1321Marginal structural model of the causal role of hepatitis B vaccination in multiple sclerosis risk

Abstract Background There are conflicting reports regarding the association between uptake of recombinant vaccine against hepatitis B virus (HBV) and risk of multiple sclerosis (MS). Most cohort or case-control studies found no significant short- or long-term increase in MS risk after immunization. Whereas others reported a significant increase in MS risk within three years of HBV vaccination. The present matched case-control study was conducted to test the hypothesis whether recombinant HBV vaccination status is causally associated with MS risk using targeted maximum likelihood estimation (TMLE) that uses data-adaptive flexible machine learning algorithms to estimate the causal parameters. Methods Confirmed 110 MS incident cases and age (± 5 years), gender and nationality matched (1:1) 110 community controls were enrolled. A pre-tested structured questionnaire was used to collect the data on demographics, environmental factors, comorbidities, history of vaccinations through face-to-face interviews both from cases and controls. We implemented case-control-weighted TMLE – a double robust, multistep procedure to estimate causal relative risk (RR), marginal odds ratio (OR) and population attributable fraction. Results This study demonstrated a non-specific protective effect of HBV vaccine against MS risk as estimated by TMLE (causal RR 0.63, 95% CI: 0.45-0.90; p = 0.004; marginal OR 0.43; 95% CI: 0.18-0.67; p = 0.006). The population attributable fraction was 20% (95% CI: 6%, 34%; p = 0.014)) Conclusions Subject to inherent limitations of the case-control design, this study suggests a non-specific protective effect of recombinant HBV vaccination against MS risk. Future studies may contemplate to confirm these results. Key message Causal analysis showed a non-specific protective causal association between uptake of recombinant HBV vaccine and MS risk in the study population.

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Cytomegalovirus seropositivity is negatively associated with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458513494489 ◽

2013 ◽

Vol 20 (2) ◽

pp. 165-173 ◽

Cited By ~ 59

Author(s):

E Sundqvist ◽

T Bergström ◽

H Daialhosein ◽

M Nyström ◽

P Sundström ◽

...

Keyword(s):

Multiple Sclerosis ◽

Protective Effect ◽

Meta Analysis ◽

Sun Exposure ◽

Epidemiological Data ◽

Case Control ◽

Negative Association ◽

Cmv Infection ◽

Negatively Associated ◽

Incident Cases

Background: Epidemiological data suggest a role for common viruses in the pathogenesis of multiple sclerosis (MS), and recent data showed a negative association of past cytomegalovirus (CMV) infection on pediatric MS risk. Objective: Our aim was to analyze the association of CMV infection with MS risk in an adult case-control material. A meta-analysis was performed to validate our findings. Methods: Epidemiological Investigation in MS (EIMS) is a case-control study with incident cases and population-based controls. Anti-CMV antibody titers were measured with ELISA, and HLA-A and DRB1 genotyping was performed with SSP-PCR, in 658 MS cases, who all fulfilled the McDonald criteria for MS, and 786 controls. Results: CMV seropositivity was associated with a decreased MS risk, OR = 0.73 (0.58–0.92 95% CI), p = 0.005, adjusted for index age, gender, smoking, sun exposure, EBNA1 IgG titer and HLA-A*02 and DRB1*15. When we removed all cases and controls younger than 18 years at index, the protective effect was still apparent. Conclusions: CMV is negatively associated with adult-onset MS pathology, consistent with results from a study on pediatric MS cases. It remains to be shown whether this negative association is due to a true protective effect of CMV infection on MS risk.

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The Impact of Universal Infant Hepatitis B Immunization on Reducing the Hepatitis B Carrier Rate in Pregnant Women

The Journal of Infectious Diseases ◽

10.1093/infdis/jiy706 ◽

2018 ◽

Vol 220 (7) ◽

pp. 1118-1126 ◽

Cited By ~ 3

Author(s):

Wei-Ju Su ◽

Shu-Fong Chen ◽

Chin-Hui Yang ◽

Pei-Hung Chuang ◽

Hsiu-Fang Chang ◽

...

