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Balčiuvienė V, Burčiuvienė A, Haarhaus M, Uogintaitė J, Janavičienė A, Santockienė L, Mitrikevičienė J, Aleknienė L, Keinaitė D. Waning Humoral Response 6 Month after Double Vaccination with the mRNA-BNT162b2 Vaccine in Hemodialysis Patients. Acta Med Litu 2023; 30:26-38. [PMID: 37575375 PMCID: PMC10417014 DOI: 10.15388/amed.2023.30.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/10/2022] [Accepted: 12/21/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Although most hemodialysis patients (HDP) exhibit an initial seroresponse to vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), studies have shown this response to be lower compared to healthy subjects. This fact raised concerns regarding the durability of the immune response and effective protection against severe Coronavirus disease 2019 (COVID-19) in this vulnerable population. The aim of our study was to evaluate the change in antibody levels over time in HDP population. Materials and Methods We performed a prospective multicenter study, evaluating antibody response among HDP at 2 and at 6 months after complete two-dose vaccination course with the mRNA-BNT162b2 (Pfizer-BioNTech) vaccine. The study was performed in 14 hemodialysis units of a private dialysis provider in Lithuania. The serum samples of 189 HDP were tested for SARS-CoV-2 IgG against the Spike glycoprotein. Results 189 HDP participated in the study. Patients were 64.3±15.7 years of age, 116 (61.4%) were males and 73 (38.6%) were females. Among them, 183 (96.8%) were seropositive for anti-S IgG at 2 months after the second immunization dose. Six months after the second dose only 145 (76.7%) of study participants had positive anti-S IgG titers. The median level of anti-S IgG titers after 2 months was 383.1 BAU/mL (166.2-995.6) and after 6 months this level significantly decreased to 51.4 BAU/mL (22.0-104.0) (p<0.001). Seroresponses at both time points inversely correlated with increasing patient's age. Risk factor for absent response after 2 months included oncologic disease. Systemic autoimmune disease and a history of myocardial infarction increased risk to be seronegative 6 months after the second vaccine dose. Conclusions The majority of hemodialysis patients seroresponded after BNT162b2/Pfizer vaccination, but vaccine-induced humoral immunity wanes over time.
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Affiliation(s)
- Vilma Balčiuvienė
- Diaverum dialysis unit, Diaverum Lithuania, Josvainių 36, LT-57275 Kėdainiai, Lithuania
| | - Asta Burčiuvienė
- Diaverum dialysis unit, Diaverum Lithuania, Savanorių 68, LT-44147 Kaunas, Lithuania
| | | | | | - Asta Janavičienė
- Diaverum dialysis unit, Diaverum Lithuania, Žeimių 19, LT-55134 Jonava, Lithuania
| | - Lina Santockienė
- Diaverum dialysis unit, Diaverum Lithuania, Beržyno 27, LT-56172 Kaišiadorys, Lithuania
| | | | - Loreta Aleknienė
- Diaverum dialysis unit, Diaverum Lithuania, Savanorių 68, LT-44147 Kaunas, Lithuania
| | - Danutė Keinaitė
- Diaverum Lithuania, Mindaugo 23, LT-3214, Vilnius, Lithuania
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Nacasch N, Cohen-Hagai K, Tayar N, Levian A, Rashid G, Benchetrit S, Neumark E, Wand O, Hod T, Rosman Y, Shashar M, Grupper A, Shitrit P. Humoral Response to Hepatitis B and COVID-19 Vaccine among Maintenance Hemodialysis Patients. Vaccines (Basel) 2022; 10:1670. [PMID: 36298535 DOI: 10.3390/vaccines10101670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Maintenance hemodialysis (MHD) patients have impaired immunological responses to pathogens and vaccines. In this study, we compared the humoral response to HBV and COVID-19 vaccines in a cohort of MHD patients. Demographic and clinical characteristics of vaccine responders and non-responders were also compared, and the association between the humoral responses to both vaccines was evaluated. The cohort included 94 MHD patients who were vaccinated at least once for HBV and twice for COVID-19. Among the 94 patients, 28 (29.8%) did not develop protective titers to HBV. Hypertension, coronary heart disease, and heart failure were more common in non-responders. Among MHD patients, 85% had positive IgG anti-spike SARS-CoV-2 levels 6 months after two doses of BNT162b2 (Pfizer/Biotech) vaccine. Age and immunosuppressive therapy were the main predictors of humoral response to COVID-19 vaccine. We did not find any association between non-responders to HBV and non-responders to COVID-19 vaccine. There was no difference in IgG anti-spike titers between HBV responders and non-responders (505 ± 644 vs. 504 ± 781, p = 0.9) Our results suggest that reduced humoral response to hepatitis B is not associated with reduced response to COVID-19 vaccine. Different risk-factors were associated with poor immune response to HBV and to COVID-19 vaccines.
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Han B, Liu W, Du J, Liu H, Zhao T, Yang S, Wang S, Zhang S, Liu B, Liu Y, Cui F. Immunogenicity and safety of hepatitis B vaccination in patients with type 2 diabetes in China: An open-label randomized controlled trial. Vaccine 2021; 39:3365-3371. [PMID: 33992438 DOI: 10.1016/j.vaccine.2021.04.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/31/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hepatitis B virus (HBV) infection remains a global public health challenge. Patients with diabetes are at greater risk of HBV infection than healthy people. The immunogenicity and safety of two major hepatitis B vaccines were evaluated in Chinese patients with diabetes. METHODS In this phase IV, open-label, randomized, controlled study, participants with diabetes were randomly recruited from 6 townshiphealthcenters in Gansu Province and received either a 3-dose Saccharomyces cerevisiae recombinant hepatitis B vaccine (Group D20SC 0-1-6, n = 113) or a 3-dose Chinese hamster ovary cell (CHO) recombinant hepatitis B vaccine (Group D20CHO 0-1-6, n = 119). Healthy control groups were randomly recruited from the same 6 health centers and received 3 doses of the saccharomyces cerevisiae recombinant hepatitis B vaccine (Group ND20SC 0-1-6, n = 77). Immunogenicity, including seroconversion rate and geometric mean concentration (GMC) at 1 month after three doses of vaccination, and safety were assessed. The seroconversion rate was defined as the concentration of HBsAb ≥ 10 mIU/mL. RESULTS The seroconversion rates of Group D20SC 0-1-6, Group D20CHO 0-1-6 and Group ND20SC 0-1-6 were 89.6%, 91.4% and 97.1%, respectively, in the per-protocol analysis, and these differences were not statistically significant. The antibody concentration in Group D20SC 0-1-6 (GMC = 601 mIU/mL) was lower than that of the healthy control group (GMC = 1465 mIU/mL), but no significant difference was found in the GMC between the Group D20CHO 0-1-6 (GMC = 778 mIU/mL) and Group D20SC 0-1-6. Adverse events (AEs) were comparable between groups, and no serious AEs were found in these three groups. CONCLUSIONS The Saccharomyces cerevisiae recombinant and CHO recombinant hepatitis B vaccines in China can induce good immunogenicity in a diabetic population, although the antibody concentration may be lower, indicating the feasibility of vaccinating a large number of diabetic patients in China with these vaccines.
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Affiliation(s)
- Bingfeng Han
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wu Liu
- Jingyuan County Center for Disease Control and Prevention, Gansu, China
| | - Juan Du
- Department of Laboratorial Science, School of Public Health, Peking University, Beijing, China
| | - Hanyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Tianshuo Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shubo Yang
- Jingyuan County Center for Disease Control and Prevention, Gansu, China
| | - Shuai Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Sihui Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Bei Liu
- Department of Laboratorial Science, School of Public Health, Peking University, Beijing, China
| | - Yaqiong Liu
- Department of Laboratorial Science, School of Public Health, Peking University, Beijing, China
| | - Fuqiang Cui
- Department of Laboratorial Science, School of Public Health, Peking University, Beijing, China.
