A simple clinical score to identify likely hepatitis B vaccination non-responders – data from a retrospective single center study

Abstract Background About 10% of Hepatitis B vaccinated individuals mount no protective antibody levels against the hepatitis B surface antigen (HBs-Ag). Older age at primary immunization, obesity and smoking have previously been reported as risk factors associated with vaccine non-response. Here we tested whether these factors alone may allow selecting subjects that benefit from individualized immunization schedules. Methods Retrospective database analysis screening > 15,000 individual anti-HBs-IgG measurements. Non-responders (NR; anti-HBs-IgG < 10 IU/L) and low-responders (LR; anti-HBs-IgG 10–100 IU/L) were identified. Vaccine type, demographics, lifestyle, and immunological factors (leucocyte subset counts) were compared between NR, LR, and responders (R). Results We identified 113 LR/NR and compared them to 134 vaccine responders. We confirmed higher median age at primary vaccination (24.0 (R) vs. 30.5 (NR) vs. 31 (LR) years, p = 0.001), higher median BMI (23.2 kg/m2 (R) vs. 23.4 kg/m2 (NR) vs. 25.1 kg/m2 (LR), p = 0.001) and being a smoker (% smokers: 30.8% (R) vs. 57.1% (NR) vs. 52.5% (LR), p = 0.01) as factors negatively associated with anti-HBs-IgG levels. In a ROC analysis including these factors in a 6-point score, a high score predicted non-response with a specificity of 85% but at low sensitivity (47%). Conclusion A simple clinical risk score based on age, obesity, and smoking identifies individuals with a high likelihood of vaccine failure. Non-responders with a low score are candidates for in-depth analyses to better understand the immunological causes of HBV vaccine non-response.

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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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Hepatitis B Virus Antibody Levels 7 to 9 Years after Booster Vaccination in Alaska Native Persons

Clinical and Vaccine Immunology ◽

10.1128/cvi.00263-14 ◽

2014 ◽

Vol 21 (9) ◽

pp. 1339-1342 ◽

Cited By ~ 8

Author(s):

James W. Keck ◽

Lisa R. Bulkow ◽

Gregory A. Raczniak ◽

Susan E. Negus ◽

Carolyn L. Zanis ◽

...

Keyword(s):

Hepatitis B ◽

Alaska Native ◽

Hepatitis B Surface Antigen ◽

Booster Vaccination ◽

Primary Vaccination ◽

Antibody Persistence ◽

Vaccine Booster ◽

Almost All ◽

Antigen Antibody ◽

Antibody Levels

ABSTRACTHepatitis B antibody persistence was assessed in individuals who had previously received a vaccine booster. We measured hepatitis B surface antigen antibody (anti-HBs) levels 7 to 9 years post-hepatitis B booster in individuals with primary vaccination at birth. While 95 (91.3%) of 104 participants had detectable anti-HBs (minimum, 0.1 mIU/ml; maximum, 1,029 mIU/ml), only 43 (41%) had protective levels of ≥10 mIU/ml. Pre- and week 4 postbooster anti-HBs levels were significant predictors of hepatitis B immunity at follow-up (P< 0.001). Almost all participants had detectable anti-HBs 7 to 9 years after the hepatitis B vaccine booster, but less than half had levels ≥10 mIU/ml.

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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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STUDY OF PREVALENCE OF HEPATITIS B SURFACE ANTIGEN (HBSAG) IN BLOOD DONOR POPULATION BORN PRIOR TO AND AFTER IMPLEMENTATION OF HBV VACCINATION IN KERALA, SOUTH INDIA

10.36106/ijar/0405657 ◽

2021 ◽

pp. 66-67

Author(s):

Indu . P.K

Keyword(s):