Keyword(s):

Hepatitis B ◽

Pregnant Women ◽

Screening Program ◽

Hepatitis B Surface Antigen ◽

Carrier Rate ◽

Cross Sectional ◽

Hbv Vaccine ◽

Hbv Vaccination ◽

The Impact ◽

Universal Infant

Abstract Background The hepatitis B virus (HBV) status of pregnant women affects HBV vaccine failure in their offspring. This study is aimed to investigate the impact of the universal infant HBV vaccination program on the long-term hepatitis B surface antigen (HBsAg) rate in pregnant women. Methods Using the National Immunization Information System, we examined a 32-year period of cross-sectional data on a maternal HBsAg and hepatitis B e antigen (HBeAg) screening program launched in July 1984. An age-period-cohort model analysis of 940 180 pregnant women screened for July 1996–June 1997 and the years 2001, 2006, 2011, and 2016 was applied. Results The annual HBsAg- and HBeAg-seropositive rates decreased from 13.4% and 6.4%, respectively, for the period 1984–1985 to 5.9% and 1.0% in 2016 (P for both trends < .0001). Pregnant women with birth years after July 1986 (the HBV vaccination cohort) had the lowest relative risk (0.27 [95% confidence interval, .26–.28]) of HBsAg positivity compared with birth years before June 1984. Conclusions The birth cohort effect in relation to the universal infant HBV immunization program has effectively reduced the HBV carrier rate in pregnant women and the burden of perinatal HBV infection on the next generation.

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Ineffectiveness of hepatitis B vaccination in cirrhotic patients waiting for liver transplantation

Canadian Journal of Gastroenterology ◽

10.1155/2000/548206 ◽

2000 ◽

Vol 14 (suppl b) ◽

pp. 59B-63B ◽

Cited By ~ 37

Author(s):

Edith Villeneuve ◽

Jean Vincelette ◽

Jean-Pierre Villeneuve

Keyword(s):

Liver Transplantation ◽

Hepatitis B ◽

De Novo ◽

Hepatitis B Surface Antigen ◽

Hbv Infection ◽

Hepatitis B Vaccination ◽

Hbv Vaccine ◽

Hbv Vaccination ◽

De Novo Hepatitis B ◽

Cirrhotic Patients

Cirrhotic patients who undergo liver transplantation are at risk of acquiring de novo hepatitis B virus (HBV) infection at the time of transplantation. It is common practice to immunize these patients against HBV, but the efficacy of vaccination is uncertain. The response to vaccination with a recombinant HBV vaccine was examined in 49 patients with cirrhosis before liver transplantation. Patients received three doses (20 µg) of Engerix-B (SmithKline Beecham) at zero, one and two months before transplantation, and their response was measured on the day of liver transplantation (9.3±1.2 months after the initial dose of vaccine). Results were compared with those reported in healthy adults vaccinated according to the same schedule. Fourteen of 49 cirrhotic patients (28%) developed antibodies to hepatitis B surface antigen (anti-HBs) levels of more than 10 U/L after vaccination compared with 97% of healthy controls. Four patients (8%) had anti-HBs levels of more than 100 U/L compared with 83% in healthy individuals. Mean anti-HBs titre in the 14 responders was 62 U/L compared with 348 U/L in controls. No factor was identified that predicted response to vaccination. One of 49 patients acquired de novo HBV infection at the time of liver transplantation. Current HBV vaccination of cirrhotic patients waiting for liver transplantation is ineffective, and new strategies need to be developed to increase the response rate.

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Knowledge, Preference, and Willingness to Pay for Hepatitis B Vaccination Services among Woman of Reproductive Age in Vietnam

BioMed Research International ◽

10.1155/2019/9154918 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Anh Tuan Le Nguyen ◽

Xuan Thanh Thi Le ◽

Toan Thanh Thi Do ◽

Cuong Tat Nguyen ◽

Long Hoang Nguyen ◽

...

