Assessment of immune response to Hepatitis B vaccine by estimation of anti - HBs antibody titer among immunized health care workers
Keywords:
Hepatitis B vaccine, Health care worker, Anti-HBs titer, ELISA, CDC
Abstract
Background: Hepatitis B vaccination is recommended for all health care workers as they constitute a high-risk group for acquiring blood borne hepatitis B infection. Anti HBs level ≥10 mIU/ml at any time after vaccination is considered as a marker of sustained immunity, which provides protection against infection. Poor sero-protection rates to hepatitis B vaccine are recognized and some individuals do not develop sufficient levels of anti-HBs antibodies. Hence, it is necessary to identify the individuals who are non-protective responders to vaccination. With this background, the present study was undertaken to determine immune response to hepatitis B vaccine amongst the health care workers.
Material and Methods: The present cross-sectional study included 200 health care workers in a tertiary teaching hospital, who were immunized with three complete doses of hepatitis B vaccine. Quantitative determination of anti HBs levels was done by ELISA. The effect of gender, age, smoking, body mass index and duration after immunization on antibody levels were analyzed.
Results: The association of anti-HBs status and gender was not statistically significant. Increase in age leads to decline of anti-HBs protective responders. Smoking and higher body mass index are significantly associated with less anti HBs titers (<10 mIU/ml).
Conclusion: The highest number of protective responders is seen in initial 5 years post vaccination duration and least protective responders are observed in >10 years post vaccination duration, indicating decline in antibody response over a period of time.
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References
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22. Acchammachary AA, Ubale M, Belurkar DD, Bhave PP, Malgaonkar AA, Kartikeyan S. A cross-sectional study of post-vaccination anti-HBs titer and knowledge of hepatitis B infection amongst medical students in a metropolitan city. Int J Res Med Sci. 2017;5(1):83-88. doi: http://dx.doi.org/10.18203/2320-6012.ijrms20164528.
23. Chaudhari C, Bhagat M, Shah T, Misra R. Antibody to Hepatitis B Surface Antigen in Vaccinated Health Care Workers. Med J Armed Forces India. 2008;64(4):329-332. doi: 10.1016/S0377-1237(08)80013-5.
24. 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(1):120. doi: 10.1186/1471-2334-7-120.
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26. Aghakhani A, Banifazl M, Izadi N, McFarland W, Sofian M, Khadem-Sadegh A et al. Persistence of antibody to hepatitis B surface antigen among vaccinated children in a low hepatitis B virus endemic area. World J Pediatr 2011; 7(4):358-360. doi: https://doi.org/10.1007/s12519-011-0286-4.
27. Wick G, Grubeck-LoebensteinB. The aging immune system: primary and secondary alterations of immune reactivity in the elderly. Exp Gerontol. 1997;32(4-5):401-413. doi: 10.1016/s0531-5565(96)00152-0.
28. Bock H, Kruppenbacher J, Sanger R. Immunogenicity of a recombinant hepatitis B vaccine in adults. Arch Intern Med. 1996;156(19):2226-2231. doi:10.1001/archinte.1996.00440180088011.
29. Shaw FE, Guess HA, Roets JM. The effect of anatomic injection site, age and smoking on the immune response to hepatitis B Vaccination. Vac. 1989;7(5):425-430. doi: 10.1016/0264-410x(89)90157-6.
30. Arcavi L, N. L. Benowitz. Cigarette smoking and infection. Arch Intern Med. 2004;164(20):2206-2216. doi: 10.1001/archinte.164.20.2206.
31. Sopori M. 2002. Effects of cigarette smoke on the immune system. Nat Rev Immunol. 2002;2(5):372-377. doi: 10.1038/nri803.
32. Winter A. P., E. A. Follett, J. McIntyre, J. Stewart, I. S. Symington. 1994. Influence of smoking on immunological responses to hepatitis B vaccine.Vac.1994;12(9):771-772. doi: https://doi.org/10.1016/0264-410X(94)90283-6.
33. Nejad EM, Jafari S, Rabirad N. Hepatitis B virus antibody levels in high-risk health care workers. Hepat Mon. 2011;11(8):662-663. doi: 10.5812/kowsar.1735143X.707.
