Excellent Response Rate to a Double Dose of the Combined Hepatitis A and B Vaccine in Previous Nonresponders to Hepatitis B Vaccine

Abstract

Revaccination of nonresponders to the standard hepatitis B vaccine regimen with a double dose of the combined hepatitis A and B vaccine was highly effective. This is most likely explained by the increased dose, a positive bystander effect conferred by the hepatitis A vaccine, or both.

Response to Hepatitis A and B Vaccine Alone or in Combination in Patients with Chronic Hepatitis C Virus and Advanced Fibrosis

“…Indeed, HBV response has been shown to be higher when using the Twinrix combination vaccine in older patients [25], but no previous studies have compared the response of the two vaccines in patients with chronic HCV and advanced fibrosis. Furthermore, a recent study of ''double dose'' combination A/B vaccine in prior nonresponders to HBV vaccination suggested the high response rate (95%) may have been due to the ''positive bystander effect confirmed by the hepatitis A vaccine'' [26]. Our results extend these observations and suggest that using a combination vaccine may provide a higher immunogenic response in these patients because of the immunostimulatory effect of the co-administered HAV vaccine.…”

Immunogenicity of an investigational hepatitis B vaccine (hepatitis B surface antigen co-administered with an immunostimulatory phosphorothioate oligodeoxyribonucleotide) in nonresponders to licensed hepatitis B vaccine

“…[2][3][4] With increased age, obesity, smoking, and some underlying conditions (e.g., renal failure receiving dialysis), nonresponse rates postvaccination rise substantially. [6][7][8][9] In this study, the safety and immunogenicity of an investigational hepatitis B vaccine (HBsAg-1018), comprised of recombinant HBsAg adjuvanted with a phosphorothioate oligodeoxynucleotide, was compared with a commercially available vaccine, HBsAg-Eng. While HBsAg-1018 demonstrated a trend toward increased rates of seroprotection and higher geometric mean antibody in nonresponders immunogenicity of HBsAg-1018 was studied in individuals who were nonresponders to up to two complete, three-dose courses of a licensed hepatitis B vaccine.…”

“…2 After the recommended threedose regimen with a minimum interval of one month between the first two doses and at least four months between the second and third doses, 2-4 a substantial proportion (5-10%) of healthy young adults fail to achieve a protective immune response (defined as an anti-HBs concentration ≥ 10 mIU/mL). [5][6][7] Risk factors associated with increased rates of nonresponse include obesity, smoking, increased age, immunodeficiency, and genetic factors. 8,9 Additional doses of vaccine (up to a second three-dose series) are recommended for nonresponders, and as many as 50% will respond to this second three-dose course.…”

Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease

“…Therefore, it may be suggested to either revaccinate with the standard hepatitis B vaccine regimen using twice the standard dose or administer the combined hepatitis A and B vaccine (Twinrix). 108 However, although among healthy individuals who did not respond to a primary three-dose series with anti-HBs concentrations of >10 mIU ⁄ mL, almost all respond to a three-dose revaccination series, 109 this may not be the case in patients with IBD. Thus, in the study by Chaparro et al, 86 nonresponders to the first three-dose vaccination received a second course of vaccine (with the same three-dose schedule), and the response (>100 mIU ⁄ mL anti-HBs titres) to this second vaccination was only 41%.…”