Compliance with and response to hepatitis B vaccination in remaining quilombo communities in Central Brazil

Motta-Castro, Ana Rita Coimbra; Gomes, Saint Clair; Yoshida, Clara Fumiko Tachibana; Miguel, Juliana Custódio; Teles, Sheila Araújo; Martins, Regina Maria Bringel

doi:10.1590/s0102-311x2009000400004

Cited by 14 publications

(16 citation statements)

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“…8,9 Also, in older age groups, the immunogenicity of this vaccine is not known, and there are many factors that may affect how immunogenic the vaccine is in these groups. 1 As has been observed for the gold-standard vaccine by other authors, [10][11][12] sex represents a statistically significant difference in terms of vaccine responders and nonresponders. Different biological characteristics and behaviors contribute to men developing a weaker immune response to vaccination than women.…”

supporting

confidence: 55%

Low Immunogenicity of Recombinant Hepatitis B Vaccine Derived from Hansenula polymorpha in Adults Aged Over 40 Years

Caetano

Del‐Rios

Pinheiro

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. The Brazilian recombinant hepatitis B vaccine (VrHB-IB) is based on the expression of the recombinant antigen in Hansenula polymorpha yeast cells. Currently, data on the immunogenicity of this vaccine in older adults are nonexistent. This study aimed to evaluate the immunogenicity of VrHB-IB in adults over 40 years of age. From May to October 2011, 235 rural settlers between 2 and 93 years of age from the State of Goias in Brazil were eligible for vaccination. Of these, 180 accepted the first dose of the vaccine and 106 (58.9%) completed the vaccination schedule. Multivariate analysis revealed that individuals ≥ 40 years of age responded significantly less well to vaccination than younger adults. Also, a greater proportion of male nonresponders was observed (versus women; P = 0.02). These results point to the need for better evaluation of the immunogenicity of VrHB-IB in older adults.Vaccination against hepatitis B is the safest and most effective method of reducing the incidence and prevalence of infection with hepatitis B virus (HBV).1 Indeed, HBV vaccination confers protection in over 90% of subjects who receive it.2 The first-generation HBV vaccine, which was produced from human HBV surface antigen (HBsAg) plasma from chronically infected patients, became commercially available in the early 1980s and is still used in some countries. 3The second-generation vaccine, also marketed in the 1980s, is produced using recombinant DNA technology. This vaccine is safe and effective, and allows for unlimited production and widespread distribution throughout the world. Currently, many countries produce the HBV vaccine using this technology, and various expression systems have been used to obtain recombinant HBsAg.1,4 Engerix-B, the gold-standard vaccine, uses Saccharomyces cerevisiae as the expression system for recombinant HBsAg. In Brazil, the Brazilian recombinant hepatitis B vaccine (VrHB-IB) is obtained by culturing genetically engineered Hansenula polymorpha yeast cells with the HBsAg gene. Initially, this vaccine was produced as a recombinant antigen (concentration 20 μg/mL). However, research has shown that in adults 30-40 years of age, the immunogenicity of the Brazilian vaccine is not equivalent to the gold-standard vaccine (Engerix B), 5 and the concentration of HBsAg was therefore increased to 25 μg/mL. A clinical trial comparing the immunogenicity of VrHB-B with Engerix-B in patients in this age group found that the vaccine produced in Brazil at the current concentration is equivalent to the gold standard. The aim of our study was to evaluate the immunogenicity of VrHB-IB vaccination in rural settlers in central Brazil. Rural settlers who were susceptible to HBV comprised the vaccination group, and most of them were > 40 years of age. At present, published studies on the immunogenicity of the Brazilian HBV vaccine in adults in this age group are rare.From May to October 2011, 467 rural settlers from the southwest region of the State of Goias, central Brazil, were recruited. All agreed to participat...

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supporting

confidence: 55%

Low Immunogenicity of Recombinant Hepatitis B Vaccine Derived from Hansenula polymorpha in Adults Aged Over 40 Years

Caetano

Del‐Rios

Pinheiro

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…Additionally, we observed high rates of susceptible individuals (55.3% and 63.0%) and also a low proportion (2.0% and 21.0%) of individuals presenting serological HBV vaccination like profile, i.e. isolate anti-HBs ≥10mIU/mL 12,[14][15][16] . Based on these alarming findings, in 2003, our research group conducted actions for health promotion such as HBV vaccine supply, health educational campaigns, and referral of active hepatitis B cases for public clinical health care.…”

mentioning

confidence: 99%

Hepatitis B: changes in epidemiological features of Afro-descendant communities in Central Brazil

