Prevalence of National Responsiveness to HBV Vaccine After 22 Years of Iranian Expanded Program on Immunization (EPI): A Systematic Review and Meta-Analysis Study

Context:

Hepatitis B Virus expanded program on immunization (EPI) started on 1993 in Iran. Most surveys have assessed the level of response to vaccine by measuring the titers of anti-HBs. This meta- analysis aimed to summarize the Iranian published data on the rate of vaccine-responders versus non-responders. Moreover, the impact of variables such as age, gender, type of vaccine, etc. on the levels of responsiveness was evaluated.

Evidence Acquisition:

All published papers on this topic in Iranian and international journals with affiliation of “Iran” were reviewed using standard keywords up to 2014. We included our study to healthy participants with no previous HBV infection and who had already received a complete course of HB vaccine. The estimated prevalence and 95% confidence intervals in 28 eligible articles for HBV vaccine responders (anti-HBs > 10 IU/mL) and non-responders (10 <) were analyzed by random effect method due to between-study heterogeneity.

Results:

The age of subjects was between 6 months and 15 years old. Overall, 5991 (51.5%) were male and 4571 (48.5%) females. Overall, 80% were responders to vaccine versus 20% nonresponders. With increase in age, the number of responders to vaccine decreased significantly (P = 0.001). There was no strong difference between responders versus nonresponders to vaccine for gender, types of vaccine, ethnicity and living area.

Conclusions:

The results arose from this meta-analysis highlighted the safety of vaccine and its effectiveness in stimulating immune response of vaccines, despite being different in generation, manufacturers and types. Moreover, there was no substantial difference between Iranian and other international investigations in the rate of nonresponsiveness to HBV vaccine.     

中药益肝丸对豚鼠产生抗-HBs的调节

将５０只豚鼠随机分为５组，分别给予低剂量、中剂量、高剂量的益肝丸提取物、猪苓多糖注射液和生理盐水。经检测血清抗－ＨＢｓ含量，结果表明益肝丸对豚鼠产生抗－ＨＢｓ有明显的促进作用。     

口腔医院患者乙型肝炎相关流行病学调查

目的：研究口腔医院患者乙型肝炎病毒（hepatitis B virus,HBV）感染在年龄、性别、不同免疫时间节点及不同科室来源之间的分布。方法：收集2019年1—4月南京医科大学附属口腔医院就诊患者3 996例的HBV感染相关检测数据,并进行统计分析。结果：按全国人口统计年龄构成比标化后,乙肝表面抗原（HBsAg）、乙肝表面抗体（抗?HBs）标准化率分别为3.86%、51.66%。抗?HBs阳性率在年龄分层里出现双波峰。人群HBsAg阳性率在实行乙肝疫苗计划免疫后降低。正畸组HBsAg阳性率显著低于种植、住院患者。结论：乙肝疫苗的计划免疫对阻碍HBV感染起着积极作用,但保护性抗体会逐年下降,需要及时进行疫苗再次接种。建议口腔医院患者在进行治疗前进行血清传染病的各项检查以了解患者基本情况,诊疗时需要做好消毒防护工作,全面预防HBV在口腔医院内的交叉感染。     

Extended HBV vaccination in liver transplant recipients for HBV-related cirrhosis: Report of two successful cases

The effectiveness of hepatitis B virus vaccination in liver transplant recipients for hepatitis B virus-related end-stage liver disease is controversial. We report two successful cases, who developed sustained protection after long-term vaccination. Case 1. A 58-year-old male, transplanted 9 years earlier, received three intramuscular monthly doses of 40 microg of recombinant S vaccine and developed an anti-hepatitis B surface titre of 154 IU/L. After an additional 40 microg dose, he reached an anti-hepatitis B surface peak of 687 IU/L and then maintained a "protective" titre (>100 IU/L) without further vaccinations for the next 40 months. At this time, revaccination with three monthly doses of 40 microg resulted in an anti-hepatitis B surface titre greater than 25,000 IU/L, sustained over time. Case 2. A 56-year-old woman, transplanted 8 years earlier, first received three intramuscular monthly doses of 40 microg of S vaccine without developing any detectable anti-HBs. She was then given multiple intradermal vaccine doses which resulted in a titre of 37 IU/L. Next, after readministration of three 40 microg intramuscular monthly doses, she developed an anti-HBs titre of 280 IU/L. In the following 4 years, the anti-HBs titre dropped below 100 IU/L four times (at month 20, 30, 38 and 44) and readministration of single 40 microg doses of vaccine was always sufficient to restore a protective titre. Conclusion. Extended HBV vaccination may afford valid protection against HBV recurrence in selected liver transplant recipients.     

