Booster Dose Vaccine Response among Children Who were Primary Hepatitis B Vaccine Non-Responders and Sensitive Groups Concerning Vaccine Response

Yıl 2019, , 160 - 164, 24.05.2019

Aysun Kara Uzun

https://doi.org/10.12956/tjpd.2018.351

Öz

Objective: In this study, booster dose vaccine response was evaluated after performing a vaccine schedule at 0,

1st and 6th months among 83 children aged between 2 and 16 years who were primary hepatitis B vaccine nonresponders

and we tried to determine which groups were sensitive concerning vaccine response.

Material and Methods: Euvax B vaccine which included 10 μg HBsAg was administered in 3 doses for the second

time at 0, 1 and 6 months as 0.5 ml intramuscularly in the deltoid muscle to 83 healthy children aged between 2 and 16

years who were primary hepatitis B vaccine non-responders and their vaccine status was determined with tests before

minor surgery. Blood tests were taken three times from children at 1, 6 and 7 months after the first vaccination and anti-

HBs titer was evaluated by using enzyme-linked immunosorbent assay technique.

Results: The mean age of the children was 9.3±3.6 years (2-15,9 years). The anti-HBs geometric mean concentration

was found to be 537.97±377.51 mIU/mL (0.6-1000) after the first vaccination, as 309.33± 337.45 mIU/mL (8-1000)

after the second vaccination and as 609.78±347.43 mIU/mL (11.1-1000) following the third vaccination. Anti-HBs

positive conversion rates in T1 were compared in 81 children who had been checked after the first vaccination and anti-

HBs positive conversion rates were found to be significantly lower in children whose anti-HBs titer was under 1 mlU/ml

before vaccination (p=0,01, Z -3.29, U 469). There was no difference concerning T6 and T7 between these two groups.

Anti-HBs positive conversion rates in T6 and T7 were found to be significantly higher in children with malnutrition

(p=0.008, Z -2.56, U 60.5, p=0.03, Z -2.11, U 26.5).

Conclusion: When observing the rapid decrease in T6 in contrast with the two dose vaccination, it is thought that anti-

HBs seroconversion rates and anti-HBs geometric mean concentration are related with reminding, anti-HBs titer before

vaccination and checking time of anti-HBs rather than the number of reminding doses. In fact, we believe that 3 dose

vaccination is better among those children whose anti-HBs titer is under <1 mIU/mL and who have malnutrition.

Anahtar Kelimeler

Booster vaccination, Child, Hepatitis B virus

Birincil Hepatit B Aşı Yanıtsız Çocuklarda Hatırlatma Doz Aşı Yanıtları ve Aşı Yanıtında Hassas Gruplar

Öz

Amaç: Çalışmada birincil hepatit B aşı yanıtsız 2-16 yaş aralığındaki 83 çocukta, 0, 1 ve 6. ay aşı şeması uygulanarak

elde edilen hatırlatma doz aşı yanıtları değerlendirilmiş ve aşı yanıtında hassas gruplar belirlenmeye çalışılmıştır.

Gereç ve Yöntemler: Küçük cerrahi girişimler öncesi yapılan tetkikler sonrasında birincil hepatit B aşı yanıtsızlığı saptanan

2-16 yaş aralığındaki sağlıklı 83 çocuğa, 2. kez 0, 1 ve 6. aylarda 3 doz 10 μg HBsAg içeren Euvax B aşısı deltoid

kasa 0.5ml kas içine uygulanmıştır. Çocuklardan birinci aşıdan 1, 6 ve 7. ay sonra olmak üzere, 3 kez kan alınarak anti-

HBs titresi enzyme-linked immunosorbent assay tekniği ile değerlendirilmiştir.

Bulgular: Çocukların yaş ortalaması 9.3±3.6 yıl (2-15.9) bulunmuştur. Birinci aşı sonrası anti-HBs ortalama geometrik

konsantrasyonu 537.97±377.51 mIU/mL (0.6-1000), 2. aşı sonrası 309.33± 337.45 mIU/mL (8-1000), 3. aşı sonrası

609.78±347.43 mIU/mL (11.1-1000) bulunmuştur. Birinci aşı sonrası tetkik yapılabilen 81 çocuk arasında T1’de anti-

HBs-positive serokonversiyon oranı, aşı öncesi anti-HBs titresi 1 mIU/mL’nin altında olan çocuklarda diğer gruba göre

istatistiksel anlamlı biçimde daha düşük bulunmuştur (p=0.01, Z -3.29, U 469). Bu 2 grup arasında T6 ve T7’de istatistiksel fark saptanmamıştır.

Malnütrisyonlu hastalarda T6 ve T7’de anti-HBs positive serokonversiyon oranı diğer gruba göre istatistiksel anlamlı olarak daha

yüksek bulunmuştur (p=0.008, Z -2.56, U 60.5, p=0.03, Z -2.11, U 26.5).

Sonuç: İki doz aşıya rağmen T6’daki hızlı düşüşe bakıldığında, anti-HBs serokonversiyon oranı ve anti-HBs ortalama geometrik konsantrasyon

değerleri hatırlatma doz sayısından ziyade, hatırlatma yapılmasına, aşı öncesi anti-HBs titresine ve anti-HBs titresi bakma zamanıyla

ilgili gözükmektedir. Ancak, aşı öncesi anti-HBs titresi <1 mIU/mL olanlar ve malnütrisyonlu çocuklarda 3 doz aşılamanın daha doğru

olacağı kanaatindeyiz.

Anahtar Kelimeler

Hatırlatma aşılaması, Çocuk, Hepatit B virüs

Kaynakça

• 1. Immunization Coverage. Availablefrom:http://www.who.int/mediacentre/ factsheets/fs378/en/. Accessed date: 1 Haziran, 2016
• 2. Zhuang GH,Yan H, Wang XL. Risk factors of and mechanism for non-responsiveness to hepatitis B vaccination. Zhonghua Gan Zang Bing Za Zhi 2006;14:157-60.
• 3. Averhoff F, Mahoney F, Coleman P, Schatz G, Hurwitz E, Margolis H. Immunogenicity of hepatitis B Vaccines. Implications for persons at occupational risk of hepatitis B virus infection. Am J Prev Med 1998;15:1–8.
• 4. http://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html (8.5.2017)
• 5. Toy M, Önder FO, Wörmann T, Bozdayi AM, Schalm SW, Borsboom GJ, et al. Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: A systematic review. BMC Infectious Diseases 2011;11:337.
• 6. Bonanni P, Pesavento G, Boccalini S, Bechini A. Perspectives of public health: Present and foreseen impact of vaccination on the epidemiology of hepatitis B. J Hepatol 2003;39:224-9.
• 7. Ozmert EN. Dünya’da ve Türkiye’de aşılama takvimindeki gelişmeler. Çocuk Sağlığı ve Hastalıkları Dergisi 2008;51:168-75.
• 8. Jafarzadeh A, Zarei S, Shokri F. Low dose revaccination induces robust protective anti-HBs antibody response in the majority of healthy non-responder neonates. Vaccine 2008;26:269-76.