Keyword(s):

Hepatitis B ◽

Willingness To Pay ◽

Cross Sectional Study ◽

Reproductive Age ◽

Hepatitis B Vaccination ◽

Critical Approach ◽

Cross Sectional ◽

Hbv Vaccine ◽

Number Of Children ◽

Hbv Vaccination

Background. Hepatitis B virus (HBV) vaccine is a critical approach to prevent HBV transmission from mother to child. However, despite high HBV prevalence, evidence about the preference of women of productive age for HBV vaccine in Vietnam was constrained. This study aims to explore the preference and willingness to pay (WTP) for the HBV vaccine in Vietnamese women in productive age. Methods. A cross-sectional study was conducted in Hanoi in April 2016. A structured questionnaire was used to collect information about respondents’ socioeconomic status and knowledge about HBV vaccination. A contingent valuation approach was employed to measure the WTP for the HBV vaccine. Logistic and interval regressions were used to determine the associated factors. Results. Among 807 women, 80.8% were willing to have the vaccine injected which had the average price of 108,600 VND (95% CI, 97,580 VND–119,570 VND). Participants not suffering any diseases during pregnancy were more likely to be willing to pay for the HBV vaccine (OR = 3.41, 95% CI = 1.73–6.70). Not having the antenatal examination at central hospitals and working as farmers/workers were positively correlated with willingness to pay for this vaccine, while the number of children of respondents had a negative correlation with WTP. Conclusions. Our sampled women expressed a high willingness to pay for the vaccine. The price people were willing to pay for the vaccine, however, is equal to half of the actual price. These findings implied needs for better targeted public education interventions about HBV and the involvement of local medical staffs and the media in providing information. Efforts to reduce the price of the vaccine should also be warranted for scaling-up the coverage of this vaccine.

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Past Methylphenidate Exposure and Stress Fractures in Combat Soldiers: A Case-Control Study

The American Journal of Sports Medicine ◽

10.1177/0363546517741705 ◽

2017 ◽

Vol 46 (3) ◽

pp. 728-733 ◽

Cited By ~ 6

Author(s):

Haggai Schermann ◽

Ilan Shalom Ben-Ami ◽

Adrian Tudor ◽

Eyal Amar ◽

Ehud Rath ◽

...

Keyword(s):

Stress Fracture ◽

Clinical Effect ◽

Case Control Study ◽

Population Attributable Fraction ◽

Case Control ◽

Stress Fractures ◽

Attributable Fraction ◽

Place Of Birth ◽

Control Study ◽

Combat Soldiers

Background: Previous research has revealed decreased bone mineral density (BMD) among children and adolescents who receive methylphenidate (MP) treatment for attention deficit hyperactivity disorder (ADHD). These findings have major clinical implications given that the prevalence of medication-treated ADHD is on the rise worldwide. We decided to investigate the clinical effect of MP exposure on the incidence of stress fractures, for which a low BMD is a risk factor. Hypothesis: Exposure to MP is a risk factor for stress fractures. Study Design: Case-control study; Level of evidence, 3. Methods: This is a case-control study of combat soldiers who served in the military for 3 years between 2005 and 2015. The case group included 2400 soldiers with at least 1 stress fracture diagnosed by a bone scan. The control group comprised 6187 combat soldiers without a diagnosis of a stress fracture. The use of MP was determined by an automated text search of medical records and manual sorting of the results. Other study variables included age; sex; weight; height; body mass index (BMI); place of birth; and characterization of fractures by location, side, and grade. Odds ratios of stress fractures, the attributable proportion among the exposed, and the population attributable fraction were calculated using standard contingency tables. Logistic regression was fitted after adjusting for covariates. Results: The previous use of MP was associated with a higher risk of stress fractures (odds ratio, 1.15 [95% CI, 1.07-1.24]). The attributable proportion was 13.2%, and the population attributable fraction was 0.3%. Logistic regression demonstrated an increased risk of stress fractures associated with past MP use, preserved after adjusting for BMI, sex, and place of birth ( P = .005). Female sex, BMI ≤20 kg/m2, and 20 < BMI ≤25 kg/m2 were independent positive predictors of a stress fracture, while African origin was a negative predictor. Most participants who used MP had only 1 fracture (77.8%), while the majority of participants who did not use MP in the past had ≥2 coincident fractures (53.5%) ( P = .003). Conclusion: This study supports the hypothesis that an MP-associated reduction in BMD has a clinical effect in the form of an increased incidence of stress fractures. The high percentage of fractures attributed to MP use may serve as a basis for risk stratification, that is, the referral of patients with a history of MP use to BMD measurements.

