Humoral Immune Response to a Yeast‐derived Hepatitis B Vaccine in Patients with Type 1 Diabetes Mellitus

Abstract

The immune response following vaccination with a recombinant hepatitis B vaccine was investigated in 32 patients with Type 1 diabetes mellitus and compared with the outcome in 32 healthy age- and sex-matched volunteers. Participants were vaccinated at 0, 30, and 180 days and in vivo immune response was determined at 30, 60, 90, 180, and 210 days. The number of responders (anti-HBs greater than 1 IU l-1) was significantly lower (p less than 0.05) among patients at 30 (2 vs 11), 60 (17 vs 26), 90 (20 vs 28) and 180 (22 vs 29) days. The number of patients protected (anti-HBs greater than 10 IU l-1) was lower (p less than 0.05) than the number of protected volunteers at 60 (5 vs 14), 90 (10 vs 19), 180 (15 vs 24), and 210 days (24 vs 31). After the complete course of vaccination 8 out of 32 patients were still unprotected against hepatitis B (p less than 0.05). The anti-HBs titre of responders at 210 days was 251 (20, 3162) (geometric mean (-SD, +SD] IU l-1 in patients and 1259 (126, 12589) IU l-1 in control subjects (p less than 0.05). The HLA-antigen DQw1 frequency in the diabetic low responders (anti-HBs less than 100 IU l-1) was 0.27 compared with 0.86 in diabetic adequate responders. No relation between anti-HBs production and concentration of HbA1c could be demonstrated.

Immune Response of Hepatitis B Vaccine Among Persons With Diabetes

“…Douvin et al (13) reported seroprotective anti-HBs levels in 91.5% of adult subjects with diabetes compared with 75.0% as reported by Bouter et al (14). Subjects in both studies received 20-μg dosages of recombinant hepatitis B vaccine intramuscularly.…”

“…Although persons with diabetes have appropriate humoral immune responses to vaccination (49), impaired cellular response may account for less robust antibody production after hepatitis B vaccination (14). Proposed explanations include a reduction in the number of circulating helper T cells, the CD4-to-CD8 lymphocyte ratio, and lymphocyte blastogenesis (23) and defects with antigen presentation (39).…”

“…As with other vaccines, the efficacy of the hepatitis B vaccine progressively declines with advancing age, as well as with the presence of obesity and other comorbid conditions (6–12). Results of studies of the hepatitis B vaccine among persons with diabetes generally follow these patterns (13,14). …”

Increased Risk of Acute Hepatitis B among Adults with Diagnosed Diabetes Mellitus

“…The immune response wanes with increasing age and comorbidities. 27,42,43 This study has several limitations. A cohort study of persons with diabetes would have provided the best measure of the risk for acute hepatitis B.…”

The impact of diabetes on the pathogenesis of sepsis

“…It was described as early as 1930 that deficient agglutinin responses are seen in the diabetic patients after subcutaneous typhoid vaccination [100, 101]. Multiple studies have shown that patients with diabetes are less likely to mount a protective antibody response to hepatitis B vaccination [102–105], leading some authorities to recommend routinely adding a booster dose to the standard regimen for patients with diabetes [102, 106]. The literature on influenza vaccination is more mixed (reviewed by Brydak and Machala [107]).…”