New Immunization Schedule Effectiveness Against Hepatitis B in Liver Transplantation Patients

Abstract

BACKGROUND: Although liver transplantation is considered to be a high-risk procedure, it is well-established as a treatment option for the cure and quality of life enhancement for individuals who suffer from diseases. Preventing an infection by hepatitis B virus through immunization schedules has been the most effective way to reduce complications, since it decreases the number of people who suffer from chronic hepatitis caused by the hepatitis B virus and eradicates its transmission. OBJECTIVE: 1. Analyzing evidence in the literature on various schedules employed for immunization against hepatitis B in patients who have received a liver transplantation. 2. Suggesting potential immunization schedules against hepatitis B in patients who suffer from liver cirrhosis, without previous verifying documentation, using the Child-Turcotte Pugh score, according to evidences found in the literature. METHODS: Systematic review of the literature, conducted on the data bases MedLine, PubMed, and Lilacs, between September, 2017 and January, 2018, by using the following keywords: “Liver Transplantation, “Immunization Schedule”, “Hepatitis B Vaccines”. In order to analyze the articles, a summary figure was especially designed and both the results and discussion were presented in a descriptive way. RESULTS: We included 24 studies; among them, eight had accelerated immunization schedules, 13 followed the conventional schedules, and three had super accelerated schedules. Regarding immunization, 21 studies were conducted with patients in the pre-transplant period, one with a transplanted patient, one with a pre-transplant group, and one with a post-transplant group. Found articles suggest that, disregarding the chosen immunization schedule, seroconversion rates tended to be lower as the liver disease advanced, compared to the healthy population. CONCLUSION: The studies did not find seroconversion superiority between the different immunization schedules (conventional and unconventional). However, since candidates to liver transplantation are usually very vulnerable, results show that super accelerated immunization schedules are possibly recommended for such group of patients; serologic test results will be higher when the immunization schedule is completed in the pre-transplant period.

Eliminating viral hepatitis in children after liver transplants: How to reach the goal by 2030

“…Regardless, no differences in the efficacy of these regimens have been shown[ 38 ]. Overall, time is a concern for participants awaiting LT, and super-accelerated or accelerated regimens should be considered for short-term prevention of HBV infections during and after LT[ 39 ].…”

Hepatitis B Vaccination in Children With Ongoing Cancer Treatment: A Safety and Efficacy Study of Super-Accelerated Vaccination Scheme

“…In previous studies, 3 doses of booster HBV vaccination were administered with sufficient responses. 4 ,14,15, 16 We preferred to use a super-accelerated schedule of 4 weeks to reach the protective antibody titers sooner and decrease the risk of treatment incompliance. In our study, all the re-vaccinated patients attained the effective titers after 4-8 weeks of vaccination, and they all remained anti-HBs positive at the end of treatment.…”

“…A super-accelerated vaccination scheme was designed based on the previous reports of significant acute and long-term protective antibody levels following multiple, double doses of vaccination during chemotherapy in children with cancer. 14 ,15, 16 Three doses (at days 0-5, 8-12, and 28-33) of booster recombinant HBV vaccines (Engerix-B, GlaxoSmithKline Pharmaceuticals Limited) were administered to children with cancer who were HBV seronegative (negative for HBsAg and anti-HBs Ab) at diagnosis.…”

“… 4 , 13 Alternative accelerated or super-accelerated schedules were reported to be feasible to get serologic response during chemotherapy or other conditions with altered immunity. 14 ,15, 16 …”

Vacinação contra hepatite B em pessoas que vivem com HIV no Estado do Piauí, Brasil

“…A maneira mais eficaz de reduzir a taxa de mortalidade, complicações evolutivas e a incidência da infecção pelo HBV é por meio dos esquemas de imunização, visto que se diminui a cadeia de transmissão da doença. A vacina contra o HBV é segura e eficaz, já que oferece uma proteção de 98 a 100% contra a hepatite B (Goel et al, 2016;Hsu et al, 2018;Moghadami et al, 2019;Rodrigues et al, 2019;Tsai et al, 2018;). Além disso, ressalta-se que a vacina contra o HBV também é disponibilizada em formulações combinadas que protegem contra diversas doenças como difteria, poliomielite, tétano, pertussis e Haemophilus influenzae tipo B. Tendo em vista a adesão da população e a redução de custos (Lavanchy, 2012).…”