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Sex Disparity in Response to Hepatitis B Vaccine Related to the Age of Vaccination

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010327 ◽

2020 ◽

Vol 17 (1) ◽

pp. 327 ◽

Cited By ~ 1

Author(s):

Andrea Trevisan ◽

Alessandro Giuliani ◽

Maria Luisa Scapellato ◽

Simona Anticoli ◽

Rita Carsetti ◽

...

Keyword(s):

Hepatitis B ◽

Antibody Titre ◽

Fold Increase ◽

Health Surveillance ◽

Male Students ◽

Hbv Vaccine ◽

Hbv Vaccination ◽

Professional Degree ◽

One Year ◽

Sex Disparity

Hepatitis B virus (HBV) infection is one of the major infectious hazards for health-care workers (HCWs) because of the frequency of percutaneous exposures to blood or body fluids. For this reason, all HCWs should be vaccinated, including students in medicine and health professional degree programs. The aim of this study was to assess the immune coverage to anti-HBV vaccine and long-lasting protective titres of anti-HBs antibodies in female and male students to evaluate gender-related differences in response to HBV vaccination. Data relative to anti-HBs antibody titre, sex, age, and age at vaccination were collected and analyzed from 5291 Italian students (1812 males and 3479 females) of the graduate courses at the School of Medicine, who underwent the mandatory health surveillance of workers exposed to biological risk. The results indicated that gender affects the immune response to HBV vaccine, particularly evident in the case of females vaccinated after one year of age who exhibited a statistically significant (p = 0.0023) 1.21-fold increase in median antibody titre with respect to males. Our findings could contribute to the optimization of HBV vaccination schedules in health surveillance of HCWs.

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Effect of Revaccination Using Different Schemes among Adults with Low or Undetectable Anti-HBs Titers after Hepatitis B Virus Vaccination

Clinical and Vaccine Immunology ◽

10.1128/cvi.00064-10 ◽

2010 ◽

Vol 17 (10) ◽

pp. 1548-1551 ◽

Cited By ~ 6

Author(s):

Chao-Shuang Lin ◽

Shi-Bin Xie ◽

Jing Liu ◽

Zhi-Xin Zhao ◽

Yu-Tian Chong ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Geometric Mean ◽

Recombinant Vaccine ◽

Recombinant Hepatitis ◽

Healthy Male ◽

Hbv Vaccine ◽

Hbv Vaccination ◽

Conversion Rates ◽

B Virus

ABSTRACT Our objective was to investigate the effect of various reimmunization schemes for hepatitis B in adults with low or undetectable anti-HBs titers. Over 2 years, 10 μg of Saccharomyces cerevisiae-recombinant hepatitis B virus (HBV) vaccine (synthesized in China) was used in at least one standardized scheme to immunize 2,310 healthy male and nonpregnant female adults. Of these, 240 subjects tested negative for hepatitis B markers. These 240 subjects were equally divided into 4 groups. The first group, designated Engerix-40, was revaccinated with 40 μg Engerix-B; the second, Engerix-20, was revaccinated with 20 μg Engerix-B; the third, Chinese-20, was revaccinated with 20 μg Chinese-made yeast-recombinant vaccine; and the last group, Chinese-10, was revaccinated with 10 μg Chinese-made yeast-recombinant vaccine. Blood samples were collected before and 1, 2, 8, and 12 months after the first injection. The anti-HBs-positive conversion rates of the Engerix-40, Engerix-20, and Chinese-20 groups were higher than that of the Chinese-10 group (P < 0.01). Over time, the anti-HBs conversion rate increased in all groups, but values were significantly different from those for the other groups only in the Chinese-10 group (P < 0.001). The anti-HBs geometric mean titers (GMTs) of the Engerix-40, Engerix-20, and Chinese-20 groups were higher than in the Chinese-10 group (P < 0.05). Increased doses raise and maintain anti-HBs titers in subjects with low or undetectable titers after HBV vaccination.

