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Published in Ken Addley, MCQs, MEQs and OSPEs in Occupational Medicine, 2023
Best fit. A larger or additional vaccine dose may be required to induce protective antibodies in immunocompromised people. A titre of less than 10 mIU/ml is regarded as a non-responder after full vaccination and repeat course plus serology for previous infection. The HBeAg restrictions were removed by UKAP and viral load is the determining factor for EPPs. Hepatitis B vaccine can be given to the immunosuppressed though they may have a limited response. Through monitoring hepatitis B, seroconversions have been very rare. Non-responders can engage in EPPs but will need to comply with regular testing as per UKAP advice.
Human Immunodeficiency Virus (HIV)
Published in S Paige Hertweck, Maggie L Dwiggins, Clinical Protocols in Pediatric and Adolescent Gynecology, 2022
Kimberly Huhmann, Andrea Zuckerman
Hepatitis B and C: Screen at entry of care and as needed based on risk thereafter.Hepatitis B vaccine recommended if patient does not have chronic hepatitis B and/or is not immune.
Prenatal Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Gabriele Saccone, Kerri Sendek
COVID vaccine is safe in pregnancy and should be recommended, as in non-pregnant adults. Immunity to rubella, varicella, hepatitis B, influenza, tetanus, and pertussis should be assessed at the first prenatal visit [105]. Ideally, needed vaccinations would be provided preconception. There is no vaccine that is more dangerous to a pregnant woman or her fetus than the disease it is designed to prevent. Recombinant, inactivated, and subunit vaccines, as well as toxoids and immunoglobulins, pose no threat to a developing fetus. Inactivated influenza vaccine should be given by injection, as killed virus to all pregnant women during the influenza season. The live attenuated form of the vaccine (intranasal spray) should not be given during pregnancy. Hepatitis B vaccine can be safely given in pregnancy. Tetanus, diphtheria, and acellular pertussis vaccine, also known as TDAP or “whooping cough” vaccine, is recommended for all pregnant women after 28 weeks (see Table 1.5 in Chaps. 1 and 40 in Maternal-Fetal Evidence Based Guidelines).
Duration of immunogenicity of high-dose and prolonged-schedule hepatitis B vaccine among patients with chronic kidney disease: A one year follow-up study in China
Published in Expert Review of Vaccines, 2022
Yujie Han, Na Cao, Xiaoxiao Lu, Tian Yao, Jing Shi, Yuanting Wu, Shuang Dong, Zhihong Shao, Jianmin Wang, Hongting Liu, Hongping Guo, Guowei Chai, Liming Liu, Fuzhen Wang, Yongliang Feng, Xiaofeng Liang, Suping Wang
Data from longitudinal studies of healthy adults after a standard vaccination regimen indicated that a decrease in the anti-HBs concentrations to less than 10 mIU/mL is not considered a loss of protection in these immunocompetent individuals due to the role of immunological memory [33]. Despite the waning concentration of anti-HBs, a full primary course of hepatitis B vaccine confers protection against acute clinical disease and chronic hepatitis B infection for long periods of time [33]. A previous study showed that the protective effect of anti-HBs in responders after hepatitis B vaccination generally lasts at least 30 years, which is why no follow-up of anti-HBs concentration is needed in a healthy population [20]. In contrast, in CKD patients, the cellular immune response may be impaired when the anti-HBs concentrations are less than 10 mIU/mL, resulting in insufficient protection from HBV infection [34]. Consequently, optimizing the immunization regimen to improve the duration of immunogenicity has become a priority and crucial strategy.
Pharmacological approaches to prevent vertical transmission of HIV and HBV
Published in Expert Review of Clinical Pharmacology, 2022
Emanuela Zappulo, Agnese Giaccone, Nicola Schiano Moriello, Ivan Gentile
Ideally the best way to prevent MTCT transmission of HBV would be to prevent ab initio the infection in the mother, this is achievable through vaccination. The first vaccine for B hepatitis was available from the beginning of ’80, a second generation of vaccine, more safe and economical to produce was developed a few years later through the use of recombinant DNA technology [42]. Most of the countries in the world (97%) had included vaccination for HBV in their immunization schedule [43]. Despite this fact, and a strong recommendation by WHO to an universal vaccination against HBV [23] there are still some substantial variation in particular between the nation of western world and less developed countries [44]. Women that had not been vaccinated for HBV during childhood can be vaccinated before or even during pregnancy (especially if they have risk factors for contracting HBV) as no adverse effect for the mother or the offspring have been noted [45]. Recently a new kind of recombinant HBV vaccine with a novel immunostimulatory sequence adjuvant has been made available (Heplisav-B). This vaccine should reach higher seroconversion rates, especially in people with an impaired immune function [46]. However there are not enough data to assess its safety during pregnancy, a dedicated pregnancy registry has been established and more evidence should come in the following years.
Immunogenicity and safety of 4 intramuscular standard-dose and high-dose hepatitis B vaccine in people living with HIV: a randomized, parallel-controlled trial
Published in Expert Review of Vaccines, 2022
Yongliang Feng, Zhuanzhuan Chen, Ruixue Xie, Tian Yao, Yuanting Wu, Feng Yang, Chenli Yuan, Xiaoyong Nie, Fuzhen Wang, Xiaofeng Liang, Suping Wang
China’s latest guidelines for the prevention and treatment of chronic hepatitis B recommend that the hepatitis B vaccine dose (e.g. 60 μg) and the number of injections, be increased in populations with impaired immunity or suboptimal response [18]. In our earlier randomized controlled trial to evaluate the immunogenicity of the 20 and 60 μg hepatitis B vaccine dose, compared with the 20 μg vaccine, in PLHIV, in China, the three high-dose (60 µg) hepatitis B vaccine did not yield a significant increase in immunogenicity and persistence among PLHIV (P > 0.05) [19]. Thus, we increased the number of dose of the hepatitis B vaccine in this study, administering up to four intramuscular standard- and higher-dose (60 μg) regimens. We report an extended follow-up in this randomized parallel controlled trial to explore the immunogenicity and safety of the four intramuscular doses of either 60 µg or 20 µg regimens, compared with the standard hepatitis B vaccine regimen in PLHIV.