Assessment of hepatitis B immunization status after antineoplastic therapy in children with cancer

Abstract

BACKGROUND AND OBJECTIVES:Hepatitis B is a disease that is preventable with vaccination. Antibody levels after vaccination may be affected by suppression of the immune system due to cancer therapy. Children with cancer have a high risk of hepatitis B virus (HBV) infection. We aimed to assess the pretreatment immunization status against HBV infection and the rate of continuity of immunization after therapy in children with cancer.DESIGN AND SETTING:Retrospective case review of patients treated from 2004 to 2008.PATIENTS AND METHODS:We reviewed the medical records of patients treated in the departments of pediatric hematology and oncology and collected data on immunization history and hepatitis B serology. Anti-HBs antibody titers were compared before and after treatment.RESULTS:This study included 159 (99 males, 60 females) children who had a serologic examination. Antineoplastic therapy had been given for acute leukemia (n=66), non-Hodgkin lymphoma (n=27), Hodgkin lymphoma (n=20), and solid tumors (n=46). Fifty-one patients had not been immunized against HBV prior to the therapy; HBV serology was negative in 49 of these patients and HBsAg was positive in 2 patients. Anti-HBs antibody positivity was present in 99 of 108 patients with an immunization history, whereas no vaccination response was present in 9 patients. The titer of anti-HBs antibody was decreased below the protection level in 33 (33%) patients with positive anti-HBs antibody, whereas the protection level was found to be maintained in 66 (67%) patients. The most significant decrease (63.6%) was observed in leukemia patients. Posttreatment HBsAg and HBV DNA positivity was detected in two of the patients with negative pretreatment serology, whereas no HBV infection developed in the group with positive anti-HBs antibody.CONCLUSIONS:This study demonstrated the importance of routine childhood vaccination in reducing the risk of HBV infection in patients with cancer.

Changes in hepatitis B antibody status after chemotherapy in children with cancer

“…study results in which they showed that 78.6% of patients with ALL lost protective levels of HbsAb after chemotherapy . Also none of the seronegative children in our study developed HBV infections, similar to results in other local studies …”

Public awareness of hepatitis B infection in Turkey as a model of universal effectiveness in health care policy

“…The WHO mandates the use of the HBV vaccine as an integral part of routine vaccination programs worldwide (5). Since 1998, HBV vaccination has been part of the routine childhood immunization program in Turkey (6).…”

Clinical indicators for nursing diagnosis Ineffective protection in adolescents with cancer

“…Regarding the level of evidence, three articles were classified as level I (15,(18)(19) , two as level II (17,20) and two as level III (16,21) . No studies located addressed the nursing diagnosis Ineffective protection among children and adolescents with cancer.…”

“…Suppression of the immune system in cancer patients renders them vulnerable to infections, such as those that can be prevented by vaccines. For example, Karaman et al (16) , when evaluating the pre-treatment immunization status of patients against hepatitis B virus infection, identified a reduction of anti-HBs antibody titer to below the protection level in 33% of patients with positive antibodies prior to treatment.…”

“…Assessment of hepatitis B immunization status after antineoplastic therapy in children with cancer (16) Insufficient antibody titers Side effects of treatment (chemotherapy), missed routine vaccinations A prospective study of chemotherapy immunologic effects and predictors of humoral influenza vaccine responses in a pediatric oncology cohort (17) Insufficient antibody titers Side effects of treatment (chemotherapy), Missed routine vaccinations…”