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Waterpipe smoking associated with multiple sclerosis: A population-based incident case–control study

Multiple Sclerosis Journal ◽

10.1177/1352458516677867 ◽

2016 ◽

Vol 23 (10) ◽

pp. 1328-1335 ◽

Cited By ~ 22

Author(s):

Ibrahim Abdollahpour ◽

Saharnaz Nedjat ◽

Mohammad Ali Sahraian ◽

Mohammad Ali Mansournia ◽

Petr Otahal ◽

...

Keyword(s):

Multiple Sclerosis ◽

Passive Smoking ◽

Case Control Study ◽

Population Based ◽

Case Control ◽

Waterpipe Smoking ◽

Incident Case ◽

Global Increase ◽

Incident Cases ◽

Control Study

Background: While cigarette and passive smoking have been identified as modifiable risk factors for multiple sclerosis (MS), there is no report regarding Waterpipe smoking–MS association. Objective: We examined the association of Waterpipe, tobacco, and passive smoking with MS. Methods: Population-based incident case–control study in Iran with 547 incident cases and 1057 general population controls (7 August 2013–17 February 2015). Logistic regression model was used. Multiplicative along with additive interaction was assessed using product term and Synergy Index (SI), respectively, and the population attributable fractions (PAFs) were calculated. Results: Having ever smoked Waterpipe, tobacco, or being exposed to passive smoking were all significantly associated with MS (odds ratio (OR) = 1.77 (1.36–2.31), OR = 1.69 (1.24–2.31), and OR = 1.85 (1.48–2.32), respectively). Clear dose–response associations were observed with the duration exposed ( p < 0.001 for all three) and the amount smoked ( p < 0.001 for Waterpipe and tobacco). Those who had all three types of smoking had an odds that was 4.1 times higher than those without any type. The three types of smoking jointly contributed to 30.9% of the MS incidence. Conclusion: We identified Waterpipe smoking as a novel risk factor for MS. Given the global increase in Waterpipe smoking, especially among young adults, this finding reinforces the need for public health interventional and educational programs to combat this global increase.

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1057. CpG-adjuvanted Hepatitis B vaccination improves seroprotection rates in Veterans with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1243 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S558-S558

Author(s):

Meagan Deming ◽

Shyam Kottilil ◽

Eleanor Wilson

Keyword(s):

