Nonresponsiveness to Hepatitis B Vaccine in Health Care Workers

Abstract

Twenty-eight health care workers who had a poor antibody response when initially vaccinated with hepatitis B vaccine were revaccinated with three additional 20-microgram doses. Eight of the twenty nonresponders, who had levels of antibody to hepatitis B surface antigen (anti-HBs) of less than 8 estimated radioimmunoassay (RIA) units, and all 8 of the hyporesponders, who had anti-HBs levels of 8 or 16 RIA units, attained anti-HBs levels of 36 RIA units or more after revaccination. Tests for HLA-A, B, C, and DR; for complement proteins C2, C4A, C4B, and BF; and for the erythrocyte enzyme glyoxalase I were done in 17 nonresponders and 3 hyporesponders. Nine (45%) had HLA-DR7 and 8 (40%) had HLA-DR3, compared with an expected rate of 23% in the general population. At least one of two extended haplotypes (B44, DR7, FC31 or B8, DR3, SCO1) were detected in 6 of the 9 who did not respond to revaccination, compared with 2 of 11 who responded to a second course of vaccine. Poor responders to vaccine may benefit from revaccination, and genetic factors may modulate the immune response to vaccination.

Non-responsiveness to hepatitis-B vaccination: Revaccination and immunogenetic typing

“…Usually, one would expect patients with autoimmune diseases to be high responders instead of low responders. Our results differ from Craven et al [5], Cooksley et al [4], and Walker et at. [27] with regard to DR-7, which they found elevated.…”

“…In this study, A-10, B-12, CW-5, DR-3, and DR-5 were found to be increased in histocompatibility testing, whereas DR-2 was decreased. With regard to DR-3, this is in agreement with Craven et al [5]. Paradoxically, an increased frequency of HLA-DR-3 was also seen in patients with autoimmune chronic active hepatitis [15].…”

“…Only 9 persons (36%) remained protected (>10 IU/1 anti-HBs) 12 months after the fourth inoculation. Similar findings among poor responders were also reported by Craven and coworkers using a different vaccine preparation [5]. On the other hand, among normal responders only 8.7% fell to unprotective levels over 12months [11].…”

T cell responses to hepatitis B surface antigen are detectable in non-vaccinated individuals

“…Individuals responding to vaccination with the induction of a high anti-HBsAg titer showed a strong T cell response non-responsiveness (HBsAg titer < 10 kU/L) to vaccination are associated with certain human leukocyte antigen (HLA)-class Ⅱ alleles. DRB1*0301, DRB1*0701, and DQB1*0201 [5,8,9] were shown to have a higher prevalence in non-responders, whereas other antigens (DRB1*0101, *1301, *1501, and DPB1*0401) seem to mediate strong immune responses [9][10][11][12] . Higher age, obesity, male gender, smoking, and chronic dialysis are risk factors for a non-/ low-responsiveness [8,9,[13][14][15] .…”

“…Hepatitis B vaccinations prevent HBV infections as well as its complications in most of the vaccines [3,4] . However, 5% to 10% fail to produce protective anti-HBsAg titers after three vaccinations irrespective of the source of the antigen, which is a problem not only for health care workers, and represents a major medical as well as economic challenge [5][6][7] . Low-(HBsAg titer 10-99 kU/L) or Abstract AIM: To evaluate, whether humoral hepatitis-B-vaccine non-responders also fail to mount a T cell response and to compare these results to normal vaccines.…”