34. Weber DJ, Rutala WA, Samsa GP, Bradshaw SE, Lemon SM. Impaired immunogenicity of hepatitis B vaccine in obese person.N Engl J Med. 1986;314(21):1393. doi: 10.1056/NEJM198605223142120.
35. Dinelli MI, Moraes-Pinto MI. Seroconversion to hepatitis B vaccine after weight reduction in obese non-protective responder. Rev Inst Med Trop Sao Paulo. 2008;50(2):129-130. doi: 10.1590/s0036-46652008000200013.
36. Papathanassoglou E, El-Haschimi K, Li XC, Matarese G, Strom T, Mantzoros C. Leptin receptor expression and signaling in lymphocytes:kinetics during lymphocyte activation, role in lymphocyte survival, and response to high fat diet in mice. J Immunol .2006;176(12):7745-7752. doi: 10.4049/jimmunol.176.12.7745.
37. Floreani A, Baldo V, Cristofoletti M, Renzulli G, Valeri A, Zanetti C, et al. Long-term persistence of anti-HBs after vaccination against HBV: an 18 year experience in health care workers. Vac. 2004;22(5-6):607-610. doi: https://doi.org/10.1016/j.vaccine.2003.09.001.
38. Plotkin S, Orsenstein W, Offit P. Vaccines. Philadelphia: Elsevier, 2008.
39. Bauer T, Jilg W. Hepatitis B surface antigen-specific T and B cell memory in individuals who had lost protective antibodies after hepatitis B vaccination. Vac. 2006;24(5):572–577. doi: https://doi.org/10.1016/j.vaccine.2005.08.058
40. Wainwright RB, McMahon BJ, Bulkow LR, Parkinson AJ, Harpster AP. Protection provided by hepatitis B vaccine in a Yupik Eskimo population. Seven-year results. Arch Intern Med. 1991;151(8):1634-1636. doi: 10.1001/archinte.151.8.1634.
2. Dannetun E, Tegnell A, Torner A, Giesecke J. Coverage of hepatitis B vaccination in Swedish healthcare workers. J Hosp Infect. 2006;63(2):201-204. doi: https://doi.org/10.1016/j.jhin.2006.01.014.
3. US Public Health Service. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for post exposure prophylaxis. MMWR 2001;29:50.
4. Elavia AJ, Banker DD. Hepatitis B virus infection in hospital personnel. Nat Med J India. 1992;5(6):265-268.
5. Kumar KA, Baghal PK, Shukla CB, Jain MK. Prevalence of hepatitis B surface antigen (HBsAg) among Health Care Workers. Indian J Comm Med. 2000;25(2):93-96.
6. Kalaskar A, Kumar M. Prevalence of hepatitis B and hepatitis C viruses among nurses and nursing students in a medical college hospital in southern Tamil Nadu, India. Int Res J Microbiol. 2012;3(1):10-13.
7. Jha AK, Chadha S, Bhalla P, Saini S. Hepatitis B infection in microbiology laboratory workers: prevalence, vaccination, and immunity status. Hepat Res Treat. 2012; 2012:520362. doi: 10.1155/2012/52036.
8. Laharia C, Subramanya C, Sosler S. An assessment of introduction of hepatitis B vaccine in India: Lessons for roll out and scale up of new vaccines in immunization programs. Indian J Public Health. 2013; 57(1):8-14. doi: 10.4103/0019-557X.111357.
9. WHO Department of Immunization, Vaccines and Biologicals. 2009. World Health Organization (WHO) Vaccine Preventable Diseases: Monitoring System. 2009 Global Summary. WHO Geneva, Switzerland.
10. Beasley, R. Palmer & WHO Expanded Programme on Immunization. (1988). Hepatitis B: immunization strategies / R. Palmer Beasley. World Health Organization. Available at https://apps.who.int/iris/handle/10665/60119.
11. Pati NT, Sethi A, Agrawal K, Agrawal K, Kumar G T, Kuma M. et al. Low level of awareness, vaccine coverage, and the need for booster among health care workers in tertiary care hospitals in India. J Gastroenterol Hepatol. 2008; 23(11):1710-1715. doi:10.1111/j.1440-1746.2008.05483.x.