Hepatitis B ◽

Hepatitis B Surface Antigen ◽

Panel Member ◽

The Elderly ◽

Hepatitis B Vaccination ◽

People Living With Hiv ◽

Research Support ◽

Hbv Vaccine ◽

Vaccine Responses ◽

Hbv Vaccination

Abstract Background Hepatitis B virus (HBV) remains a global health issue, leading to complications including cirrhosis and hepatocellular carcinoma. Individuals co-infected with Human Immunodeficiency Virus (HIV) and HBV have increased liver-related morbidity and mortality compared to those with HBV mono-infection. Vaccination can effectively prevent HBV infection, but certain critical populations including people living with HIV (PLWH) are less likely to achieve seroprotection (antibody to hepatitis B surface antigen (HBsAb) titer ≥ 10 IU/mL) after vaccination; seroprotection rates (SPR) in PLWH range from 34 to 88% in clinical trials, with improved SPR in those with immunologic reconstitution and viral suppression. With improved immunologic status, SPR have dramatically improved in our Veteran Infectious Disease clinic population. However, a subset of patients remain HBV vaccine nonresponders despite re-vaccination attempts, perhaps due to intrinsic immunologic anergy. We hypothesized that Veterans with HIV who were nonresponders to prior HBV vaccines may respond to a more immunogenic vaccine. Heplisav-B is a 2-dose series, with improved SPR in other classically difficult to vaccinate groups (including the elderly and those with diabetes), but has not yet been studied in individuals with HIV. Methods HBV vaccine nonresponders who had previously been vaccinated and boosted with median 3 and up to 8 doses of alum-adjuvanted HBV vaccines were re-vaccinated with Heplisav-B. HBsAb titers were assessed at days 0, 30, and 60 to follow vaccine responses. Results Participants had a median age of 65 (range 44 to 83) and were virologically suppressed on antiretroviral therapy. Enrollment and vaccination was interrupted by the COVID-10 pandemic, but 8 of 10 (80%) enrolled participants had seroprotective titers at day 60, with 6 having titers > 1000 IU/mL. Of the 8 additional participants who had available serologies after the first dose, all were seroprotected, and 3 had titers > 1000 IU/mL.16 of 18 (89%) participants achieved seroprotection with Heplisav-B. Conclusion Heplisav-B is immunogenic in persons with HIV and should be a reasonable option for HBV vaccination of PLWH who are previous nonresponders. Disclosures Shyam Kottilil, MD PhD, Arbutus Pharmaceuticals (Grant/Research Support)Gilead Sciences (Grant/Research Support)Merck Inc (Grant/Research Support, Advisor or Review Panel member)

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The association between protection motivation and hepatitis b vaccination intention among migrant workers in Tianjin, China: a cross-sectional study

10.21203/rs.3.rs-24197/v2 ◽

2020 ◽

Author(s):

Cai Liu ◽

Stephen Nicholas ◽

Wang Jian

Keyword(s):

Logistic Regression ◽

Hepatitis B ◽

Migrant Workers ◽

Self Efficacy ◽

Binary Logistic Regression ◽

Protection Motivation ◽

Principal Component Factor Analysis ◽

Cross Sectional ◽

Hbv Vaccine ◽

Hbv Vaccination

Abstract Background: Migrant workers are a susceptible population to the hepatitis b virus (HBV) and a vulnerable spot in China’s immunization procedures. There is no free HBV immunization program for migrant workers in China, so understanding migrant workers’ motivation to receive the HBV vaccine is the first step in designing effective immunization policies.Methods: A fully specified protection motivation theory (PMT) model of HBV vaccination intention among migrant workers was specified. Data were collected through a cross-sectional survey of 406 migrant workers in three migrant-dense industries in Tianjin, China. Principal component factor analysis was used to produce PMT factors and nested binary logistic regression modeling was applied to assess the associations between protection motivation and HBV vaccination intention of migrant workers.Results: The nested binary logistic regression model suggested that the severity factor and self-efficacy factor were positively related to HBV vaccination intention (OR=2.15, 95% CI: 1.25-3.71; OR=2.75, 95% CI: 1.62-4.66) while the response costs was negatively related to the HBV vaccination motivation (OR=0.50, 95% CI: 0.29-0.83). The socio-demographic variables showed that younger, married and good self-rated health status participants were statistically associated with the intention of taking the HBV vaccine. Sex, education level and income group were not significantly associated with vaccination intention. The migrant-industry variables showed that migrant location had a strong effect on migrant workers’ vaccination intention.Conclusion: Socio-demographic, migrant-industry variables and PMT factors (severity, self-efficacy and response costs) were statistically associated with migrant workers’ intention to vaccinate. Our results suggest that health policy makers should provide more information to migrants on HBV severity; inform migrant workers on where, when and how to get the HBV vaccine; tap into work organizations as a location for vaccinations; and identify migrant worker subgroups for targeted interventions.

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