The effect of universal infant vaccination on the prevalence of hepatitis B immunity in adult solid organ transplant candidates

Abstract

Background Hepatitis B virus (HBV) immunity is recommended to optimize outcomes after solid organ transplantation (SOT). This study assessed the prevalence and predictors of HBV immunity at the time patients were placed on transplant waiting list over a period from 1997 to 2019 in a low HBV endemic region. Methods Data were obtained from the University Hospitals Leuven transplant database. Minors and patients with past/current HBV infection were excluded. From 1986, Belgian patients are covered by the universal infant vaccination; therefore, birth cohort was stratified in those born ≥1986 vs <1986. Results The study population consisted of 3297 SOT candidates. HBV immunity rate was superior in renal transplant candidates (55.3%), and this number was 21.5%, 15.4% and 16.8% for liver, cardiac and pulmonary transplant candidates, respectively, P < .001. Among liver transplant candidates, HBV immunity rate was 14.8% in decompensated cirrhotic patients and 27.9% in those without advanced cirrhosis (P < .001). The overall immunity rate increased from 19.3% in period 1997‐2008 to 32.8% in 2009‐2019, P < .001. In multivariable analyses, younger age (odds ratio (OR) 95% confidence interval (CI): 0.97‐0.98, P < .001) and birth cohort ≥ 1986 (OR 95% CI: 1.18‐2.66, P = .006) were associated with increased HBV immunity. Conclusion An increase in HBV immunity was observed over a 20‐year period related to the introduction of universal infant HBV vaccination. Nevertheless, this study highlights the low overall HBV immunity at the time of listing for organ transplantation and points out the need of an increased awareness and vaccination strategy at an early disease stage.

Hepatitis B virus prevalence in first‐time blood donors in Flanders, Belgium: Impact of universal vaccination and migration

“…Among vaccinated 18-to 21-year old blood donors in China, the prevalence of HBsAg accounted for 3.4% suggesting exposure to HBV not prevented by vaccination. 37 Both Koc et al 38 and Theeten et al 39 indicated that the vaccinated serostatus in Belgium was more prevalent in vaccinated birth cohorts targeted in infancy (more than 80%) than in those targeted in adolescence (about 40%-60%). Moreover, the self-reported coverage of vaccination against HBV between 1999 and 2017 in Flanders, Belgium, exceeded 90% of the infants from 2005 onwards while it was below 90% for adolescents up to 2017.…”