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Jahn M, Korth J, Dorsch O, Anastasiou OE, Sorge-Hädicke B, Tyczynski B, Gäckler A, Witzke O, Dittmer U, Dolff S, Wilde B, Kribben A. Humoral Response to SARS-CoV-2-Vaccination with BNT162b2 (Pfizer-BioNTech) in Patients on Hemodialysis. Vaccines (Basel) 2021; 9:360. [PMID: 33918085 PMCID: PMC8070660 DOI: 10.3390/vaccines9040360] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/01/2021] [Accepted: 04/03/2021] [Indexed: 12/19/2022] Open
Abstract
mRNA-based SARS-CoV-2 vaccines offer a preventive strategy against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections that is of interest in the care of patients on hemodialysis (HDP). We measured humoral immune responses in 72 HDP after standard vaccination with two doses of the mRNA-based SARS-CoV-2 vaccine BNT162b2 (Pfizer-BioNTech). Antibody responses were evaluated with an anti-SARS-CoV-2 IgG ChemiLuminescent ImmunoAssay (CLIA) two weeks after the second dose. In addition, SARS-CoV-2 IgG was determined in a control of 16 healthy healthcare workers (HCW). The control group of HCW has shown a strong antibody response with a median (MD (Q1; Q3)) antibody titer of 800.0 AU/mL (520.5; 800.0). In comparison to HCW, HDP under 60 years of age responded equally (597.0 AU/mL (410.5; 800.0), p = 0.051). However, the antibody responses of the HDP negatively correlated with age (r2 = 0.2954 p < 0.0001), leading to significantly lower antibody titers in HDP over 60 years (280.0 AU/mL (45.7; 477.0), p < 0.0001). To thoroughly understand the immunogenicity of the new mRNA-based vaccines in HDP, longitudinal data on the effectiveness and durability of antibody responses are needed. Modifications of immunization schedules should be considered in HDP with low or without antibody responsiveness after standard vaccination to boost immune reactivity and prolong protective effects in these vulnerable patients.
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Affiliation(s)
- Michael Jahn
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Oliver Dorsch
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, KfH-Nierenzentrum Friesener Straße 37a, 96317 Kronach, Germany;
| | - Olympia Evdoxia Anastasiou
- Institute for Virology, University Hospital Essen, University Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Burkhard Sorge-Hädicke
- KfH Kuratorium für Dialyse und Nierentransplantation e.V, KfH-Nierenzentrum Alfried-Krupp-Str. 43, 45131 Essen, Germany;
| | - Bartosz Tyczynski
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Anja Gäckler
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (O.W.); (S.D.)
| | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University Duisburg-Essen, Virchowstr. 179, 45147 Essen, Germany; (O.E.A.); (U.D.)
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (O.W.); (S.D.)
| | - Benjamin Wilde
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (J.K.); (B.T.); (A.G.); (B.W.); (A.K.)
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Udomkarnjananun S, Takkavatakarn K, Praditpornsilpa K, Nader C, Eiam-Ong S, Jaber BL, Susantitaphong P. Hepatitis B virus vaccine immune response and mortality in dialysis patients: a meta-analysis. J Nephrol 2019; 33:343-354. [DOI: 10.1007/s40620-019-00668-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022]
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Abstract
There is substantial variation between individuals in the immune response to vaccination. In this review, we provide an overview of the plethora of studies that have investigated factors that influence humoral and cellular vaccine responses in humans. These include intrinsic host factors (such as age, sex, genetics, and comorbidities), perinatal factors (such as gestational age, birth weight, feeding method, and maternal factors), and extrinsic factors (such as preexisting immunity, microbiota, infections, and antibiotics). Further, environmental factors (such as geographic location, season, family size, and toxins), behavioral factors (such as smoking, alcohol consumption, exercise, and sleep), and nutritional factors (such as body mass index, micronutrients, and enteropathy) also influence how individuals respond to vaccines. Moreover, vaccine factors (such as vaccine type, product, adjuvant, and dose) and administration factors (schedule, site, route, time of vaccination, and coadministered vaccines and other drugs) are also important. An understanding of all these factors and their impacts in the design of vaccine studies and decisions on vaccination schedules offers ways to improve vaccine immunogenicity and efficacy.
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Erdoğdu Hİ, Atalay E, Gürsoy G, Canbakan B, Aktürk S, Yazıcı C, Yücel O, Mersin S, Üçer S, Merhametsiz Ö, Öner C, Erat M. Factors affecting inadequate response to HBV vaccine in hemodialysis patients: northeast anatolia survey with six hemodialysis centers. Clin Exp Nephrol 2018; 23:530-536. [PMID: 30488288 DOI: 10.1007/s10157-018-1676-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND In hemodialysis patients Hepatitis B virus (HBV) infection is one of the problems. Because of HBV vaccine response is lower than in the general population, in this study it is aimed to determine the factors that may cause inadequate HBV vaccine response in hemodialysis patients. METHODS In study, HBsAg, anti-HBs, anti-HBc IgG data belonging to 278 patients were obtained from file and computer records. It was seen that seronegative cases had been given recombinant HBV vaccine. Anti-HBs titers were monitored 1 month after vaccination was completed. According to this, the patients are divided into two groups. Those with anti-HBs < 10 IU/mL were identified as non-responders and with anti-HBs ≥ 10 IU/mL as responders. Factors such as age, serum albumin and urea reduction rate which may affect inadequate response to HBV vaccine were evaluated. As statistical examination, Chi-square test was used for the analysis of the data determined by counting, and logistic regression was used for statistically significant independent variables in chi-square test. p value of < 0.05 was considered statistically significant (Confidence interval: 95%). RESULTS Out of 278 patients, according to exclusion criteria 81 patients were excluded. 13.2%(26/197) of HBV vaccinated patients had insufficient response. The inadequate response rate to HBV vaccination was found to be higher in patients with age ≥ 65 (p = 0.039), serum albumin < 3.5 g/dL (p = 0.024) and urea reduction rate ≤ 65 (p = 0.028). No statistically significant relationship was found between inadequate response to HBV vaccine and anti-HCV positivity, presence of diabetes mellitus, anemia status, vitamin D therapy and vascular access pathway variability. CONCLUSION We conclude that relatively high patient age, low albumin level and insufficient urea reduction rate may cause inadequate HBV vaccine response. Taking these factors into consideration may provide a useful insight for an adequate response to vaccination.
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Affiliation(s)
- Halil İbrahim Erdoğdu
- Department of Internal Medicine, Health Research Center, Kafkas University, Kars, Turkey.
| | - Eray Atalay
- Department of Internal Medicine, Health Research Center, Kafkas University, Kars, Turkey
| | - Gül Gürsoy
- Department of Internal Medicine and Endocrinology, Kafkas University, Kars, Turkey
| | - Başol Canbakan
- Department of Internal Medicine and Neprology, Kafkas University, Kars, Turkey
| | - Serkan Aktürk
- Department of Hemodialysis and Nephrology, Kars Harakani State Hospital, Kars, Turkey
| | - Canan Yazıcı
- Departement of Internal Medicine, Ardahan State Hospital, Ardahan, Turkey
| | - Orhan Yücel
- Department of Hemodialysis and Nephrology, Kars Harakani State Hospital, Kars, Turkey
| | - Sinan Mersin
- Department of Internal Medicine, Kartal Lütfi Kırdar Education and Research Hospital, Istanbul, Turkey
| | - Sengül Üçer
- Department of Clinical Microbiology and Infectious diseases, Kafkas University, Kars, Turkey
| | - Özgür Merhametsiz
- Department of Hemodialysis and Nephrology, Iğdır State Hospital, Iğdır, Turkey
| | - Can Öner
- Department of Family Medicine, Kartal Lütfi Kırdar Education and Research Hospital, Istanbul, Turkey
| | - Merve Erat
- Department of Internal Medicine, Health Research Center, Kafkas University, Kars, Turkey
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Abstract
In a period of turmoil concerning vaccination practices, there is a serious conflict between scientifically reasonable, evidence-based guidelines and the far-fetched rumors or misconceptions concerning the vaccination practices in the general population. When a significant portion of the medical and paramedical personnel may be deliberately unvaccinated against common biological agents, achieving effective vaccination rates in the dialysis population may be complicated. Vaccination rates are unacceptably low in dialysis patients and seroconversion rates are even lower; further, serological follow-up is generally poor. The particularly anergic immune system of the advanced chronic kidney disease patients is partly a cause of both high rates of infection and low rates of seroconversions. This narrative review is an effort to summarize current knowledge concerning the vaccination practices in dialysis patients with some specific recommendations based on these facts. Of particular interest is a new vaccine, the Zoster Recombinant, Adjuvanted Vaccine (Shingrix), which we will include in our discussion.