12. Shrestha SK, Bhattarai MD. Study of hepatitis B among different categories of health care workers. J Coll Physicians Surg Pak. 2006;16(2):108-111. doi: 2.2006/JCPSP.108111.
13. Shefer A, Atkinson W, Friedman C, Kuhar DT, Mootrey G, Bialek SR, et al Immunization of Health Care Workers, “Recommendation of advisory committee on immunization practice (ACIP) and the Hospital Infection Control Practice advisory committee (HICPAC),” MMWR, Recommendation and Report. 1997;46:1–42.
14. Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part II: immunization of adults. MMWR Recomm Rep. 2006;55(RR-16):1-33; quiz CE1-4.
15. Jack AD, Hall AJ, and Maine N, Mendy M, Whittle HC. What level of hepatitis B antibody is protective? J Infect Dis. 1999;179(2):489-492. doi: https://doi.org/10.1086/314578.
16. Alikasifoglu M, Cullu F, Kutlu T, Arvas A, Taştan Y, Erginöz E, et al. Comparison study of the immunogenicity of different types and dosages of recombinant hepatitis B vaccine in healthy neonates. J Trop Pediatr. 2001;47(1):60-62. doi: 10.1093/tropej/47.1.60.
17. Tripathy S, Sathi HC, Puspa SS, Shankar R, Singh VK. Study of immune response after hepatitis B vaccination in medical students and healthcare workers. Ind J Prevent Soc Med. 2011;42:315-321.
18. Nashibi R, Alavi SM, F. Yousefi F, Salmanzadeh S, Moogahi S, Ahmadi F et al. Post-vaccination immunity against hepatitis B virus and predictors for non-protective responders among medical staff. Jundishapur J Microbiol. 2015;8(3): e19579. doi: 10.5812/jjm.19579.
19. Francis DP, Hadler SC, Thompson SE, Maynard JE, Ostrow DG, Altman N, et al. The prevention of hepatitis B with vaccine: report of the Centers for Disease Control multicenter efficacy trial among homosexual men. Ann Intern Med. 1982;97(3):362-366. doi: 10.7326/0003-4819-97-3-362.
20. CDC. Updated US Public Health Service Guidelines for the Management of Occupational Exposure to HBV, HCV and HIV and Recommendation for Post exposure Prophylaxis. MMWR 2001;50(RR11):1-42.
21. Poovorawan Y, Sanpavat S, Pongpunglert W, Chumdermpadetsuk S, Sentrakul P, Vandepapelière P, et al. Long-term efficacy of hepatitis B vaccine in infants born to hepatitis B e antigen-positive mothers. Pediatr Infect Dis J. 1992;11(10):816-821. doi: 10.1097/00006454-199210000-00002.
22. Acchammachary AA, Ubale M, Belurkar DD, Bhave PP, Malgaonkar AA, Kartikeyan S. A cross-sectional study of post-vaccination anti-HBs titer and knowledge of hepatitis B infection amongst medical students in a metropolitan city. Int J Res Med Sci. 2017;5(1):83-88. doi: http://dx.doi.org/10.18203/2320-6012.ijrms20164528.
23. Chaudhari C, Bhagat M, Shah T, Misra R. Antibody to Hepatitis B Surface Antigen in Vaccinated Health Care Workers. Med J Armed Forces India. 2008;64(4):329-332. doi: 10.1016/S0377-1237(08)80013-5.
24. 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(1):120. doi: 10.1186/1471-2334-7-120.
25. Wood RC, Macdonald KL, White KE, Hedberg CW, Hanson M, Osterholm MT. Risk factors for lack of detectable antibody following hepatitis B vaccination of Minnesota health care workers. J Am Med Assoc. 1993;270(24):2935-2939. doi:10.1001/jama.1993.03510240047030.
26. Aghakhani A, Banifazl M, Izadi N, McFarland W, Sofian M, Khadem-Sadegh A et al. Persistence of antibody to hepatitis B surface antigen among vaccinated children in a low hepatitis B virus endemic area. World J Pediatr 2011; 7(4):358-360. doi: https://doi.org/10.1007/s12519-011-0286-4.
