ANTIBODY TITRATION AND IMMUNE RESPONSE OF IRANIAN â-THALASSEMIC PATIENTS TO HEPATITIS B VIRUSE VACCINE (BOOSTER EFFECT)

May 18, 2009

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ANTIBODY TITRATION AND IMMUNE RESPONSE OF IRANIAN â-THALASSEMIC PATIENTS TO

HEPATITIS B VIRUSE VACCINE (BOOSTER EFFECT)

Authors: Azita Azarkeivan a; Gharib Karimi b; Mojgan Shaiegan b; Mahtab

Maghsudlu b; Ali Tabbaroki b

Affiliations: a Iranian Blood Transfusion Organization Research Center and

Tehran Thalassemia Clinic, PGIMER, Tehran, Iran

b Iranian Blood Transfusion Organization Research Center, Tehran, Iran

DOI: 10.1080/08880010902895900

Publication Frequency: 8 issues per year

Published in: Pediatric Hematology and Oncology, Volume 26, Issue 4 May 2009 ,

pages 195 - 201

Subjects: Oncology: Hematologic Oncology; Hematology: Hematologic Oncology;

Pediatrics & Child Health;

Abstract

Background: Thalassemia is hereditary anemia with lifelong transfusion as

treatment and hepatitis B virus (HBV) infection is one of the transfusion

transmitted infections (TTI). HBV vaccinination is obligatory for these patients

by 3 double-dose injections. The authors studied the HBV status and immune

response to vaccination by hepatitis B surface antibody (HBsAb) titration in

their thalassemic patients. They also compared these results with their previous

study to find out the effectiveness of a booster dose in the immunity of

patients against HBV. Materials and Methods: Hepatitis B surface antigen

(HBsAg), HBsAb, and hepatitis B core antibody (HBcAb) were detected in sera of

416 patients at the Tehran Adult Thalassemia Clinic. The immune status was

classified into 4 categories: (1) immune to HBV via the vaccination (positive

vaccinal)-if HBs Ag: negative, HBsAb: positive, HBcAb: negative; (2) immune to

HBV via the natural disease (past infection)-if HBs: negative, HBsAb and HBcAb:

both positive; (3) nonimmune to HBV (negative)-if all three parameters were

negative; (4) carrier of HBV (carrier state)-if HBs Ag was positive and HBsAb

and HBc Ab: both negative. Also grading of immunity done by HBsAb titration as

positive if HBsAb titer was more than 100 IU/mL, negative if HBsAb titer was

less than 10 IU/mL, and weakly positive if antibody level was 10-100 IU/mL.

Results: There were 416 patients: 302 (72.5%) with thalassemia major , 104

(25%) thalssemia intermedia (TI), 7 (1.6%) sickle thalassemia (ST), and 3(0.7%)

-thalassemia (HbH disease). The mean age was 25.6 ± 8.3 yr and median age was 24

yr; there were 247 (59.4%) males and 169 (40.6%) females. A total of 257

patients (61.7%) were splenectomized. According to our classification 289

(69.4%) were immunized by vaccination; 80 (19.2%) were immunuzed by past

infection; 44 (10.5%) were negative, and 3 (0.7%) were in carrier state of HBV.

In grading of immunity to HBV vaccination, 319 (76.6%) patients had HBsAb> 100

IU/mL (positive), 77 (18.5%) between 10 and 100 IU/mL (weakly positive), and 20

(4.8%) less than 10 IU/mL (negative). There was no significant correlation

between the level of HBsAb and spelenectomy or type of thalassemia. Conclusion:

Response rate to vaccination is more than 95% after complete course (3 doses) in

healthy individuals but failure to fulfill vaccination seems a problem in

chronic transfused patients. These results reflect advantages of a booster dose

of vaccine, which increased the protection level among these high-risk patients

from 46.9% (in the authors' previous data) up to 69.4% in this study.

May 18, 2009