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Affiliation(s)
- Georges Kosmadakis
- Hemodialyis Unit and Pole Metabolique, Centre Hospitalier Jacques Lacarin, Vichy, France
| | - Julie Albaret
- Hemodialyis Unit and Pole Metabolique, Centre Hospitalier Jacques Lacarin, Vichy, France
| | | | - Frederic Somda
- Hemodialyis Unit and Pole Metabolique, Centre Hospitalier Jacques Lacarin, Vichy, France
| | - Didier Aguilera
- Hemodialyis Unit and Pole Metabolique, Centre Hospitalier Jacques Lacarin, Vichy, France
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Abstract
Background: Hemodialysis (HD) patients are at an increased risk of acquiring hepatitis B virus (HBV) infection. Active HBV immunization in these patients is recommended. A response rate in HD patients is variable but generally lower than healthy individuals. Objective: The aim of this study is to assess the response of HD patients to the HBV vaccine and correlate response and long-term immunity to various clinical and biomedical factors. Patients and Methods: One hundred and one patients, with a mean age 48.7 ± 18.5 years, received 40 μg of HBV vaccine administered intramuscularly in the deltoid region at 0, 1, 2 and 6 months. The patients' responses to the vaccine were determined by measuring hepatitis B surface antibody (HBsAb) 6 weeks after the last injection and monitored thereafter at 3-month intervals. Results: Seventy-one patients (70.3%) mounted a response with HBsAb >10 mIU/ml 6 weeks following the fourth dose of vaccine, and thus were considered considered as adequate responders. Forty-nine (48.5%) patients mounted an excellent response with HBsAb >100 mIU/ml 6 weeks after the fourth dose. Thirty patients (29.7%) were nonresponders. Responders were significantly younger than nonresponders (P = 0.01). Gender, hemoglobin level, serum albumin, ferritin, parathyroid hormone level and hepatitis C virus infection had no effect on the response to the vaccine. Similarly, there was no difference in diabetic state and adequacy of HD between the two groups. Fifty-nine patients (88%) had persistent protective antibodies at 1 year, while eight (12%) lost such protection. Predictors of persistent immunity at 1 year were high HBsAb level at the completion of the vaccination regime and, to a lesser extent, young age. Conclusion: A 70% response rate to HBV vaccine was observed in the cohort of this study. Young age predicts a favorable response to HBV vaccine in HD patients. High (>100 mIU/ml) HBsAb levels achieved at vaccine completion predict persistent immunity at 1 year.
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Affiliation(s)
- Samir H Almueilo
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
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Elhanan E, Boaz M, Schwartz I, Schwartz D, Chernin G, Soetendorp H, Gal Oz A, Agbaria A, Weinstein T. A randomized, controlled clinical trial to evaluate the immunogenicity of a PreS/S hepatitis B vaccine Sci-B-Vac™, as compared to Engerix B ®, among vaccine naïve and vaccine non-responder dialysis patients. Clin Exp Nephrol 2017; 22:151-158. [PMID: 28456864 DOI: 10.1007/s10157-017-1416-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 04/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dialysis patients have a suboptimal response to hepatitis B (HBV) vaccination. This study aimed to compare the immunogenicity of two vaccines: the third-generation Sci-B-Vac™ vs. the second-generation Engerix B®. The cohort included two groups of dialysis patients: naïve and previously vaccinated non-responders. Primary endpoints were antibody titers ≥10 IU/L at 3 and 7 month post-vaccination. Secondary objectives were seroprotection rates in vaccine-naïve patients and in previously vaccinated non-responders. METHODS Eighty-six patients were assigned to vaccine (Sci-B-Vac™ or Engerix B®) using computer-generated randomization, stratified by age, gender, diabetes, and previous HBV vaccination. Sci-B-Vac™ was administered in three doses, 10 μg, at 0, 1, and 6 months in naïve patients; or 20 μg in previously vaccinated non-responders. Engerix B® included four doses, 40 μg at 0, 1, 2, and 6 months. RESULTS Each group had 43 patients. Seroconversion was 69.8% with Engerix B® vs. 73.2% with Sci-B-Vac™. Antibody titers at 7 months were higher with Sci-B-Vac™ (266.4 ± 383.9, median 53.4) than with Engerix® (193.2 ± 328.9, median 19). However, these differences were not significant, perhaps due to a suboptimal sample size. CONCLUSIONS This study suggests comparable immunogenicity for both vaccines. Thus, we cannot reject the null hypothesis that there is no difference in seroconversion by vaccine type. It is noteworthy that naïve patients were vaccinated with a standard dose of Sci-B-Vac™, while Engerix B® was administered at a double dose. Similarly, although mean antibody titer levels in the Sci-B-Vac™ group were higher than in the Engerix® group, this difference did not reach significance. Consequently, a future clinical trial should recruit a larger cohort of patients, using a standard double-dose protocol in both groups.
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Affiliation(s)
- E Elhanan
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - M Boaz
- Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel
- Ariel University, Ariel, Israel
| | - I Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - D Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - G Chernin
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - H Soetendorp
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Gal Oz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Agbaria
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - T Weinstein
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel.
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Zitt E, Hafner-Giessauf H, Wimmer B, Herr A, Horn S, Friedl C, Sprenger-Mähr H, Kramar R, Rosenkranz AR, Lhotta K. Response to active hepatitis B vaccination and mortality in incident dialysis patients. Vaccine 2016; 35:814-820. [PMID: 28049587 DOI: 10.1016/j.vaccine.2016.12.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 12/08/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023]
Abstract
All patients with advanced chronic kidney disease or on renal replacement therapy should receive active hepatitis B vaccination. The aim of this retrospective cohort study was to investigate the association between the immune response to hepatitis B vaccination and all-cause, cardiovascular or infection-related mortality in incident dialysis patients starting dialysis between 2001 and 2008 (n=426) in two Austrian dialysis centers. Vaccination response was defined as follows: absent anti-HBs antibody titer or a titer <10IU/L was classified as non-response, seroconversion (SC) was defined as a titer ⩾10IU/L, and seroprotection (SP) as a titer ⩾100IU/L. Kaplan-Meier survival curves and multivariable adjusted Cox Proportional Hazards Models were used to determine the association between vaccination response and all-cause, cardiovascular and infection-related mortality. Of all patients 207 (48.6%) were non-responders, SC was observed in 219 (51.4%), SP in 118 (27.7%) patients. During a median follow-up of 51.2 months 228 (53.5%) patients died. Patients with SP and SC showed a significantly lower all-cause (p<0.001 for both) and cardiovascular mortality (p=0.006 for SP, p=0.01 for SC). SP and SC were independently associated with a significant risk reduction for all-cause mortality (SP: HR 0.69, 95% CI 0.49-0.97, p=0.03; SC: HR 0.72, 95% CI 0.55-0.95, p=0.02). In conclusion, achieving seroconversion and seroprotection after active hepatitis B vaccination is associated with significantly reduced all-cause mortality in incident dialysis patients. This simple and readily available tool allows estimation of patient survival independently of other well-known key parameters such as age, gender, the presence of diabetes and markers of malnutrition and inflammation.
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Affiliation(s)
- Emanuel Zitt
- Department of Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, Feldkirch, Austria; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Hildegard Hafner-Giessauf
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Birgitta Wimmer
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Alexander Herr
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sabine Horn
- Department of Internal Medicine, LKH Villach, Villach, Austria
| | - Claudia Friedl
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hannelore Sprenger-Mähr
- Department of Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, Feldkirch, Austria; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Reinhard Kramar
- Austrian Dialysis and Transplant Registry, Rohr im Kremstal, Austria
| | - Alexander R Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Karl Lhotta
- Department of Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, Feldkirch, Austria; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.