Immunity to hepatitis A and B persists for at least 15 years after immunisation of adolescents with a combined hepatitis A and B vaccine

BackgroundThe exact duration of antibody persistence to hepatitis A and B and the need for booster dosing following primary immunisation remains undefined. A long-term study was designed to follow antibody persistence and immune memory on an annual basis for up to 15 years following vaccination during adolescence.MethodsSubjects received a combined hepatitis A and B vaccine (Twinrix™, GSK Vaccines, Belgium) at 12–15 years of age, either as 2-dose of the adult formulation or 3-dose of the paediatric formulation. Blood samples were taken every year thereafter to assess antibody persistence and immune memory to hepatitis A and B. Antibodies to hepatitis A virus (anti-HAV) and hepatitis B surface antigen (anti-HBs) were measured at Years 11–15. At Year 15 immune memory was further assessed by measuring the anamnestic response to a challenge dose of the monovalent vaccine, which was administered to subjects whose antibody concentrations fell below the pre-defined cut-offs (anti-HAV: <15 mIU/mL; anti-HBs: <10 mIU/mL).Results209 subjects returned for follow-up at Year 15 of whom 162 were included in the long-term according-to-protocol immunogenicity cohort. All subjects remained seropositive for anti-HAV antibodies, while 81.1% and 81.8% still had anti-HBs antibodies ≥10 mIU/mL in the 2- and 3-dose groups, respectively. Following hepatitis B vaccine challenge dose administration to 19 subjects, all except one in the 3-dose group, mounted a robust anamnestic response. The safety and reactogenicity profile of the hepatitis B challenge was consistent with previous experience.ConclusionImmunity to hepatitis A and B persists 15 years after adolescent vaccination with a combined hepatitis A and B vaccine. Highly effective anamnestic response indicates that a booster dose should not be required for 15 years after primary vaccination.Trial registrationhttp://www.clinicaltrials.gov NCT00875485.     

乙型肝炎表面抗体的抗独特型研究

用 HBsAg/a 决定簇的7A_4单克隆抗体(McAb_1)复合物,免疫同系 BALB/C 小鼠,制备了高效价抗独特型(Ab_2)血清和两株抗独特型 McAb(McAb_2).Ab_2血清和 McAb_2都能识别7A_4McAb_1的互补位独特型.Ab_2血清中有与异种(豚鼠、驴、兔和羊)抗—HBs 结合的抗体,两株 McAb 不能与异种抗-HBs结合的抗体,两株 McAb 不能与异种抗-HBs 结合,属非内影像 Ab_2γ.研究表明,HBsAg/a 决定簇的 McAb_1有不同的互补位,McAb_2可作为一种生物探针,用于区别 McAb_1的互补位.     

Seroprevalence of hepatitis B virus among health care workers in Korea

We studied the seroprevalence of HBsAg, anti-HBs and anti-HBc and the vaccination histories among health care workers (HCWs) at a large suburban referral hospital in Korea. The purpose of this study was to determine the immune status of HCWs against hepatitis B virus and we also wanted to prepare a practical guideline to protect HCWs from occupational exposure. During December, 2003, 571 HCWs (56 physicians, 289 nurses, 113 technicians and 113 aid-nurses) aged between 21 and 74 yr were included in the surveillance. The positive rates of HBsAg and anti-HBs were 2.4% (14/571) and 76.9% (439/571), respectively. The positive rate of anti-HBs was lower in the physician group, and this was associated with the male gender and older age. Of the 439 anti-HBs positive cases, 320 cases (73.1%) were anti-HBc negative and this was significantly associated with a past history of HBV vaccination. The distribution of the anti-HBs levels was not associated with age (except for HCWs in their sixties), gender or occupation. Our study revealed that the seroprevalence rates of HBsAg and anti-HBs in HCWs in Korea were not different from those of the general population. Based on this surveillance, we can make reasonable decisions in case of occupational exposure to hepatitis B virus.     

乙肝疫苗免疫耐受性相关基因研究进展

乙肝疫苗接种可刺激机体免疫系统产生保护性抗体,但部分人群接种后并没有有效的抗体产生.发生乙肝疫苗低或无应答的免疫耐受因素众多,机体的遗传因素是一个重要原因.该文就接种乙肝疫苗后所产生的免疫耐受现象与机体遗传相关基因的研究进展进行综述.     

国产乙型肝炎酵母重组疫苗的免疫效果观察

采用０、１、６月免疫程序，对３６４名６￣１２岁健康小学生接种３批国产乙肝酵母重组疫苗。结果接种儿童中均未观察到严重的全身反应和局部反应。首针免疫后３、７和１２个月，抗ＨＢｓ阳转率分别为８２．４％，９８．８％和９９．１％，首免后１２个月抗体ＧＭＴ未见明显下降。表明国产乙肝酵母重组疫苗是安全的，并可诱导较高抗体应答。     

固相反向间接血凝试验检测抗-HBS的抗独特型抗体

本文建立了固相反向间接血凝检测抗-HBS 的抗独特型抗体的方法。该方法是用羊抗人 IgG 包被聚苯乙稀微孔板(V型),捕捉血清中的抗-HBS 的抗独特型抗体(IgG),再加抗-HBS 致敏的血球,观察其凝集结果。用本法对正常人血清际本116例以及 HBsAg 阳性血清标本102例进行了抗-HBS 的抗独特型抗体检测。在 HBsAg 阳性血清标本中共检出抗-HBS 的抗独特型抗体阳型标本24例,阳性率为23.7％。实验表明,该方法具有简便、准确、快速等优点,又不需要特殊设备,适合于各级医疗单位。