Vaccination against Viral Hepatitis A and B in Adults Aged over 40 Years – Antibody Persistence and Immune Memory
Authors:
R. Chlíbek; J. Smetana; V. Boštíková; M. Špliňo
Authors‘ workplace:
Fakulta vojenského zdravotnictví Univerzity obrany, Hradec Králové
Published in:
Epidemiol. Mikrobiol. Imunol. 60, 2011, č. 3, s. 99-108
Overview
Study objective:
Primary vaccination with combined vaccine against viral hepatitis A (VHA) and viral hepatitis B (VHB) induces higher anti-hepatitis B surface (anti-HBs) antibody responses and similar anti-hepatitis A virus (anti-HAV) antibody responses in adults aged over 40 years in comparison with concomitant monovalent vaccines against VHA and VHB. The objectives were to assess, in a clinical study, persistence of anti-HAV and anti-HBs antibodies in adults aged over 40 years four years after primary VHA/VHB vaccination and antibody response following a booster dose of the vaccine.
Material and Methods:
Five hundred and ninety-six subjects aged > 40 years were vaccinated with three doses of the combined VHA/VHB vaccine at Months 0, 1, 6 (HAB group) or with concomitant VHA and VHB vaccines at Months 0, 6 and 0, 1, 6 (ENG+HAV and HBVX+VAQ, respectively). Blood samples were collected one month following primary vaccination (Month 7) and then at one-year intervals for four years after the booster dose with the same vaccine as used for the primary vaccination. The anti-HBs and anti-HAV antibody levels were determined prior to the booster dose and at days 14 and 30 after the booster dose.
Results:
At Month 7, > 97 % of study subjects were seropositive for anti-HAV antibodies in all groups analyzed. Four years after primary vaccination, anti-HAV antibody seropositivity persisted in > 93 % of study subjects, increasing to > 99 % after the booster dose. At Month 7, the highest proportion of study subjects with anti-HBs antibody levels > 10 mIU/ml was found in the HAB group (91.7 % versus 79.7 % in the ENG+HAV group versus 71.0 % in the HBVX+VAQ group). Four years after vaccination, anti-HBs antibody levels of 10 mIU/ml persisted in 57.1 % of the HAB study subjects in comparison with 40.1 % and 26.6 % of the study subjects in the ENG+HAV and HBVX+VAQ groups, respectively. One month after the booster dose, anti-HBs antibody levels increased and antibody levels > 10 mIU/ml was achived in 95.2 % of study subjects in the HAB group, 90.5 % in the ENG+HAV group and 85.3 % in the HBVX+VAQ group.
Conclusion:
In the adults aged over 40 years, an adequate anti-HAV antibody response persisted for at least four years after vaccination and was higher and more sustained in those who received the combined HAB vaccine. A strong antibody response to the booster dose indicative of the presence of immune memory was seen in all study groups.
Key words:
vaccination – hepatitis – booster dose – immune memory – protection
Sources
1. Advisory Committee on Immunization Practices (ACIP), Fiore, A. E., Wasley, A., Bell, B. P. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep., 2006, 55, p. 1–23.
2. Brown, G. R., Persley, K. Hepatitis A epidemic in the elderly. South Med. J., 2002, 95, p. 826–833.
3. Centers for Disease Control and Prevention (CDC). Defining overweight and obesity. Dostupné na www: http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm. Accessed January 2010.
4. Cooper, M. C. The elderly travellers. Travel Med. Infect. Dis., 2006, 4, p. 218–222.
5. European Consensus Group on hepatitis B Immunity. Are booster immunisation needed for lifelong hepatitis B imunity? Lancet, 2000, 355, p. 561–565.
6. Genton, B., D’Acremont, V., Furrer, H. J. et al. Hepatitis A vaccines and the elderly. Travel Med. Infect. Dis., 2006, 4, p. 303–312.
7. Hepatitis B. Dostupné na www: http://www.cdc.gov/ vaccines/pubs/pinkbook/downloads/hepb.pdf. Accessed February 2011.
8. Höhler, T., Groeger-Bicanic, G., Hoet, B. et al. Antibody persistence and immune memory elicited by combined hepatitis A and B vaccination in older adults. Vaccine, 2007, 25, p. 1503–1508.
9. Chen, W. H., Kozlovsky, B. F., Effros, R. B. et al. Vaccination in the elderly: an immunological perspective. Trends Immunol., 2009, 30, p. 351–359.
