Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 3  |  Page : 562-565

Assessment of the immune response to hepatitis B virus vaccine as a major factor in the prevention of hepatitis B infection


1 Department of Tropical Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Clinicl Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Tropical Medicine, Ministry of Health, Egypt

Date of Submission08-Oct-2013
Date of Acceptance19-Jan-2014
Date of Web Publication26-Nov-2014

Correspondence Address:
Ahmed Ali El-Sersy
Elhamoul, Menof, Menoufia
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.145513

Rights and Permissions
  Abstract 

Objective
The aim of the work was to study the effect of hepatitis B virus (HBV) vaccine as a major factor in the prevention of HBV infection.
Background
Measuring the level of hepatitis B surface antibodies in different age groups to determine the time of fading of hepatitis B surface antibodies and whether there is a need for a booster dose or not.
Patients and methods
Ninety random persons selected among those attending Menoufia Fever Hospital, Menoufia governorate, who were previously vaccinated with HBV vaccine, were classified into three groups.
Results
Significantly, the seroprotection rate among vaccinated children up to 5 years was 70.0%, with a mean concentration of HBsAb of 139 mIU/ml; of them, 40.0% were over-responders (>100 mIU/ml), 30% were adequate responders (10-100 mIU/ml), and 30.0% were nonresponders.
In the second group, the mean concentration of HBsAb was 70 mIU/ml, wherein 43.3% were considered responders; of them, 13.3% were over-responders, 30% were adequate responders, and 56.7% were nonresponders (HBsAb <10 mIU/ml). The HCW of the third group shows that the mean concentration of HBsAb was 639 mIU/ml; 20.0% were adequate responders and 80.0% were over-responders.
Conclusion
The HBV vaccine has a major effect on the prophylaxis and the prevention of HBV infection. The HBV vaccine efficacy decreased with increasing age up to 18 years. There was 100% response in healthcare workers 5 years after vaccination.

Keywords: booster dose of hepatitis B virus vaccine, hepatitis B virus infection in children, hepatitis B virus vaccine in healthcare workers, hepatitis B vaccine, past history to hepatitis B infection, prevention of hepatitis B virus infection


How to cite this article:
Nouh ME, El-Deep GS, El-Lehleh AM, Zaher EM, El-Sersy AA. Assessment of the immune response to hepatitis B virus vaccine as a major factor in the prevention of hepatitis B infection. Menoufia Med J 2014;27:562-5

How to cite this URL:
Nouh ME, El-Deep GS, El-Lehleh AM, Zaher EM, El-Sersy AA. Assessment of the immune response to hepatitis B virus vaccine as a major factor in the prevention of hepatitis B infection. Menoufia Med J [serial online] 2014 [cited 2020 Feb 24];27:562-5. Available from: http://www.mmj.eg.net/text.asp?2014/27/3/562/145513


  Introduction Top


Hepatitis B virus (HBV) is a common cause of liver disease throughout the world. An estimated one-third of the world's population has serologic evidence of past infection, and the virus causes more than one million deaths annually [1] .

HBV vaccine is a vaccine developed for the prevention of HBV infection. The vaccine contains one of the viral-envelope proteins: hepatitis B surface antigen (HBsAg) [2] .

The first HBV vaccine was prepared from inactivated HBsAg particles purified from the plasma of asymptomatic carriers of HBV [3] .

After the primary course of three vaccinations, a blood test may be performed after an interval of 1-4 months to establish whether there has been an adequate response, which is defined as an anti-hepatitis B surface antigen (anti-Hbs) antibody level above 100 mIU/ml. Such a full response occurs in about 85-90% of the individuals [4] .

An antibody level between 10 and 100 mIU/ml is considered as a poor response, and these people should receive a single booster vaccination at this time, but do not need further retesting [5] .