Lima

Lago

Weis-Torres

et al. 2020

Sci Rep

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Hepatitis B virus (HBV) infection is still a concern in vulnerable populations. in a study performed by our team in 1999-2003 in two Afro-Brazilian communities, Furnas dos Dionísios (FD) and São Benedito (SB), high prevalence rates of HBV exposure (42.7% and 16.0%, respectively), high susceptibility to HBV (55.3% and 63.0%) and low HBV vaccination like profile rates (2.0% and 21.0%) were observed. In 2015-2016, we reassessed HBV epidemiological and molecular features in these two communities to verify the impact of health actions adopted in the last years. the prevalence rate of HBV exposure among the enrolled 331 subjects was 35.3% in FD and 21.8% in SB. HBV chronic infection (5.8% in FD, 4.9% in SB) remained high. The rate of HBV vaccination like profile increased from 10.7% to 43.5% (2.0% to 45.9% in FD, 21.0% to 39.5% in SB) while susceptible subjects declined from 58.9% to 26.3% (55.3% to 18.8% in FD, 63.0% to 38.7% in SB). Among 18 HBsAg positive samples, 13 were successfully sequenced (pre-S/S region). Phylogenetic analyses showed that all isolates belong to HBV subgenotype A1, clustering within the Asian-American clade. Despite the maintenance of high prevalence rate of HBV exposure over these 13 years of surveillance, significant improvements were observed, reinforcing the importance of facilitated HBV vaccination to difficult-to-access population to close gaps in prevention. Hepatitis B virus (HBV) infection is still a major public health issue worldwide despite the availability of an effective vaccine and potent antiviral treatments 1-3. An estimated 2 billion people have been infected with HBV and 257 million people are chronic carriers of the virus. Serious complications of chronic HBV infection such as cirrhosis, liver failure, and hepatocellular carcinoma accounted for 887 000 deaths in 2015 4,5. Hepatitis B surface antigen (HBsAg) is the main HBV clinical marker indicating acute or chronic infection and its prevalence is used to categorize HBV endemicity as low, intermediate low, intermediate high, or high 2,6. Even though Brazil is now a low endemic country, it has some areas with high HBV prevalence, especially in the Amazon basin, some counties of Southern Brazil and, isolated communities 7-9. In Brazil, HBV immunization was first implemented in 1989 for infants in the western area of the Amazonas State and since 1998 HBV vaccine has been incorporated into the immunization schedule for infants as a national policy 10. Nowadays, HBV vaccination is available to all individuals regardless of age or risk group, being considered satisfactory and effective, moving Brazil from moderate HBV endemicity to low-endemicity classification 7. Although Brazilian multi-center population-based studies have observed a decrease in HBV infection prevalence in the last decades, especially among children and young adults 10,11 , vaccination is still a challenge in difficult-to-access populations and therefore, observations cannot be extrapolated to rural or vulnerable populations 7 .

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“…Such gaps may also exist in other developing countries since only 23.7% of the 8–10-year-old children in East Java, Indonesia, were anti-HBs positive after introduction of universal vaccination program [17] and the vaccine coverage in remaining quilombo communities in Central Brazil is suboptimal [18]. Therefore, the significance of full compliance with the recommended procedures to prevent perinatal HBV transmission should be emphasized in China as well as other developing countries.…”

Section: Discussionmentioning

confidence: 99%

Gaps in the prevention of perinatal transmission of hepatitis B virus between recommendations and routine practices in a highly endemic region: a provincial population-based study in China

Zhang

Luo

et al. 2012

BMC Infect Dis

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BackgroundHepatitis B virus (HBV) infection is endemic in China; perinatal transmission is the main source of chronic HBV infection. Simultaneous administration of hepatitis B immune globulin (HBIG) and hepatitis B vaccine is highly effective to prevent perinatal transmission of HBV; however, the effectiveness also depends on full adherence to the recommended protocols in daily practice. In the present investigation, we aimed to identify gaps in immunoprophylaxis of perinatal transmission of HBV between recommendations and routine practices in Jiangsu Province, China.MethodsTotally 626 children from 6 cities and 8 rural areas across Jiangsu Province, China, born from February 2003 to December 2004, were enrolled; 298 were born to mothers with positive hepatitis B surface antigen (HBsAg) and 328 were born to HBsAg-negative mothers. Immunoprophylactic measures against hepatitis B were retrospectively reviewed for about half of the children by checking medical records or vaccination cards and the vaccine status was validated for most of children.ResultsOf 298 children born to HBV carrier mothers, 11 (3.7%) were HBsAg positive, while none of 328 children born to non-carrier mothers was HBsAg positive (P < 0.01). The rates of anti-HBs ≥ 10 mIU/ml in children of carrier and non-carrier mothers were 69.5% and 69.2% respectively (P = 0.95). The hepatitis B vaccine coverage in two groups was 100% and 99.4% respectively (P = 0.50), but 15.1% of HBV-exposed infants did not receive the timely birth dose. Prenatal HBsAg screening was performed only in 156 (52.3%) of the carrier mothers. Consequently, only 112 (37.6%) of HBV-exposed infants received HBIG after birth. Furthermore, of the 11 HBV-infected children, only one received both HBIG and hepatitis B vaccine timely, seven missed HBIG, two received delayed vaccination, and one missed HBIG and received delayed vaccination.ConclusionsThere are substantial gaps in the prevention of perinatal HBV infection between the recommendations and routine practices in China, which highlights the importance of full adherence to the recommendations to eliminate perinatal HBV infection in the endemic regions.

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Compliance with and response to hepatitis B vaccination in remaining quilombo communities in Central Brazil

Abstract: 123 (83.1%;

Cited by 14 publications

References 5 publications

Low Immunogenicity of Recombinant Hepatitis B Vaccine Derived from Hansenula polymorpha in Adults Aged Over 40 Years

Low Immunogenicity of Recombinant Hepatitis B Vaccine Derived from Hansenula polymorpha in Adults Aged Over 40 Years

Hepatitis B: changes in epidemiological features of Afro-descendant communities in Central Brazil

Gaps in the prevention of perinatal transmission of hepatitis B virus between recommendations and routine practices in a highly endemic region: a provincial population-based study in China

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