10. Chlíbek, R., Smetana, J., Šindelář, R. et al. Imunogenita vakcín proti virovým hepatitidám A a B u osob starších 40 let – vliv rizikových faktorů. Epidemiologie, mikrobiologie, imunologie, 2007, 56, 3, p. 119–128.
11. Chlíbek, R., Von Sonnenburg, F., Van Damme, P. et al. Antibody Persistence and Immune Memory 4 Years Post-Vaccination With Combined Hepatitis A and B Vaccine in Adults Aged Over 40 Years. J. Travel Med., 2011, 8, 2, p. 145–148.
12. Leder, K., Weller, P. F., Wilson, M. E. Travel vaccines and elderly persons: review of vaccines available in the United States. Clin. Infect. Dis., 2001, 33, p. 1553–1566.
13. Mutsch, M., Spicher, V. M., Gut, C. et al. Hepatitis A virus infections in travelers, 1988 –2004. Clin. Infect. Dis., 2006, 42, p. 490–497.
14. Nothdurft, H. D. Hepatitis A vaccines. Expert Rev. Vaccines, 2008, 7, p. 535–545.
15. Nothdurft, H. D., Zuckerman, J., Stoffel, M. et al. Accelerated vaccination schedules provide protection against hepatitis A and B in last-minute travelers. Travel Med., 2004, 11, p. 260–262.
16. Sawabe, M., Arai, T., Esaki, Y. et al. Fulminant hepatic failure in the elderly: a clinicopathological study of autopsy cases aged over 65 years. Pathol. Int., 2000, 50, p. 98–105.
17. Sonder, G. J. Hepatitis B vaccination in travellers. Expert Rev. Vaccines, 2008, 7, p. 673–677.
18. Spira, A. M. A review of combined hepatitis A and hepatitis B vaccination for travellers. Clin. Ther., 2003, 25, p. 2337–2351.
19. Stoffel, M., Lievens, M., Dieussaert, I. et al. Immunogenicity of Twinrix™ in older adults: a critical analysis. Expert Rev. Vaccines, 2003, 2, p. 9–14.
20. Van Damme, P., Van Herck, K. A review of the efficacy, immunogenicity and tolerability of a combined hepatitis A and B vaccine. Expert Rev. Vaccines, 2004, 3, p. 249–267.
21. Van Damme, P., Van Herck, K. A review of the long--term protection after hepatitis A and B vaccination. Travel Med. Infect. Dis., 2007, 5, p. 79–84.
22. Van der Wielen, M., Van Damme, P., Chlibek, R. et al. Hepatitis A/B vaccination of adults over 40 years old: comparison of three vaccine regimens and effect of influencing factors. Vaccine, 2006, 24, p. 5509–5515.
23. Van Damme, P., Van Herck, K. A review of the efficacy, immunogenicity and tolerability of a combined hepatitis A and B vaccine. Expert Rev. Vaccines, 2004, 3, p. 249–267.
24. Van Herck, K., Leroux-Roels, G., Van Damme, P. et al. Ten-year antibody persistence induced by hepatitis A and B vaccine (Twinrix™) in adults. Travel Med. Infect. Dis., 2007, 5, p. 171–175.
25. Wasley, A., Fiore, A., Bell, B. P. Hepatitis A in the era of vaccination. Epidemiol. Rev., 2006, 28, p. 101–111.
26. World Health Organization. International travel and health 2010. Dostupné na www: http://www.who.int/ith/ ITH2010.pdf. Accessed January 2011. Accessed January 2011.
27. World Health Organization International travel and health: situation as on 1 January 2009. Dostupné na www: http://www.who.int/ith/ITH_2009.pdf. Accessed January 2010.
28. Wolters, B., Müller, T., Ross, S. et al. Comparative evaluation of the immunogenicity of combined hepatitis A and B vaccine by a prospective and retrospective trial. Hum. Vaccines, 2009, 5, p. 248–253.
29. Zanetti, A. R., Van Damme, P., Shouval, D. The global impact of vaccination against hepatitis B: a historical overview. Vaccine, 2008, 26, p. 6266–6273.
Labels
Hygiene and epidemiology Medical virology Clinical microbiologyArticle was published in
Epidemiology, Microbiology, Immunology
2011 Issue 3
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