Post-vaccination Immunity Against Hepatitis B Virus and Predictors for Non-responders Among Medical Staff

Abstract

Background:Hepatitis B virus (HBV) is a major cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). HB vaccination is an essential step in the prevention of the disease and its consequent complications.Objectives:Immune status of medical personnel in teaching hospitals of Khuzestan is not well known. Since these personnel are usually at risk of needle stick and other high-risk events, some challenges exist in infection control committee with regard to managing these events. This study was conducted to assess post-vaccination immunity status and non-response to HBV vaccine as well as its predictors among medical staff in a teaching hospital affiliated to Ahvaz Jundishapur University of Medical Sciences (AJUMS) in Ahvaz, southwest Iran.Patients and Methods:In this retrospective cross-sectional study, the medical staff of a teaching hospital was evaluated for their immune response against HBV and factors affecting it. The study conducted in Razi Hospital, Ahvaz City, southwest of Iran, in 2013. Demographical, clinical, and laboratory data registered in medical files of hospital staff were analyzed by SPSS software version 16 using chi-square and Fisher exact tests. Differences with P value < 0.05 were considered significant. To identify predictors for non-responders, we used odds ratio (OR) with 95% confidence interval (CI).Results:Out of 239 participants, 43 (18 %) were men and 196 (82%) were women. Their mean age was 31.9 ± 18.1 years (range of 20 - 55 years). Fourteen (5.9%) participants were non-responders, 37 (15.5%) were poor responders, and 188 (78.6%) were good responders. The non-responders were older (> 50 years) than the responders (P = 0.0001), while the body mass index (BMI) was not significantly different (P = 0.37) between them. Diabetes mellitus (DM) (OR: 7.3, 95% CI, 1.3 - 41.7, P = 0.05), and using immunosuppressive drugs (ISD) (OR: 3.2, 95% CI, 1.1 - 11.5, P = 0.03) were two variables in association with non-response to HB vaccine.Conclusions:Non-response rate to HB vaccine in our study was approximately 6%. Age over 50 years, DM, and receiving immunosuppressive drugs may be considered as predictors for non-response to HB vaccine in medical staff.

Factors influencing immunologic response to hepatitis B vaccine in adults

“…A previous meta-analysis in 2002 observed many factors influencing response to hepatitis B vaccine, especially a decrease response to recombinant HBV vaccine at higher ages11, which suggested that earlier vaccination should be prioritized for prevention at the population level. However, in the last decade, numerous emerging reports, which focused on the seroprotection rate of hepatitis B vaccine in adults12131415161718192021222324252627282930313233343536373839404142434445464748, are still inconclusive to immunize what adults are the most appropriate in order to increase the seroprotection rate. Factors influencing immunologic response to hepatitis B vaccine in adults have been inconsistently examined in existing studies.…”

Respuesta inadecuada a la vacuna contra la hepatitis B en personal de salud del Hospital Nacional, Paraguay

“…Suponemos que existen otros factores que impiden una adecuada respuesta inmune. En relación al peso un estudio reporta que en personal de salud un índice de masa corporal (IMC) <42 k/m 2 se asocia a 3% de falta de respuesta, mientras que con IMC ≥42 k/m 2 esa frecuencia aumenta a 14,9% (19) . En nuestro reporte, la obesidad resultó un factor de riesgo significativo (p 0,02) de mala respuesta a la vacuna.…”

“…Entre los no respondedores se reporta que 21,9% son fumadores, posiblemente por la disminución de las respuestas inmunes (21) . Se sabe que el tabaquismo reduce la respuesta antigénica de los linfocitos T helper 1 (19) . El acceso a la vacuna HB en personal de salud no es universal (9) .…”

Assessment of immune response to Hepatitis B vaccine by estimation of anti - HBs antibody titer among immunized health care workers

“…All HCWs, who are recently vaccinated should undergo anti-HBs testing, performed 1-2 months after administration of the last dose of the vaccine. Age, gender, obesity, smoking, immunity, and genetic factors may be responsible for reduced immune response to vaccination as documented in various Indian research studies [17,18]. An anti-HBs titer less than 10mIU/ml is regarded as nonresponsive, levels between 10 and 100 mIU/ml are considered as hypo response and more than 100mIU/ml is considered as high level of immunity following vaccination.…”

“…Poor seroprotection rates to hepatitis B vaccine are documented in subjects of older age group, Body Mass Index (BMI) ≥ 25, smokers and poor nutritional status [17,18].This makes it necessary to identify the individuals who are hypo responsive to vaccination thus taking necessary actions. The need for the present study is becoming increasingly important in Indian scenario to create awareness and ensure complete protection from Hepatitis B infection in high risk individuals particularly among health care workers.…”