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12
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Grzegorzewska AE, Świderska MK, Mostowska A, Warchoł W, Jagodziński PP. Antibodies to HBV surface antigen in relation to interferon-λ3 in hemodialysis patients. Vaccine 2016; 34:4866-4874. [PMID: 27595449 DOI: 10.1016/j.vaccine.2016.08.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/29/2016] [Accepted: 08/24/2016] [Indexed: 12/22/2022]
Abstract
AIM To investigate circulating IFN-λ3 and IFNL3 polymorphisms in hemodialysis (HD) patients differing in HBV surface antigen antibody (anti-HBs) production. METHODS The study included 106 HBV-vaccinated HD patients (88 developed anti-HBs) and 36 HBV-infected HD subjects (27 developed anti-HBs). Plasma IFN-λ3 (enzyme-linked immunosorbent assay) and rs12979860 (C>T) and rs8099917 (T>G) in IFNL3 (high-resolution melting curve analysis) were analyzed with regard to the association with anti-HBs production in response to HBV vaccination or infection. The results were adjusted for gender, age, cause of renal disease, dialysis vintage, dialysis modality, IFN-λ3, and 25(OH)D as appropriate. RESULTS HBV vaccine responders had higher circulating IFN-λ3 (ng/L) than non-responders (120, 36-233 vs. 53, 33-109, P<0.000001). Patients who generated anti-HBs after HBV infection also had higher circulating IFN-λ3 levels than those who did not (133, 35-215 vs. 71, 9-229, P=0.043). The IFN-λ3 concentration correlated with the anti-HBs titer in vaccinated (r=0.614, P<0.000001) and infected patients (r=0.589, P=0.0002). Plasma IFN-λ3 was the only significant indicator of responsiveness to HBV vaccination (adjusted P=0.018) and remained the only significant associate for the development of post-infection anti-HBs (adjusted P=0.049). A plasmaIFN-λ3 level of 85.5ng/L was thecut-off value for theprognosis of an anti-HBs titer below vs. equal to or over 10IU/L in the entire group of HD patients (ROC sensitivity 68.7%, specificity 85.2%, and AUC 0.827). Significant associations were not found between IFN-λ3 and IFNL3 rs12979860. Subjects treated with low flux HD that harbored the TT genotype in rs8099917 showed higher IFN-λ3 levels than patients bearing the G allele in rs8099917 (139, 68-233 vs. 103, 9-208, P=0.049). CONCLUSION In HD patients, circulating IFN-λ3 strongly correlates with anti-HBs production after HBV vaccination and infection. IFNL3 rs8099917 polymorphisms seem to be associated with IFN-λ3 plasma levels in HD subjects.
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Affiliation(s)
- Alicja E Grzegorzewska
- Chair and Department of Nephrology, Transplantology and Internal Diseases, Poznan University of Medical Sciences, Poznań 60-355, Przybyszewskiego 49, Poland.
| | - Monika K Świderska
- Student Nephrology Research Group, Chair and Department of Nephrology, Transplantology and Internal Diseases, Poznan University of Medical Sciences, Poznań 60-355, Przybyszewskiego 49, Poland.
| | - Adrianna Mostowska
- Chair and Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poznań 60-781, Święcickiego 6, Poland.
| | - Wojciech Warchoł
- Chair and Department of Biophysics, Poznan University of Medical Sciences, Poznań 60-780, Grunwaldzka 6, Poland.
| | - Paweł P Jagodziński
- Chair and Department of Biochemistry and Molecular Biology, Poznan University of Medical Sciences, Poznań 60-781, Święcickiego 6, Poland.
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Grzegorzewska AE, Świderska MK, Warchoł W. Antibodies to hepatitis B virus surface antigen and survival of hemodialysis patients - a prospective study. Expert Rev Vaccines 2016; 15:1063-74. [PMID: 27166852 DOI: 10.1080/14760584.2016.1188697] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Antibodies to hepatitis B virus (HBV) surface antigen (anti-HBs) may develop in response to HBV vaccination or infection. We investigated whether anti-HBs are an independent predictor of survival in hemodialysis (HD) patients. METHODS A 6-year prospective study was conducted in 532 HD patients. Survival analyses were performed using the Kaplan-Meier method and the Cox proportional hazard model. RESULTS In HBV non-infected patients, age (P = 0.005), coronary artery disease (P = 0.002), and non-response to HBV vaccine (P = 0.008) were the independent risk factors of all-cause mortality. In HBV infected patients, the only independent predictor of all-cause mortality was coronary artery disease (P = 0.002). CONCLUSION The ability to produce the protective anti-HBs titer in response to HBV vaccine is a positive predictor of survival in HBV non-infected HD patients.
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Affiliation(s)
- Alicja E Grzegorzewska
- a Department of Nephrology, Transplantology and Internal Diseases , Poznan University of Medical Sciences (PUMS) , Poznań , Poland
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14
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Van Der Meeren O, Peterson JT, Dionne M, Beasley R, Ebeling PR, Ferguson M, Nissen MD, Rheault P, Simpson RW, De Ridder M, Crasta PD, Miller JM, Trofa AF. Prospective clinical trial of hepatitis B vaccination in adults with and without type-2 diabetes mellitus. Hum Vaccin Immunother 2016; 12:2197-2203. [PMID: 27123743 PMCID: PMC4994745 DOI: 10.1080/21645515.2016.1164362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: Patients with diabetes mellitus are at increased risk for hepatitis B virus (HBV) infection and its complications. HBV vaccination is recommended for adults with diabetes in the United States and other countries. However, few studies have assessed safety and immunogenicity of hepatitis B vaccine in such patients. We assessed the safety and immunogenicity of recombinant hepatitis B vaccine in subjects with and without diabetes mellitus. Methods: Prospective, multi-country controlled study in 21 centers (www.clinicaltrials.gov NCT01627340). Four hundred and sixteen participants with Type-2 diabetes and 258 controls matched for age and body mass index (BMI) (2:1 ratio) received 3-doses of HBV vaccine (Engerix-B™, GSK Vaccines, Belgium) according to a 0, 1, 6 months schedule. Antibodies were measured against HBV surface antigen and expressed as seroprotection rates (anti-HBs ≥10mIU/mL) and geometric mean concentration (GMC). Results: The median age and BMI in patients with diabetes and controls (according-to-protocol cohort) were 54 y and 32.1 kg/m2, and 53 y and 30.8 kg/m2, respectively. Seroprotection rates (GMCs) one month post-dose-3 were 75.4% (147.6 mIU/mL) and 82.0% (384.2 mIU/mL) in patients with diabetes and controls, respectively. Age-stratified seroprotection rates for patients with diabetes were 88.5% (20–39 years), 81.2% (40–49 years), 83.2% (50–59 years), and 58.2% (≥60 years). The overall safety profile of hepatitis B vaccine was similar between groups. Conclusions: Hepatitis B vaccine is immunogenic in patients with diabetes and has a similar safety profile to vaccination in healthy controls. Because increasing age was generally associated with a reduction in seroprotection rates, hepatitis B vaccine should be administered as soon as possible after the diagnosis of diabetes.
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Affiliation(s)
- Olivier Van Der Meeren
- a Eastern Clinical Research Unit, Department of Medicine , Monash University, and Eastern Health , Box Hill, Victoria , Australia
| | | | - Marc Dionne
- c Centre Hospitalier Universitaire , Quebec , Canada
| | - Richard Beasley
- d Medical Research Institute of New Zealand , Wellington , New Zealand
| | - Peter R Ebeling
- e Department of Medicine, School for Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences , Monash University , Victoria , Australia
| | | | - Michael D Nissen
- g Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute , University of Queensland , Herston , Queensland , Australia.,h GSK Vaccines , Singapore
| | | | - Richard W Simpson
- j Eastern Clinical Research Unit, Department of Medicine , Monash University, and Eastern Health , Box Hill , Victoria , Australia
| | - Marc De Ridder
- a Eastern Clinical Research Unit, Department of Medicine , Monash University, and Eastern Health , Box Hill, Victoria , Australia.,k Faculté de Pharmacie , Université Libre de Bruxelles , Bruxelles , Belgium
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15
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Khedmat H, Aghaei A, Ghamar-Chehreh ME, Agah S. Sex bias in response to hepatitis B vaccination in end-stage renal disease patients: Meta-analysis. World J Nephrol 2016; 5:115-124. [PMID: 26788471 PMCID: PMC4707164 DOI: 10.5527/wjn.v5.i1.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/22/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To systematically review the literature for studies investigating the potential effect of gender of dialysis patients on the immunogenicity of hepatitis B virus vaccines.