Previous reports suggested that vaccination would provide an effective cover of 5-7 years. Subsequently, it has been appreciated that long-term immunity derives from immunological memory, which outlasts the loss of antibody levels, and hence, subsequent testing and administration of booster doses is not required in successfully vaccinated immunocompetent individuals [6] .


  Patients and methods Top


This cross-sectional study was conducted between May 2011 and April 2012. Ninety random individuals selected from those attending Menoufia Fever Hospital, Menoufia governorate, who were previously vaccinated with HBV vaccine were included. They were classified into the following three groups.

  1. Group I: comprised 30 persons with age less than 5 years.
  2. Group II: comprised 30 persons with age between 5 and 18 years.
  3. Group III: comprised 30 persons with age above 18 years.


All groups were subjected to history taking, and demographic and other relevant information for every person, including history of the presence of host factors affecting the antibody level of HBV vaccine, were recorded. A thorough clinical examination was performed, with stress on pallor, jaundice, liver, spleen, and lymph nodes, with investigations such as complete urine and stool analysis, complete blood count, liver function tests, including serum total and direct bilirubin, alanine transaminase, aspartate aminotransferase, the prothrombin time, and concentration and serum albumin. Renal function tests including blood urea and serum creatinine were performed.

Hepatitis B markers (HBsAg, HBs antibodies, HBcore antibodies) were determined using enzyme-linked immunosorbant assay (ELISA). HCV antibodies were determined by ELISA; abdominopelvic ultrasonography was performed in all persons to detect hepatomegaly, splenomegaly, periportal fibrosis, liver cirrhosis, and portal hypertension.


  Results Top


This study included three groups: the first group was composed of 30 children (under 5 years old). They were from different localities in the Menoufia governorate and of both sexes: 19 (63.3%) were male and 11 (36.7%) were female. The second group was composed of 30 persons of both sexes from 5to 18 years old: 19 (63.3%) were male and 11 (36.7%) were female. They were administered the same doses of the same brand of the vaccine (Yeast Recombinant Hep B Vaccine) by the Egyptian Ministry of Health at the same site and according to the same schedule at 2, 4, and 6 months. Hence, both host-related and immunization-related factors that might affect our results were similar.

The third group was above 18 years old, and consisted of 30 healthcare workers at the Menoufia Fever Hospital of both sexes: 18 (60%) were male and 12 (20%) were female; they were vaccinated by Yeast Recombinant Hep B Vaccine by the Egypt Ministry of Health at 0, 1, and 6 months at the same time in Menoufia Fever Hospital; they were included in this study 5 years after completing the vaccination schedule.

In this study, the seroprotection rate among vaccinated children in the first group was 70.0%, with a mean concentration of HBsAb of 139 mIU/ml; of them, 40.0% were over-responders (>100 mIU/ml), 30.0% were responders (10-100 mIU/ml), and 30% were nonresponders.

In this study, there was a negative effect of age on the level of HBsAb in the second group (from 5 to 18 years old).

In this study, in the second group, the mean concentration of HBs antibodies was 70 mIU/ml; of them 13.3% were over-responders, 30.0% were adequate responders, and 56.7% were nonresponders.

In the third group, we found that five cases were positive for HBcAb, with no effect on the level of HBsAb, and they were underinvestigated by PCR and were negative. This may be due to their infection before vaccination, a long interval, and/or because they were working on the field of infectious diseases, and were exposed to recurrent HBV infection.

In this study, we found that in the third group of healthcare workers, with the mean concentration of HBsAb of 639 mIU/ml, 100% were responders.

In this study, there was no statistically significant difference between HbsAb and renal function or the ultrasound data of the studied groups, and also, the HBsAb titer had a significantly positive correlation with TLC. The positive correlation with TLC count may be due to accompanied minor infection as all of them were related to the fever hospital ([Figure 1] and [Figure 2] and [Table 1], [Table 2] and [Table 3]).
Figure 1: The relation between the HBsAb titer and the age group.