Hepatitis B ◽

Blood Donor ◽

Blood Donors ◽

Hepatitis B Surface Antigen ◽

Vaccination Schedule ◽

Hbv Infection ◽

Hepatitis B Vaccination ◽

P Value ◽

Hbv Vaccine ◽

Hbv Vaccination

BACKGROUND: Since 1995 Hepatitis B vaccination became a part of Extended immunization Program (EIP) in India, neonates started getting immunoprophylaxis against Hepatitis B virus. Since vaccination started recently, exact prevalence of immunized persons were not available, but anyway vaccinated blood donors over 18 years old are progressively increasing MATERIALS AND METHODS: In this study 2400 blood donors were screened for HBsAg by enzyme linked immunosorbent assays, among the donor blood samples which are positive for HBsAg were noted. Various demographic patterns of blood donor were analyzed. To know about impact of vaccination on prevalence HBV infection among donors who born after the implementation of mandatory HBV vaccination schedule was compared with blood donors those who are born before HBV vaccination schedule RESULTS: Among the blood donors overall prevalence of HBV infection was 0.75% HBsAg. HBV vaccinated blood donor were protected from getting disease ,showing P value of 18 years (0.07), 19 years(0.01), 20 years(0.02) CONCLUSION: Young blood donors born after implementation of universal HBV vaccination in lndia presented higher prevalence of HBsAg but lower incidence of HBsAg seroconversion than older. HBV vaccine boosting for adolescents at 15–17 years old prior to reaching blood donor age may improve blood safety.

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Antibody responses after hepatitis B vaccination among maintenance haemodialysis patients

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v37i3.9119 ◽

1970 ◽

Vol 37 (3) ◽

pp. 88-91 ◽

Cited By ~ 2

Author(s):

K Nahar ◽

M Jahan ◽

A Nessa ◽

S Tabassum

Keyword(s):

Hepatitis B ◽

Antibody Titer ◽

Primary Vaccination ◽

Carrier State ◽

Hepatitis B Vaccine ◽

Hepatitis B Vaccination ◽

Seroprotection Rate ◽

Hbv Vaccine ◽

Maintenance Haemodialysis ◽

B Virus

In haemodialysis patients, hepatitis B virus infection has higher mortality and is more likely to result in the carrier state. Although Hepatitis B vaccine is effective in producing protection against HBV infection, the antibody response may be variable. In this study, seroprotection rate of hepatitis B vaccine in maintenance haemodialysis patients was studied after primary vaccination and after completion of the full vaccine regime. 50 unvaccinated patients on maintenance haemodialysis were included in this study. Patients negative for HBsAg, Anti-HBc (total) and Anti-HCV were vaccinated with 40μg of Engerix B following a schedule of 0, 1, and 2 months. The antibody titer was tested at 3rd month and if the titer was <10 or between 10-100 mIU/ml, they were given another 4th dose of vaccine at 6th month, and their antibody titer was tested again at 7th month. In maintenance haemodialysis patients, the response rate to HBV vaccine was 44% after the primary vaccination and 80% after completion of the full vaccine regime. DOI: http://dx.doi.org/10.3329/bmrcb.v37i3.9119 BMRCB 2011; 37(3): 88-91

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A Vectored Measles Virus Induces Hepatitis B Surface Antigen Antibodies While Protecting Macaques against Measles Virus Challenge

Journal of Virology ◽

10.1128/jvi.00923-07 ◽

2007 ◽

Vol 81 (19) ◽

pp. 10597-10605 ◽

Cited By ~ 62

Author(s):

Jorge Reyes del Valle ◽

Patricia Devaux ◽

Gregory Hodge ◽

Nicholas J. Wegner ◽

Michael B. McChesney ◽

...

Keyword(s):

