Effect of Revaccination with Recombinant Hepatitis B Virus Vaccine Containing Higher Antigen Concentration in Non-responder Children

Riska Habriel Ruslie; Gontar Alamsyah Sirega

doi:10.3889/oamjms.2020.5458

Authors

Riska Habriel Ruslie Department of Child Health, Faculty of Medicine, Universitas Prima Indonesia, Medan, Indonesia
Gontar Alamsyah Sirega Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.5458

Keywords:

effectiveness, HBsAb, non-responder, vaccine

Abstract

BACKGROUND: Hepatitis B is a global health problem carrying significant morbidity and mortality. Vaccination against hepatitis B virus (HBV) has been implemented with good effectiveness, but a small proportion of children do not respond well after complete routine vaccination. They are called non-responders and are at higher risk for HBV infection.

AIM: The objective of the study was to determine the effect of revaccination with recombinant HBV vaccine containing higher antigen concentration in non-responder children.

METHODS: A prospective study was conducted from January 2018 until December 2019. Inclusion criteria were children aged 9–15 months and had three doses of recombinant HBV at 0, 1, and 6 months old. Exclusion criteria were the presence of acute or chronic hepatitis B and conditions which alter immune function and immunosuppressant medications consumption. Demographic and clinical characteristics were gathered from each subject along with serum HBsAb titer examination. Subjects with serum anti-hepatitis B surface antigen (HBsAb) titer of <10 IU/L were classified into non-responders and underwent revaccination with 3 doses of vaccine containing 20 μg HBsAg. The revaccination series was repeated until all subjects showed seroconversion. After each series, repeated serum HBsAb titer measurements were conducted.

RESULTS: A total of 400 children were enrolled in this study with a mean age of 12.1 (SD 2.64) months. Subjects were dominated with females (54.0) and normal nutritional status (79.0). The rate of non-responsiveness was 9.0%. Of all non-responders, 88.9% experienced seroconversion after the first revaccination series. After the third revaccination series, all subjects had serum HBsAb titer at the protective level.

CONCLUSION: Revaccination with recombinant HBV vaccine containing higher antigen concentration in non-responder children is effective.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Jouneghani AS, Chaleshtori MH, Khoshdel A, Kheiri S, Farrokhi E, Khalafian P, et al. Evaluation of response to hepatitis B vaccine in Iranian 6-18-year-old students. J Res Med Sci. 2017;22:116. https://doi.org/10.4103/jrms.jrms_204_17 PMid:29184574

Ahad MA, Alim MA, Guho A, Islam QT, Azad KA. Role of booster dose on antibody titer after recombinant hepatitis B vaccination. J Med. 2009;10:67-76. https://doi.org/10.3329/jom.v10i2.2817

Han K, Shao X, Zheng H, Wu C, Zhu J, Zheng X, et al. Revaccination of non- and low- responders after a standard three dose hepatitis B vaccine schedule. Hum Vaccin Immunother. 2012;8(12):1845-9. https://doi.org/10.4161/hv.21818 PMid:22906933

Filippelli M, Lionetti E, Gennaro A, Lanzafame A, Arrigo T, Salpietro C, et al. Hepatitis B vaccine by intradermal route in non responder patients: An update. World J Gastroenterol. 2014;20(30):10383-94. https://doi.org/10.3748/wjg.v20.i30.10383 PMid:25132754

Joukar F, Mansour-Ghanaei F, Naghipour M, Asgharnezhad M. Immune responses to single-dose versus double-dose hepatitis B vaccines in healthcare workers not responding to the primary vaccine series: A randomized clinical trial. Hepat Mon. 2016;16(2):e32799. https://doi.org/10.5812/hepatmon.32799 PMid:27148385

Raven SF, Hoebe CJ, Vossen AC, Visser LG, Hautvast JL, Roukens AH, et al. Serological response to three alternative series of hepatitis B revaccination (Fendrix, Twinrix, and HBVaxPro-40) in healthy non-responders: A multicentre, open-label, randomised, controlled, superiority trial. Lancet Infect Dis. 2019;20(1):92-101. https://doi.org/10.1016/s1473-3099(19)30417-7

Rusmil K, Fadlyana E, Bachtiar NS. Booster vaksinasi hepatitis B terhadap anak yang non responder. Sari Pediatri. 2010;12(2):88-91. https://doi.org/10.14238/sp12.2.2010.88-91

Shouval D. Hepatitis B vaccines. J Hepatol. 2003;39 Suppl 1:S70-6. PMid:14708681

Dinelli MI, Moraes-Pinto MI. Seroconvertion to hepatitis B vaccine after weight reduction in obese non-responder. Rev Inst Med Trop Sao Paulo. 2008;50(2):129-30. https://doi.org/10.1590/s0036-46652008000200013 PMid:18488095

Clemens R, Sänger R, Kruppenbacher J, Höbel W, Stanbury W, Bock HL, et al. Booster immunization of low- and non-responders after a standard three dose hepatitis B vaccine schedule--results of a post-marketing surveillance. Vaccine. 1997;15(4):349-52. https://doi.org/10.1016/s0264-410x(96)00205-8 PMid:9141203

Cardell K. Studies on Hepatitis B Vaccination and Factors Associated with the Vaccine Response, Dissertation. Linköping: Linköping University Sweden; 2009.

De Silvestri A, Pasi A, Martinetti M, Belloni C, Tinelli C, Rondini G, et al. Family study of non-responsiveness to hepatitis B vaccine confirms the importance of HLA class III C4A locus. Genes Immun. 2001;2(7):367-72. https://doi.org/10.1038/sj.gene.6363792 PMid:11704802