who have responded to a primary course. All adequately vaccinated individuals have shown evidence of immunity in the form of persisting anti-HBs and/or in vitro B-cell stimulation or an anamnestic response to a vaccine challenge. Nonetheless several countries and individuals currently have a policy of administering booster doses to certain risk groups. Boosters may be used to provide reassurance of protective immunity against benign breakthrough infection. For immunocompromised patients, regular testing for anti-HBs, and a booster injection when the titre falls below 10 mIU/mL, is advised. Long-term monitoring should continue, to confirm the absence of clinically significant breakthrough episodes of hepatitis B and to find out if a carrier state develops after 15 years. Also, non-responders to a primary course should continue to be studied.
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Belloni C, Pistorio A, Tinelli C, Komakec J, Chirico G, Rovelli D, Gulminetti R, Comolli G, Orsolini P, Rondini G. Early immunisation with hepatitis B vaccine: a five-year study. Vaccine 2000; 18:1307-11. [PMID: 10618526 DOI: 10.1016/s0264-410x(99)00414-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We evaluated the response to the recombinant Hepatitis B vaccine using an accelerated schedule versus the traditional schedule by studying the immunologic memory induced in 200 children with HBs-Ag negative mothers. At seroconversion, the traditional schedule presented a higher percentage of children with serum HBs-Ag concentrations over 100 mIU/ml than the accelerated schedule. After five years this difference was no longer statistically significant and children who presented anti-HBsAg concentrations below 10 mUI/ml received an additional booster dose which stimulated the antibody concentration to exceed 100 mIU/ml in all cases. Recombinant HBV vaccine induced better long term immunologic memory when it was administered earlier.
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Affiliation(s)
- C Belloni
- Division of Neonatal Intensive Care, IRCCS San Matteo, Viale della Libertà, 49-27100, Pavia, Italy.
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Shih HH, Chang MH, Hsu HY, Lee PI, Ni YH, Chen DS. Long term immune response of universal hepatitis B vaccination in infancy: a community-based study in Taiwan. Pediatr Infect Dis J 1999; 18:427-32. [PMID: 10353515 DOI: 10.1097/00006454-199905000-00006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To evaluate the long term immunity provided by a universal hepatitis B vaccination program in infancy and the booster effect on school age children who had no protective antibody titers to hepatitis B surface antigen. METHODS We conducted a community-based seroepidemiologic study of 1337 healthy 7-year-old children in Taiwan one decade after the implementation of a mass hepatitis B vaccination program. A booster vaccination was suggested for noncarrier children who did not have protective titers of surface antibody. Serologic responses and infection rates were compared with those of the nonboostered children. In a nonselected group of 39 volunteer noncarrier vaccinees, quantitative serologic response was determined before, 1 month after a booster vaccination and 1 year later. RESULTS A total of 572 children (42.8%) had low concentrations of surface antibody, and 9 were hepatitis B surface antigen carriers (0.7%). Eighty-two percent of "nonprotected" vaccinees showed immunologic memory to a booster dose and developed protective antibody titers 1 month later; 60.6% maintained protective titers 1 year later. The frequency of new hepatitis B virus infection was similar for those who received a booster and those who did not as investigated by the core antibody seroconversion during 1-year follow-up. However, the risk was low, with annual incidences of <1% in both groups, and none became chronic carriers. CONCLUSION According to these data a universal vaccination program in infancy provides adequate protection against hepatitis B virus infection for school age children and a booster vaccination is not recommended.
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Affiliation(s)
- H H Shih
- Department of Pediatrics, National Taiwan University Hospital, Taipei
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Affiliation(s)
- S M Lemon
- Department of Medicine, University of North Carolina at Chapel Hill, 27599-7030, USA
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Immunogénicité du vaccin contre l'hépatite B, GenHevac B, administré en trois injections (0, 1, 6 mois) chez le préadolescent en milieu scolaire. Med Mal Infect 1995. [DOI: 10.1016/s0399-077x(05)80416-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Abstract
Plasma-derived vaccines and yeast-derived recombinant vaccines against hepatitis B virus (HBV) infection have gained an acceptable record of efficacy. However, non- or hyporesponsiveness to immunization does not only occur in cases of obesity, renal failure or immune suppression, but also in healthy individuals. There is therefore a rationale for developing more immunogenic vaccines against HBV, especially for those populations who are potential non- or hyporesponders. Currently used recombinant hepatitis B vaccines consist of antigen particles assembled with the product of 226 amino acids encoded in the S gene. Since proteins encoded in the pre-S gene are also incorporated in the HBV envelope, pre-S gene products should, at least in theory, be useful in improving protection with hepatitis B vaccines. Inactivated hepatitis A vaccines are more potent than currently used hepatitis B vaccines. Two injections of a standard dose of HAVRIX (SB) by the intramuscular route, or even a single injection using a higher dose (HAVRIX 1440), will achieve protective levels of antibodies. Therefore, increased potency is not essential with inactivated hepatitis A vaccines. New hepatitis A vaccines are likely to be recombinant or attenuated live types. Another aspect of the improvement of existing hepatitis A and B vaccines is unification into a combined form.
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Affiliation(s)
- S Iwarson
- Department of Infectious Diseases, Göteborg University, Ostra Hospital, Gothenburg, Sweden
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Li Volti S, Giammanco-Bilancia G, Giammanco G, Mollica F. Duration of hepatitis B antibody response in children immunised with hepatitis B and compulsory vaccines. Eur J Epidemiol 1995; 11:217-9. [PMID: 7672079 DOI: 10.1007/bf01719491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty four subjects were simultaneously administered DT toxoids, OPV and HBV vaccines at the age of 3, 4-5 and 11 months and then followed up for 2 and 4 years in order to evaluate the duration of the immune response and the need and the timing of HBV revaccination. A fall in anti-HBs titre below 10 mIU/ml was observed at the follow up in 4/24 (16.7%) of the subjects. In other 5 children (20.8%) anti-HBs titre was found to be just above 10 mIU/ml. This would suggest that a revaccination is indicated and it could be performed at the age of 5-6 years when children enter school. This schedule is simple, effective and money saving since it reduces the cost/benefit ratio and the number of visits for immunisations, and it is expected to improve the compliance for the vaccination.
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Affiliation(s)
- S Li Volti
- Institute of Pediatrics, University of Catania, Italy
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