METHODS: Literature searches were conducted by the MEDLINE and Google Scholar. The key words used included “hepatitis B (HB)”, “vaccine”, “dialysis”, “hemodialysis”, “sex”, “male” and “female”. Data of seroresponse to HB vaccine in clinical trials regarding sex of the recipients have been achieved and analyzed. Finally data from 19 clinical trials have been pooled and analyzed.
RESULTS: Analysis of response to HB vaccination in our dialysis population showed males significantly respond less to hepatitis B vaccination (P = 0.002, Z = 3.08) with no significant heterogeneity detected [P = 0.766; heterogeneity χ2 = 14.30 (df = 19); I2 = 0%]. A reanalysis of the pooled data was conducted regarding the dialysis mode to evaluate potential differential impact of sex on HB vaccine response. Hemodialysis was the only subgroup that showed a significant difference regarding dialysis mode in response to HB vaccination regarding sex (P = 0.042, Z = 2.03).
CONCLUSION: This Meta-analysis showed significant effect for the sex of chronic kidney disease and dialysis patients on the immunogenicity of HB vaccine. This sex discrimination was most prominent among hemodialysis patients.
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Villena R, Zubieta M, Hurtado C, Salgado C, Silva G, Fernández J, Villarroel M, Fernández M, Brahm J, O'Ryan M, Santolaya ME. [Seroconversion in response to a reinforced primary hepatitis B vaccination in children with cancer]. ACTA ACUST UNITED AC 2015; 86:236-43. [PMID: 26298296 DOI: 10.1016/j.rchipe.2015.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Immune response against vaccine antigens may be impaired in children with cancer. The aim of this study was to evaluate the seroconversion response against hepatitis B vaccination (HBV) at the time of chemotherapy onset and/or remission in children with cancer. PATIENTS AND METHOD Prospective, two-centre, controlled, non-randomised study conducted on children recently diagnosed with cancer, paired with healthy subjects. Cases received HBV at time 0, 1 and 6 months with DNA recombinant HBV at a dose of 20 and 40 μg if < or > than 10 years of age, respectively, at the time of diagnosis for solids tumours and after the remission in case of haematological tumours. Controls received the same schedule, but at of 10 and 20 μg doses, respectively. HBs antibodies were measured in serum samples obtained at 2, 8 and 12 months post-vaccination. Protective titres were defined as > 10 mIU/ml at 8th month of follow up. RESULTS A total of 78 children with cancer and 25 healthy controls were analysed at month 8th of follow up. Seroconversion rates in the cancer group reached 26.9%, with no differences by age, gender or type of tumour (P = .13, .29, and .44, respectively). Control group seroconversion was 100% at the 8th month, with P < .0001 compared with the cancer group. At month 12 of follow up, just 31.9% of children with cancer achieved anti-HBs antibodies > 10 mIU/ml. CONCLUSIONS Vaccination against hepatitis B with three doses of DNA recombinant vaccine at an increased concentration, administrated at the time of onset of chemotherapy and/or remission provided an insufficient immune response in a majority of children with cancer. More immunogenic vaccines should be evaluated in this special population, such as a third generation, with more immunogenic adjuvants, enhanced schedules at 0, 1, 2, 6 month, evaluation of antibody titres at month 8 and 12h to evaluate the need for further booster doses.
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Affiliation(s)
- Rodolfo Villena
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile.
| | - Marcela Zubieta
- Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile; Fundación Nuestros Hijos, Santiago, Chile
| | - Carmen Hurtado
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Laboratorio de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carmen Salgado
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile
| | - Gladys Silva
- Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile
| | | | - Milena Villarroel
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile; Hospital de niños Dr. Luis Calvo Mackenna, Santiago, Chile
| | | | - Javier Brahm
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Laboratorio de Gastroenterología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Miguel O'Ryan
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - María Elena Santolaya
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), Santiago, Chile; Hospital de niños Dr. Luis Calvo Mackenna, Santiago, Chile
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Abstract
The safety and immunogenicity profiles of currently available recombinant hepatitis B vaccines are excellent. However, it remains a real challenge to induce protective immunity in the target groups that respond poorly or not at all to conventional vaccines. Ideally, a hepatitis B vaccine can be developed that conveys lifelong protection against infection rapidly after the injection of a single dose. Although this goal is far from being reached, important improvements have been made. Novel vaccine adjuvants have been developed that enhance the immunogenicity of recombinant hepatitis B vaccines while maintaining a good safety profile. The different adjuvants and adjuvant systems that are discussed herein have all been thoroughly evaluated in clinical trials and some have reached or are close to reach the market.
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Zanoni G, Contreas G, Valletta E, Gabrielli O, Mengoli C, Veneri D. Normal or defective immune response to Hepatitis B vaccine in patients with diabetes and celiac disease. Hum Vaccin Immunother 2014; 11:58-62. [PMID: 25483516 DOI: 10.4161/hv.34309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A defective production of protective levels of antibodies to Hepatitis B (HB) vaccine is reported to occur in 4-10% of healthy subjects and a correlation with the presence of specific human leukocyte antigen (HLA) molecules, including DQ2, which also confers genetic predisposition to celiac disease (CD) and type I diabetes mellitus (T1DM), has been suggested. The aim of this study was to analyze the serological response to HB vaccine and measles-containing vaccines in 69 diabetic patients (T1DM), 42 patients with celiac disease (CD) and 79 healthy control subjects (CT). The median interval between the third dose of HB vaccine and serum collection was 6.8, 3.5, and 4.7 years for T1DM, CD and CT groups, respectively. 50/69 (72%) T1DM patients, 32/42 (76%) CD patients and 61/79 (77%) CT subjects showed protective anti-HBs antibodies after vaccination, with no statistically significant difference. On the contrary, a lower statistically significant difference was found in the mean HBsAb level of T1DM subjects when compared with the other two groups. No correlation between HLA DQ2 expression in T1DM and vaccine response was detected. The comparison of serological response to measles after vaccination also showed no statistically significant differences in the three groups. Contrasting results between these data and those reported in the literature might be due to differences in the time intervals between vaccination and testing. Prospective studies in pathological and healthy groups with the same age at HBV vaccination and with the same time interval for blood sample collection to determine antibody titers are necessary in order to provide more conclusive data.
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Affiliation(s)
- Giovanna Zanoni
- a Department of Pathology and Diagnostics; Section of Immunology; University of Verona; Italy
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Eleftheriadis T, Pissas G, Antoniadi G, Liakopoulos V, Stefanidis I. Factors affecting effectiveness of vaccination against hepatitis B virus in hemodialysis patients. World J Gastroenterol 2014; 20:12018-12025. [PMID: 25232238 PMCID: PMC4161789 DOI: 10.3748/wjg.v20.i34.12018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/29/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) is a major global health problem. Despite the success of the general measures against blood transmitted infections in hemodialysis (HD) units, the prevalence of HBV infection among the HD patients is still high. Thus vaccination against HBV is indicating in this population. However, compared with the general population the seroprotection achieved in HD patients remains relatively low, at about 70%. In this review patient, HD procedure and vaccine-associated factors that affect the efficacy of HBV vaccination are analyzed. Also alternative routes of HBV vaccine administration as well as new and more immunogenic vaccine formulations are discussed. However, besides scientific progress, vigilance of HD physicians and staff regarding the general measures against the transmission of blood borne infections and the vaccination against HBV is also required for reducing the prevalence of this viral infection.