Click here to view
Figure 2: Correlation between serum albumin and the HbsAb titer (correlation ratio, r < 0.05).

Click here to view
Table 1: Sex distribution among the studied groups


Click here to view
Table 2: The correlation between HBsAb responses in the studied groups


Click here to view
Table 3: The relation between the HBcAb group and HBsAb in the studied groups


Click here to view



  Discussion Top


This study showed that in the first group (up to 5 years), there was no significant difference between the immune response to HBV vaccine and either age or sex, and this was in agreement with Khashaba et al. [7] , who showed that there was no significant relation between the immune response to HBV vaccine and either age or sex. Our results were also in agreement with the El-Sawy and Mohammed's [8] study, wherein there was no significant difference between the immune response to HBV vaccine and either age or sex.

Our study disagreed with that of Adoga et al. [9] , who showed that men were significantly more likely to develop protective antibody titer than women after the second dose of vaccination.

Also, our study disagreed with that of Joshi et al. [10] , who reported a higher geometric mean titer in women than in men after a three-dose regimen. Although there is no clear explanation for this discrepancy, future studies could further examine this question.

In our study, the seroprotection rate among vaccinated children in the first group was 70.0%, with the mean concentration of HBsAb 139 mIU/ml; of them, 40.0% were over-responders (>100 mIU/ml), 30.0% were responders (10-100 mIU/ml), and 30% were nonresponders. This is in agreement with El-Ansary et al. [11] , who showed that the seroprotection rate was 67.9% among vaccinated children 5 years after vaccination. This study is also in agreement with Klinika et al. [12] , who showed that a protective level of anti-HBs was found in 78% of the children, including 33% with high titers (100-999 mIU/ml), and 12% with very high (≥1000 mIU/ml) titers. Of them, 22% did not have a protective level of anti-HBs, and in 7% antibodies were undetectable.

In this study, in the second group (from 5 to 18 years), there was a negative effect of age on the level of HBsAb. This was in agreement with El-Sayed et al. [13] , who showed that there was a negative influence of age on the efficacy of HBV vaccine. We also agree with the results of Charles et al. (1999), who showed that advancing age in adults has a negative influence on the efficacy of HBV vaccination up to 18 years of age.

In this study, in the second group, the mean concentration of HBs antibodies was 70 mIU/ml: of them, 13.3% were over-responders, 30.0% were adequate responders, and 56.7% were nonresponders. These results are in agreement with Jafarzadeh et al. [14] , who showed that at 10 years after primary vaccination with recombinant HBV vaccine in Egypt, 47.9% of the children had protective levels of anti-HBs antibody.

In the third group, we found that five cases were positive to HBcAb, with no effect on the level of HBsAb, and they were under investigated by PCR and were negative. This may be due to the fact that they were infected before vaccination, had a long interval and/or they were exposed to recurrent HBV infection because they worked on the field of infectious diseases.

In this study, we found that in the third group of healthcare workers, the mean concentration of HBsAb was 639 mIU/ml: 100% of them were responders, and this was in agreement with Zeeshan et al. [15] , who found that seroconversion rates reported after HBV vaccination globally ranges from 85 to 90% in healthcare workers.

With regard to the third group, our results were in agreement with Brodrick and Jonas [16] , who showed that the recommended series of three intramuscular doses of HBV vaccine induces a protective antibody response in more than 95% of infants and children.


  Conclusion Top


  1. HBV vaccine has a major effect in the prophylaxis and the prevention of HBV infection.
  2. The HBV vaccine efficacy decreased with increasing age up to 18 years of age.
  3. There was 100% response in healthcare workers 5 years after vaccination.
  4. The cause for the decreasing effect of HBV vaccine with age has to be determined.