Hepatitis B ◽

Surface Antigen ◽

Measles Virus ◽

Hepatitis B Surface Antigen ◽

Vaccine Dose ◽

Chronic Infections ◽

Hbv Vaccine ◽

Virus Challenge ◽

Viral Loads ◽

Antibody Levels

ABSTRACT Hepatitis B virus (HBV) acute and chronic infections remain a major worldwide health problem. Towards developing an anti-HBV vaccine with single-dose scheme potential, we engineered infectious measles virus (MV) genomic cDNAs with a vaccine strain background and expression vector properties. Hepatitis B surface antigen (HBsAg) expression cassettes were inserted into this cDNA and three MVs expressing HBsAg at different levels generated. All vectored MVs, which secrete HBsAg as subviral particles, elicited humoral responses in MV-susceptible genetically modified mice. However, small differences in HBsAg expression elicited vastly different HBsAg antibody levels. The two vectors inducing the highest HBsAg antibody levels were inoculated into rhesus monkeys (Macaca mulatta). After challenge with a pathogenic MV strain (Davis87), control naive monkeys showed a classic measles rash and high viral loads. In contrast, all monkeys immunized with vaccine or a control nonvectored recombinant vaccine or HBsAg-expressing vectored MV remained healthy, with low or undetectable viral loads. After a single vaccine dose, only the vector expressing HBsAg at the highest levels elicited protective levels of HBsAg antibodies in two of four animals. These observations reveal an expression threshold for efficient induction of HBsAg humoral immune responses. This threshold is lower in mice than in macaques. Implications for the development of divalent vaccines based on live attenuated viruses are discussed.

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1066. Immune Escape Mutant Detection Using Commercially Available Methods for Hepatitis B Surface Antigen Serological Testing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1252 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S562-S562

Author(s):

Robert Gish ◽

Vincent Streva

Keyword(s):

Hepatitis B ◽

Immune Escape ◽

Hepatitis B Surface Antigen ◽

Panel Member ◽

The United States ◽

Hbv Infection ◽

Hepatitis B Vaccination ◽

Review Panel ◽

B Virus ◽

Escape Mutants

Abstract Background Although overall infection rates of Hepatitis B virus (HBV) in the United States (US) remain stable, as many as 2.2 million persons are still chronically infected with Hepatitis B Virus (HBV)1. Persons who inject drugs (PWID) are at a higher risk of HBV infection and since 2009 three states (KY, TN, WV) have reported up to a 114% increase in cases of acute HBV infection due to higher infection rates among a non-Hispanic white populations (30–39 years), and injection drug users2. Hepatitis B vaccination is recommended as primary prevention for adults who are at increased risk for HBV infection, including PWID. However, data from the National Health Interview Survey indicate that hepatitis B vaccination coverage is low among adults in the general population3, and it is likely to be lower among injection drug users. Hepatitis B Surface Antigen (HBsAg) is the first serological marker to appear after HBV exposure and infection; this marker is included in the recommended panel for acute hepatitis diagnosis and accurate detection is necessary for early and accurate diagnosis. Serological testing challenges exist for HBsAg due to the high degree of genetic variability which can further be exacerbated by endogenous and exogenous pressures. The immuno-dominant region may have one or more mutations described as immune escape mutations which can decrease or abrogate HBsAg binding to antibodies used in immunoassays. Although the prevalence of these mutations is not well documented in the United States, international studies have shown that up to 79% of HBV-reactivated patients (vs 3.1% of control patients; p< 0.001) carry HBsAg mutations localized in immune-active HBsAg regions4. Methods A study was conducted using a panel of 10 unique recombinant HBsAg immune escape mutants. Panel members were tested by commercially available HBsAg serological immunoassays. Results It was found that although commercially available HBsAg immunoassays are the primary diagnostic tool for HBV diagnosis, not all HBsAg immune escape mutants are detected, with some method detecting as few as 5 out of 10 of these mutant samples. Figure 1 Conclusion Improvement is needed in commercially available methods for the accurate detection of HBsAg. Disclosures Robert Gish, MD, Abbott (Consultant)AbbVie (Consultant, Advisor or Review Panel member, Speaker’s Bureau)Access Biologicals (Consultant)Antios (Consultant)Arrowhead (Consultant)Bayer (Consultant, Speaker’s Bureau)Bristol Myers (Consultant, Speaker’s Bureau)Dova (Consultant, Speaker’s Bureau)Dynavax (Consultant)Eiger (Consultant, Advisor or Review Panel member)Eisai (Consultant, Speaker’s Bureau)Enyo (Consultant)eStudySite (Consultant, Advisor or Review Panel member)Exelixis (Consultant)Fujifilm/Wako (Consultant)Genentech (Consultant)Genlantis (Consultant)Gilead (Consultant, Advisor or Review Panel member, Speaker’s Bureau)GLG (Consultant)HepaTX (Consultant, Advisor or Review Panel member)HepQuant (Consultant, Advisor or Review Panel member)Intercept (Consultant, Speaker’s Bureau)Ionis (Consultant)Janssen (Consultant)Laboratory for Advanced Medicine (Consultant)Lilly (Consultant)Merck (Consultant)Salix (Consultant, Speaker’s Bureau)Shionogi (Consultant, Speaker’s Bureau)Viking (Consultant)