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20
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Hsiang JC, Wong GLH, Chan HLY, Chan AWH, Chim AML, Wong VWS. Metabolic syndrome delays HBeAg seroclearance in Chinese patients with hepatitis B. Aliment Pharmacol Ther 2014; 40:716-26. [PMID: 25039861 DOI: 10.1111/apt.12874] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 04/19/2014] [Accepted: 06/22/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Delayed hepatitis B e antigen (HBeAg) seroclearance increases the risk of cirrhosis and hepatocellular carcinoma (HCC). The effect of metabolic syndrome (MetS) on HBeAg seroclearance in chronic hepatitis B (CHB) patients remains unclear. AIMS To examine the effect of MetS on HBeAg seroclearance. METHODS A prospective cohort of 413 treatment-naïve HBeAg-positive CHB patients from 2005 to 2012 was studied. Clinical, virological and histological parameters were evaluated. The patients were classified into three groups according to the metabolic characteristics; normal, pre-MetS and MetS based on the International Diabetes Federation criteria. The primary outcome was age at HBeAg seroclearance. RESULTS The overall HBeAg seroclearance rate was 11.4% per annum during 19 351 patient-months of follow-up with no difference in HBeAg seroclearance rates between 162 treatment-free and 251 patients receiving nucleos(t)ide analogues. Patients with pre-MetS and MetS were older when HBeAg seroclearance occurred (44 ± 12 and 53 ± 7 years, respectively) than the normal patients (37 ± 9 years, all P < 0.01). Patients with pre-MetS and MetS had more advanced liver fibrosis (33.0% and 53.1%, respectively) than the normal patients (18.4%, all P < 0.05). By the age of 50, 59.3% of the metabolic normal patients, 42.1% of the pre-MetS and 18.7% of the MetS patients had achieved HBeAg seroclearance (all P < 0.05, except P = 0.07 for pre-MetS vs. MetS). In multivariate analysis, MetS and type II diabetes at baseline were predictors of delayed HBeAg seroclearance after adjusting for viral load, anti-viral therapy and necroinflammatiom. CONCLUSION Chinese patients with chronic hepatitis B and with pre-metabolic syndrome or metabolic syndrome have delayed HBeAg seroclearance.
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Affiliation(s)
- J C Hsiang
- State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong , Hong Kong, China
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21
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Filippelli M, Lionetti E, Gennaro A, Lanzafame A, Arrigo T, Salpietro C, La Rosa M, Leonardi S. Hepatitis B vaccine by intradermal route in non responder patients: An update. World J Gastroenterol 2014; 20:10383-10394. [PMID: 25132754 PMCID: PMC4130845 DOI: 10.3748/wjg.v20.i30.10383] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/12/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus (HBV) infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90% of general population. Individuals who develop an anti-HBs titer less than 10 mIU/mL after primary vaccination cycle are defined “no responders”. Many factors could cause a non response to the HBV vaccination, such as administration of the vaccine in buttocks, impaired vaccine storage conditions, drug abuse, smoking, infections and obesity. Moreover there are some diseases, like chronic kidney disease, human immunodeficiency virus infection, chronic liver disease, celiac disease, thalassaemia, type I diabetes mellitus, down’s syndrome and other forms of mental retardation that are characterized by a poorer response to HBV vaccination than healthy subjects. To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection. Recent studies seem to indicate that the administration of HBV recombinant vaccine by the intradermal route is very effective and could represent a more useful strategy than intramuscular route. This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients. A comprehensive review of the literature using PubMed database, with appropriate terms, was undertaken for articles in English published since 1983. The literature search was undertaken in September 2013.
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Elrashidy H, Elbahrawy A, El-Didamony G, Mostafa M, George NM, Elwassief A, Saeid Mohamed AG, Elmestikawy A, Morsy MH, Hashim A, Abdelbasseer MA. Antibody levels against hepatitis B virus after hepatitis B vaccination in Egyptian diabetic children and adolescents. Hum Vaccin Immunother 2013; 9:2002-6. [PMID: 23787761 DOI: 10.4161/hv.25426] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The remarkable effectiveness of universal infantile hepatitis B (HB) vaccination is well documented in many countries. Nevertheless, the influence of insulin-dependent diabetes mellitus (IDDM) on the sero-protective level of antibody to hepatitis B surface antigen (anti-HBs) after HB vaccination has not been investigated in Egyptian children. The aim of this study was to investigate long-term anti-HBs sero-protective levels after infantile HB vaccination in Egyptian IDDM children. RESULTS The mean age of the healthy children was 10.86 ± 1.21 y (range, 5.5-15 y); 49 (45.8%) were boys and 58 (54.2%) were girls. The mean age of the IDDM children was 10.29 ± 3.04 y (range, 4-17 y); 32 (50.8%) were boys and 31 (49.2%) were girls. There were no significant differences between the healthy and IDDM children with respect to age and sex (p>0.05). Among the 107 healthy children, 43 (40%) did not have a protective anti-HBs level (anti-HBs<10 IU/L) and 64 (60%) had a protective level (anti-HBs ≥ 10 IU/L). In contrast, among the IDDM children, 44 (69.8%) and 19 (30.2%) did not and did have protective anti-HBs levels, respectively. This difference in anti-HBs concentration between healthy and diabetic children was highly significant (p<0.001). None of the vaccinated healthy or IDDM children was reactive to HBsAg or total anti-HBc. PATIENTS AND METHODS A total of 170 children (81 boys, 89 girls) who had been routinely vaccinated against HB were included. Their mean age was 10 ± 2.1 y. The enrolled children were divided into healthy (n = 107) and IDDM (n = 63) cohorts. Body Mass Index and levels of hepatitis B surface antigen (HBsAg), total antibody to hepatitis B core antigen (anti-HBc), and anti-HBs were evaluated in all children. In addition, the duration of diabetes mellitus (DM) and levels of glycated hemoglobin (HbA1c) were measured in IDDM children. CONCLUSION Our results are alarming. It appears that the majority of Egyptian diabetic children vaccinated against HB may not have sufficient anti-HBs levels to protect them from HB. Moreover, this study emphasizes the need for a population-based strategy for the management of patients without an anti-HBs protective level after HB vaccination and justifies the need to elucidate the heritability of those children.
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Affiliation(s)
- Heba Elrashidy
- Department of Microbiology and Botany; Faculty of Science; Al-Zakazik University; Al-Zakazik, Egypt
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Whitaker JA, Rouphael NG, Edupuganti S, Lai L, Mulligan MJ. Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV-1. Lancet Infect Dis. 2012;12:966-976. [PMID: 23174382 DOI: 10.1016/s1473-3099(12)70243-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV and hepatitis B virus co-infection leads to substantially increased morbidity and mortality compared with either infection alone. Immunisation with hepatitis B virus vaccine is the most effective way to prevent the infection in people with HIV; however, these patients have decreased vaccine responses and a short duration of protection compared with immunocompetent individuals. Control of HIV replication with highly active antiretroviral therapy and increased CD4 cell counts are associated with improved immune responses to hepatitis B vaccination. New vaccination strategies, such as increased vaccine dose, use of the intradermal route, and addition of adjuvants, could improve response rates in adults with HIV.
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Grzegorzewska AE, Pajzderski D, Sowińska A, Mostowska A, Jagodziński PP. IL4R and IL13 polymorphic variants and development of antibodies to surface antigen of hepatitis B virus in hemodialysis patients in response to HBV vaccination or infection. Vaccine 2013; 31:1766-70. [DOI: 10.1016/j.vaccine.2013.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/27/2013] [Accepted: 02/12/2013] [Indexed: 02/08/2023]
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Leonardi S, Praticò AD, Lionetti E, Spina M, Vitaliti G, Rosa ML. Intramuscular vs intradermal route for hepatitis B booster vaccine in celiac children. World J Gastroenterol 2012; 18:5729-33. [PMID: 23155313 PMCID: PMC3484341 DOI: 10.3748/wjg.v18.i40.5729] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 07/16/2012] [Accepted: 08/14/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare intradermal (ID) and intramuscular (IM) booster doses, which have been used in healthy and high risk subjects, such as healthcare workers, haemodialysis patients, human immunodeficiency virus patients, and renal transplant recipients unresponsive to initial hepatitis B vaccination, in celiac individuals.