The presence of a history of HBV infection, that is, HBcAb+, did not affect the response to the HBV vaccine.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.Lim KW, Kirchner JT. Hepatitis B. Am Fam Physician 2004; 69 :75-82.  Back to cited text no. 1
    
2. Cardell, K, Åkerlind, B, Sällberg, M, Fryden, A. Excellent response rate to a double dose of the combined hepatitis A and B vaccine in previous non responders to hepatitis B vaccine. J Infect Dis 2008; 198 :299-226.  Back to cited text no. 2
    
3. Pungpapong S, Kim W, Poterucha J. Natural history of hepatitis B virus infection: an update for clinicians. Mayo Clin Proc 2007; 82 :967-975.  Back to cited text no. 3
    
4. Pasricha N, Datta U, Chawla Y. Immune responses in patients with HIV infection after vaccination with recombinant hepatitis B virus vaccine. BMC Infectious Diseases 2006; 6 :65.  Back to cited text no. 4
    
5. Dienstag JL. Hepatitis B virus infection. N Engl J Med 2008; 359:1486-1500.  Back to cited text no. 5
    
6. Gabbuti A, Romanò L, Blanc P, Meacci, F, Amendola A, Mele A, et al. Long-term immunogenicity of hepatitis B vaccination in a cohort of Italian healthy adolescents. Vaccine 2007; 25 :3129-3132.  Back to cited text no. 6
    
7. Khashaba A, Manal S, Mohammed M, Ghada S, Rashad M. Study of immune response to hepatitis B vaccine in Egyptian preschool children. J of Viral Hepatitis 2006; 2 :234 -241.  Back to cited text no. 7
    
8. El-Sawy IH, Mohamed ON. Long term immunogenicity and efficacy of recombinant hepatitis B vaccine in Egyptian children. East Mediterr Health 2000; 5 :922-932.  Back to cited text no. 8
    
9. Adoga MP, Pennap G, Akande BO, Mairiga JP, Pechulano S, Agwale SW. Evaluation of a recombinant DNA hepatitis B vaccine in a vaccinated Nigerian population. J Public Health Med 2010; 14 :212-190.  Back to cited text no. 9
    
10.Joshi N, Kumar A, Sreenivas DV, Palan S, Nagarjuna Kumar YR. Safety and immunogenicity of indigenous recombinant hepatitis B vaccine (Shanvac-B) in comparison with commercially available vaccine. Indian J Gastroenterol 2000; 19 :71-73.  Back to cited text no. 10
    
11.El-Ansary M, Mohamed E, Mahdy S. The seroprotection rate among vaccinated children in Egypt after five years of vaccination. Int J Epidemiol 2002; 3 :592-42.  Back to cited text no. 11
    
12.Klinika CZ, Wieku D, Warszawskiego UM, Wojewódzki S. Are teenagers immunized in infancy still protected against hepatitis B? Am J Gastroenterology 2010; 67 :13-17.  Back to cited text no. 12
    
13.El-Sayed B, Mohamed E, Ahmed E, El-Sayed I, Gihan AS. The long-term immunogenicity of the vaccine in Egyptian children after five and ten years of vaccination. Int J Epidemiol 2011; 4 :645 -690.  Back to cited text no. 13
    
14.Jafarzadeh S, Sexton DJ, Mick N, Marchese P. The seroprotection rate among vaccinated children in Egypt after ten years of vaccination. Int J Epidemiol 2006; 2 :432-450.  Back to cited text no. 14
    
15.Zeeshan M, Jabeen K, Ali AN, Ali AW, Farooqui SZ, Mehraj V, Zafar A. Evaluation of immune response to hepatitis B vaccine in health care workers at a tertiary care hospital in Pakistan: an observational prospective study. BMC Infect Dis 2007; 7 :120.  Back to cited text no. 15
    
16.Broderick AL, Jonas MM. Hepatitis B in children. Semin Liver Dis 2003; 23 :59-68.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and methods
Results
Discussion
Conclusion
Acknowledgements
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed731    
    Printed16    
    Emailed0    
    PDF Downloaded112    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]