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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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Prevalence and risk factors of hepatitis b infection in HIV infected children seen at national hospital Abuja

Nigerian Journal of Paediatrics ◽

10.4314/njp.v48i2.1 ◽

2021 ◽

Vol 48 (2) ◽

pp. 62-65

Author(s):

O.A. Adeoye ◽

O. Oniyangi ◽

I.A. Ojuawo

Keyword(s):

Risk Factors ◽

Hepatitis B ◽

Hepatitis B Surface Antigen ◽

Significant Risk ◽

Hepatitis B Vaccination ◽

Rapid Progression ◽

Hepatitis B Infection ◽

National Hospital ◽

Blood Samples ◽

Paediatric Hiv

Background: Human immunodeficiency virus infection remains a global pandemic. Co infection with hepatitis B virus leads to rapid progression to AIDS if not diagnosed and promptly treated or better still prevented. The study aims at determining the prevalence and risk factors of hepatitis B infection in HIV infected children being followed up at the Paediatric HIV clinic. Patients and methods: A cross-sectional study of 261 HIV infected children aged eight months to fourteen years to determine the prevalence of Hepatitis B infection and pattern of hepatitis B vaccination was carried out between July and October 2012 at the Paediatric HIV clinic of National Hospital Abuja. Ethical approval was obtained from Ethical Committee of the hospital. Vaccination and transfusion history were obtained from the parents and guardians of the subjects using a proforma after signed informed consent. Blood samples were collected for Hepatitis B surface antigen screening and Hepatitis B screening in those with HBsAg positive blood samples. Results: Only 3 (1.15%) of the 261 HIV infected children had Hepatitis B infection. All the children less than 5 years old in this cohort received hepatitis B vaccination and none of them had Hepatitis B infection. The HIV/HBV co infected children were older than ten years (p = 0.047) and history of blood transfusion (p = 0.003) was also significant. However, scarification (p = 0.996), local circumcision (p = 0.928); uvulectomy (p = 0.898) were not significant risk factors in this cohort. Conclusion: There is need to intensify routine hepatitis B vaccination and routine screening of blood before necessary transfusion. This would further lead to a low prevalence of Hepatitis B in HIV infected children and the general populace at large.

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Hepatitis B Awareness Among Medical Students And Their Vaccination Status In A Medical College In Western UP.

10.36106/ijsr/0601604 ◽

2019 ◽

pp. 57-59

Author(s):

Rajni Dawar ◽

Tabassum Yasmin ◽

Ajay Kumar Jha

Keyword(s):

Medical Students ◽

High Risk ◽

Data Collection ◽

Hepatitis B ◽

Health Care Professionals ◽

Hepatitis B Surface Antigen ◽

Vaccination Status ◽

Hepatitis B Vaccination ◽

Universal Precautions ◽

Medical College

Background: India is in the intermediate hepatitis B virus endemicity zone with hepatitis B surface antigen prevalence among the general population ranging from 2% to 8%.Health care professionals are at a high risk of getting .Hep B infection which can be prevented by strategies like vaccination, increasing awareness and following universal precautions. The present study was conducted on medical students (3rd Semester) to evaluate their knowledge regarding HBV and to know their vaccination status. Also along with data collection, students were educated about hepatitis B vaccine and about universal precautions before they start with their clinical postings. Methods: Cross sectional study was carried out on 3rd semester MBBS students (batch 2012-2013). All the students present on the day of data collection were included in the study and interviewed using pretested questionnaire. Data was analyzed using percentages. Results: Most of the students had good knowledge about disease and modes of transmission & prevention. Surprisingly only 56.6 percent were aware of high risk of transmission to health professional and doctors. Main source of information was media (85.4percent).Nearly 82% of the students were immunized and main reason among those unimmunized was unawareness about vaccine availability. Conclusions: It is recommended that Hepatitis B vaccination should be made available for all unimmunized students who enter medical profession. The orientation and sensitization programm should be held to create awareness regarding HBV infection preferably at the time of admission into medical college ,else no later than start of their clinical posting.

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