METHODS: We conducted our study on 58 celiac patients, vaccinated in the first year of life, whose blood analysis had showed the absence of protective hepatitis B virus (HBV) antibodies. All patients had received the last vaccine injection at least one year before study enrolment and they had been on a gluten free diet for at least 1 year. In all patients we randomly performed an HBV vaccine booster dose by ID or IM route. Thirty celiac patients were revaccinated with recombinant hepatitis B vaccine (Engerix B) 2 μg by the ID route, while 28 celiac patients were revaccinated with Engerix B 10 μg by the IM route. Four weeks after every booster dose, the anti-hepatitis B surface (HBs) antibody titer was measured by an enzyme-linked immune-adsorbent assay. We performed a maximum of three booster doses in patients with no anti-HBs antibodies after the first or the second vaccine dose. The cut off value for a negative anti-HBs antibody titer was 10 IU/L. Patients with values between 10 and 100 IU/L were considered "low responders" while patients with an antibody titer higher than 1000 IU/L were considered "high responders".
RESULTS: No significant difference in age, gender, duration of illness, and years of gluten intake was found between the two groups. We found a high percentage of "responders" after the first booster dose (ID = 76.7%, IM = 78.6%) and a greater increase after the third dose (ID = 90%, IM = 96.4%) of vaccine in both groups. Moreover we found a significantly higher number of high responders (with an anti-HBs antibody titer > 1000 IU/L) in the ID (40%) than in the IM (7.1%) group, and this difference was evident after the first booster dose of vaccination (P < 0.01). No side effects were recorded in performing delivery of the vaccine by either the ID or IM route.
CONCLUSION: Our study suggests that both ID and IM routes are effective and safe options to administer a booster dose of HBV vaccine in celiac patients. However the ID route seems to achieve a greater number of high responders and to have a better cost/benefit ratio.
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Son J, Lee SB, Lee DW, Kim IY, Lee SJ, Lee SM, Song SH, Seong EY, Kwak IS. Immunogenicity of low-dose MF59-adjuvanted 2009 influenza A/H1N1 vaccine in dialysis patients. Clin Exp Nephrol 2013; 17:275-83. [PMID: 22990301 DOI: 10.1007/s10157-012-0696-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND In response to the pandemic 2009 A/H1N1 virus, monovalent MF59-adjuvanted vaccines were prepared. Recently, single 3.75-μg doses of MF59-adjuvanted vaccines have shown good immunogenicity in young adults. However, the immunogenicity of these vaccines has not been evaluated in dialysis patients. METHODS Dialysis patients received a single 3.75-μg dose of MF59-adjuvanted vaccine by intramuscular injection. For immunogenicity assays, serum samples were obtained before vaccination and 28 days after vaccination. All sera were tested by hemagglutination inhibition assays. RESULTS Overall, 48 hemodialysis (HD) patients and 34 peritoneal dialysis (PD) patients were included in immunogenicity analysis. In HD patients, geometric mean titers (GMTs) were significantly increased compared with baseline GMTs in both young (aged 18-60 years) and elderly (aged ≥ 60 years) patients (51.2 ± 51.4 vs. 14.1 ± 20.7 in young patients, P = 0.012; 37.9 ± 73.9 vs. 6.8 ± 8.0 in elderly patients, P = 0.018, respectively). The rates of seroprotection and seroconversion were 27.6 and 17.2 % in young patients and 31.6 and 26.3 % in elderly patients, respectively. Among PD patients, GMTs were increased only in young patients (39.8 ± 51.4 vs. 6.8 ± 5.0, P = 0.001). The rates of seroprotection and seroconversion were 36.0 and 36.0 % in young patients and 11.1 and 0.0 % in elderly patients, respectively. CONCLUSION A single 3.75-μg dose of MF59-adjuvanted vaccine was suboptimal to elicit protective antibody response in dialysis patients. Antibody responses against vaccine were compromised especially in elderly PD patients. Trials of different vaccination protocols such as a two-dose schedule or a higher hemagglutinin antigen dose of MF59-adjuvanted vaccine are necessary for improving antibody response in dialysis patients.
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Grzegorzewska AE, Wobszal PM, Mostowska A, Jagodziński PP. Antibodies to hepatitis B virus surface antigen and interleukin 12 and interleukin 18 gene polymorphisms in hemodialysis patients. BMC Nephrol 2012; 13:75. [PMID: 22863216 PMCID: PMC3468411 DOI: 10.1186/1471-2369-13-75] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 07/28/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The interleukin (IL)18 rs360719 CC genotype is associated with the development of antibodies to hepatitis B virus surface antigen (anti-HBs) in hemodialysis (HD) patients. IL18 shares biological properties with IL12 in promoting the T-hepler 1 (Th1) system. We studied whether polymorphisms in the IL12A 3` untranslated region (UTR) and IL12B 3`UTR may contribute to anti-HBs development (titre ≥ 10 IU/L) in HD patients either individually or jointly with the IL18 polymorphism. METHODS In 518 HD patients and 240 controls the IL12A rs568408 3'UTR G > A polymorphism was genotyped by high-resolution melting curve analysis. Polymerase chain reaction restriction fragment length polymorphism was used to detect the IL12B rs3212227 3'UTR A > C and IL18 -1297 T > C rs360719 polymorphisms. The associations between the IL12A, IL12B and IL18 genotypes and the risk of impaired anti-HBs development were estimated by computing the odds ratios and their 95% confidence intervals using logistic regression analysis. RESULTS In the logistic regression analysis, the higher frequency of rs360719 CC individually (2.9% in 207 patients without anti-HBs development vs 8.0% in 311 patients with anti-HBs development, p = 0.009) and of rs360719 CC combined with rs568408 GG (p = 0.048), rs568408 GA (p = 0.035), rs568408 GG/AA (p = 0.034) or rs3212227 AA (p = 0.046) was associated with an increased chance for the development of anti-HBs in HD patients. Patients bearing both rs568408 AA and rs360719 TT had a 10.9-fold or 8.9-fold lower chance, respectively, to develop anti-HBs compared with those carrying any other genotype (p = 0.005) or those who had both wild-type rs568408 GG and rs360719 TT (p = 0.011). Carriers of both rs3212227 CC and rs360719 TC had a 4.6-fold lower chance for anti-HBs development than carriers of any other genotype (p = 0.042). CONCLUSION Development of anti-HBs in HD patients is associated with gene polymorphisms of interleukins involved in the Th1 system.
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Affiliation(s)
- Alicja E Grzegorzewska
- Chair and Department of Nephrology, Transplantology and Internal Diseases Poznań University of Medical Sciences, 49 Przybyszewskiego Blvd, 60-355, Poznań, Poland
| | - Piotr M Wobszal
- Chair and Department of Nephrology, Transplantology and Internal Diseases Poznań University of Medical Sciences, 49 Przybyszewskiego Blvd, 60-355, Poznań, Poland
| | - Adrianna Mostowska
- Department of Biochemistry and Molecular Biology, Poznań University of Medical Sciences, Poznań, Poland
| | - Paweł P Jagodziński
- Department of Biochemistry and Molecular Biology, Poznań University of Medical Sciences, Poznań, Poland
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Mathews CE, Brown EL, Martinez PJ, Bagaria U, Nahm MH, Burton RL, Fisher-Hoch SP, McCormick JB, Mirza S. Impaired function of antibodies to pneumococcal surface protein A but not to capsular polysaccharide in Mexican American adults with type 2 diabetes mellitus. Clin Vaccine Immunol. 2012;19:1360-1369. [PMID: 22761295 DOI: 10.1128/cvi.00268-12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The goal of the study was to determine baseline protective titers of antibodies to Streptococcus pneumoniae surface protein A (PspA) and capsular polysaccharide in individuals with and individuals without type 2 diabetes mellitus. A total of 561 individuals (131 individuals with diabetes and 491 without) were screened for antibodies to PspA using a standard enzyme-linked immunosorbent assay (ELISA). A subset of participants with antibodies to PspA were retested using a WHO ELISA to determine titers of antibodies to capsular polysaccharide (CPS) (serotypes 4, 6B, 9V, 14, 18C, 19A, 19F, and 23F). Functional activity of antibodies was measured by assessing their ability to enhance complement (C3) deposition on pneumococci and promote killing of opsonized pneumococci. Titers of antibodies to protein antigens (PspA) were significantly lower in individuals with diabetes than controls without diabetes (P = 0.01), and antibodies showed a significantly reduced complement deposition ability (P = 0.02). Both antibody titers and complement deposition were negatively associated with hyperglycemia. Conversely, titers of antibodies to capsular polysaccharides were either comparable between the two groups or were significantly higher in individuals with diabetes, as was observed for CPS 14 (P = 0.05). The plasma specimens from individuals with diabetes also demonstrated a higher opsonophagocytic index against CPS serotype 14. Although we demonstrate comparable protective titers of antibodies to CPS in individuals with and individuals without diabetes, those with diabetes had lower PspA titers and poor opsonic activity strongly associated with hyperglycemia. These results suggest a link between diabetes and impairment of antibody response.