27. Wick G, Grubeck-LoebensteinB. The aging immune system: primary and secondary alterations of immune reactivity in the elderly. Exp Gerontol. 1997;32(4-5):401-413. doi: 10.1016/s0531-5565(96)00152-0.
28. Bock H, Kruppenbacher J, Sanger R. Immunogenicity of a recombinant hepatitis B vaccine in adults. Arch Intern Med. 1996;156(19):2226-2231. doi:10.1001/archinte.1996.00440180088011.
29. Shaw FE, Guess HA, Roets JM. The effect of anatomic injection site, age and smoking on the immune response to hepatitis B Vaccination. Vac. 1989;7(5):425-430. doi: 10.1016/0264-410x(89)90157-6.
30. Arcavi L, N. L. Benowitz. Cigarette smoking and infection. Arch Intern Med. 2004;164(20):2206-2216. doi: 10.1001/archinte.164.20.2206.
31. Sopori M. 2002. Effects of cigarette smoke on the immune system. Nat Rev Immunol. 2002;2(5):372-377. doi: 10.1038/nri803.
32. Winter A. P., E. A. Follett, J. McIntyre, J. Stewart, I. S. Symington. 1994. Influence of smoking on immunological responses to hepatitis B vaccine.Vac.1994;12(9):771-772. doi: https://doi.org/10.1016/0264-410X(94)90283-6.
33. Nejad EM, Jafari S, Rabirad N. Hepatitis B virus antibody levels in high-risk health care workers. Hepat Mon. 2011;11(8):662-663. doi: 10.5812/kowsar.1735143X.707.
34. Weber DJ, Rutala WA, Samsa GP, Bradshaw SE, Lemon SM. Impaired immunogenicity of hepatitis B vaccine in obese person.N Engl J Med. 1986;314(21):1393. doi: 10.1056/NEJM198605223142120.
35. Dinelli MI, Moraes-Pinto MI. Seroconversion to hepatitis B vaccine after weight reduction in obese non-protective responder. Rev Inst Med Trop Sao Paulo. 2008;50(2):129-130. doi: 10.1590/s0036-46652008000200013.
36. Papathanassoglou E, El-Haschimi K, Li XC, Matarese G, Strom T, Mantzoros C. Leptin receptor expression and signaling in lymphocytes:kinetics during lymphocyte activation, role in lymphocyte survival, and response to high fat diet in mice. J Immunol .2006;176(12):7745-7752. doi: 10.4049/jimmunol.176.12.7745.
37. Floreani A, Baldo V, Cristofoletti M, Renzulli G, Valeri A, Zanetti C, et al. Long-term persistence of anti-HBs after vaccination against HBV: an 18 year experience in health care workers. Vac. 2004;22(5-6):607-610. doi: https://doi.org/10.1016/j.vaccine.2003.09.001.
38. Plotkin S, Orsenstein W, Offit P. Vaccines. Philadelphia: Elsevier, 2008.
39. Bauer T, Jilg W. Hepatitis B surface antigen-specific T and B cell memory in individuals who had lost protective antibodies after hepatitis B vaccination. Vac. 2006;24(5):572–577. doi: https://doi.org/10.1016/j.vaccine.2005.08.058
40. Wainwright RB, McMahon BJ, Bulkow LR, Parkinson AJ, Harpster AP. Protection provided by hepatitis B vaccine in a Yupik Eskimo population. Seven-year results. Arch Intern Med. 1991;151(8):1634-1636. doi: 10.1001/archinte.151.8.1634.
CITATION
DOI: 10.17511/jopm.2019.i10.09
Published: 2019-11-05
How to Cite
Kailas Badave, G., & Puneriya, P. (2019). Assessment of immune response to Hepatitis B vaccine by estimation of anti - HBs antibody titer among immunized health care workers. Tropical Journal of Pathology and Microbiology, 5(10), 807-814. https://doi.org/10.17511/jopm.2019.i10.09
Section
Original Article
OAI - Open Archives Initiative