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Leonardi S, Vitaliti G, Garozzo MT, Miraglia del Giudice M, Marseglia G, La Rosa M. Hepatitis B vaccination failure in children with diabetes mellitus? The debate continues. Hum Vaccin Immunother 2012; 8:448-52. [PMID: 22370513 DOI: 10.4161/hv.19107] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aim of our study was to evaluate the presence of specific antibodies against HBsAg in diabetic children (IDDM) previously vaccinated against hepatitis B virus. PATIENTS AND METHODS 110 diabetic children were retrospectively studied and 100 healthy controls were recruited. In all patients surface antigen, HBV core IgG, antibodies against HBV "e" antigen and quantitative HBV surface antibodies were detected. In 45 patients molecular typing of HLA alleles was performed. Metabolic control was evaluated as mean glycated hemoglobin (HbA1c) and all patients were compliant to insulin therapy. RESULTS 46 of 110 diabetic children (41.8%) and 16 of 100 healthy controls (16%) were found to have not anti-HBs antibodies (p < 0.0001). The mean antibody titer was found significantly-lower (p < 0.0001) in IDDM children than healthy controls. No correlation was found between antibody titer, age, duration of disease and HbA1c. We did not find any difference of gender, age, years of onset of the disease and metabolic control, between diabetics with anti-HBs antibodies and those without. CONCLUSIONS Our data confirm the reduced seroprotection rate for HBV vaccination in diabetics. However it remains poorly clarify the real clinical significance of this result. In our study no diabetic children showed markers of HBV infection.
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Strom A, Menart B, Simon MC, Pham MN, Kolb H, Roden M, Pozzilli P, Leslie RDG, Schloot NC. Cellular interferon-γ and interleukin-13 immune reactivity in type 1, type 2 and latent autoimmune diabetes: action LADA 6. Cytokine 2012; 58:148-51. [PMID: 22305546 DOI: 10.1016/j.cyto.2012.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/13/2011] [Accepted: 01/08/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Type 1 diabetes and latent autoimmune diabetes in adults (LADA) are thought to result from immune-mediated β-cell destruction. It remains unclear why LADA is clinically less severe compared to type 1 diabetes. This study aimed to compare the pro-inflammatory (interferon-γ, IFN-γ) and anti-inflammatory (interleukin-13, IL-13) T-cell responses in humans with LADA and type 1 diabetes. RESEARCH DESIGN AND METHODS IFN-γ and IL-13 T-cell responses to a panel of 16 (auto)-antigens were tested using an enzyme linked immune-spot technique and peripheral T-cells from 35 patients with type 1 diabetes, 59 patients with type 2 diabetes, 23 LADA patients, and 42 control subjects. RESULTS LADA and type 1 diabetes patients did not display any statistically significant differences in the frequency of IFN-γ or IL-13 responses to auto-antigenic stimuli, positive control or mitogen. Overall very low T cell reactivity to autoantigens was detected in all groups. IL-13 responses but not IFN-γ responses to recall antigen tetanus toxoid were higher in healthy control subjects compared to patients with type 1 or type 2 diabetes or LADA (P<0.05). Diabetes, independent of type, was associated with weaker response to recall antigen tetanus toxoid. CONCLUSIONS LADA patients are indistinguishable from type 1 diabetes patients for cellular IFN-γ and IL-13 responses upon mitogen and recall antigen stimulation. These results extend previous findings showing that systemic cytokine/chemokine and humoral responses in type 1 diabetes and LADA are similar.
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Affiliation(s)
- Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich-Heine-University, Leibniz Institute for Diabetes Research, Düsseldorf, Germany.
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Zitt E, Sprenger-Mähr H, Knoll F, Neyer U, Lhotta K. Vitamin D deficiency is associated with poor response to active hepatitis B immunisation in patients with chronic kidney disease. Vaccine 2011; 30:931-5. [PMID: 22142584 DOI: 10.1016/j.vaccine.2011.11.086] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 10/19/2011] [Accepted: 11/22/2011] [Indexed: 12/25/2022]
Abstract
Vitamin D deficiency is highly prevalent in patients suffering from chronic kidney disease. At present it is not known whether this condition is associated with poor response to hepatitis B vaccination in these patients. We performed a retrospective analysis of 200 patients with chronic kidney disease stages 3-5D, who had undergone hepatitis B vaccination with three 40 μg recombinant hepatitis B vaccine doses in a single centre. Anti-HBs antibody titres and 25-hydroxyvitamin D (25(OH)D) levels were measured by chemiluminescence immunoassays. Vitamin D deficiency with serum levels <10 ng/mL was found in 35.5% of patients. These patients had a lower seroconversion rate than did patients with levels ≥10 ng/mL (45% vs 64%; P=0.011) and their median (25th, 75th percentile) anti-HBs antibody titres were lower (0 (0, 117)IU/L vs 48 (0, 236.5)IU/L). Non-responders had lower 25(OH)D concentrations than did responders (12.9±6.5 ng/mL vs 15.1±7.4 ng/mL; P=0.034). Treatment with a vitamin D receptor activator had no influence on the immune response. In a multiple logistic regression analysis vitamin D deficiency (OR 0.480; P=0.023) and diabetes (OR 0.496; P=0.038) remained independent and significant negative predictors of seroconversion. In conclusion, in patients with chronic kidney disease vitamin D deficiency is associated with a poor antibody formation upon hepatitis B vaccination.
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Affiliation(s)
- Emanuel Zitt
- Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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Grzegorzewska AE, Wobszal P, Jagodziński PP. Interleukin-18 promoter polymorphism and development of antibodies to surface antigen of hepatitis B virus in hemodialysis patients. Kidney Blood Press Res 2011; 35:1-8. [PMID: 21832842 DOI: 10.1159/000329932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 06/01/2011] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Interleukin (IL)-18 is involved in hepatitis B virus (HBV) clearance and augments antibodies against surface antigen of HBV (anti-HBsAg) production during DNA vaccination. The IL-18 -1297C>T (rs360719) polymorphism may modulate the IL-18 expression. AIM To determine the potential association of IL-18 -1297C>T polymorphism with development of anti-HBsAg in hemodialysis (HD) patients. METHODS The frequency of IL-18 -1297C>T alleles and genotypes was identified by polymerase chain reaction restriction fragment length polymorphism in 435 HD patients. Group 1 (n = 219) developed an anti-HBsAg titer >10 IU/l as a result of vaccination or HBV transmission. Group 2 (n = 216) included patients who did not develop an anti-HBsAg titer >10 IU/l in response to at least one full series of vaccination or HBV transmission. The significance of genotype frequency was tested using the Fisher exact test. RESULTS In group 1, the frequencies of -1297CC, -1297CT and -1297TT genotypes were 7.3, 39.7 and 53.0%, respectively, and in group 2 they were 1.9, 42.1 and 56.0%, respectively. The odds ratio for CC versus CT + TT was 0.239 (95% CI 0.079-0.728, p = 0.010), and for CC versus TT it was 0.240 (95% CI 0.078-0.738, p = 0.009). CONCLUSION In HD patients, the IL-18 -1297CC genotype may play a role in anti-HBsAg development in response to HBV surface antigen.
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Affiliation(s)
- Alicja E Grzegorzewska
- Department of Nephrology, Transplantology and Internal Diseases, Karol Marcinkowski University of Medical Sciences, Poznań, Poland.
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