Hepatitis-B vaccine Essays

Hepatitis-B vaccine Essays Hepatitis-B vaccine Essay Hepatitis-B vaccine Essay ESCALETED DOSE OF HEPATITIS-B VACCINE IN CHILDHOOD HAEMATOLOGICAL MALIGNANCIES WHILE ON CHEMOTHERAPY. Abstract. This prospective survey was conducted to happen out an effectual inoculation agenda against hepatitis B infection for the kids with haematological malignances. 60 patients between 2-15 old ages with haematological malignances on chemotherapy, negative for HBsAg and neer vaccinated for HBV before, were vaccinated with 40 mgm of vaccinum at 0, 1 and 2 months. The antibody titre was measured 6 hebdomads after disposal of last dosage and analyzed. Out of 60 enrolled, 5 died during the class of intervention and 4 dropped out before completion, go forthing 51 for concluding analysis. More than 70 % exhibited protective degree of antibody ( A ; gt ; 10 mIU/ml ) against hepatitis B virus. There was no important consequence of age or sex on the antibody response, although it was higher among misss ( 90.9 % ) than male childs ( 65 % ) . Patients of non-Hodgkin s lymphoma were found to be in a better position to exhibit antibody response, compared to the leukemic kids ( P = 0.024 ) .This surve y concluded that haematological malignant neoplastic disease patients should be vaccinated with escalated doses of the vaccinum alternatively of the conventional doses. Introduction In childhood malignances, hepatitis B infection remains a major co-morbid status, which may impact the result of intervention ( Indolfi P et Al, 1992 ) . The high hazard for developing hepatitis B infection is due to immunosuppression secondary to chemotherapy, radiation therapy, multiple blood transfusions, endovenous medicines, every bit good as repeated invasive probes ( Meral A et Al, 2000 ) . Treatment with immunosuppressive drugs enhances the possibility farther of developing chronic bearer province or reactivation of HBV infection in symptomless bearers ( Ramesh M et Al, 2000 ) . This plays an inauspicious predictive function in their disease-free endurance because of holds in chemotherapy ( Meral A et Al, 2000 ) . Sing this high hazard of infection, kids with malignant neoplastic disease should be routinely vaccinated against hepatitis B. However, several surveies have shown that if vaccinated with conventional doses and agenda, the antibody titre against hepatitis B did non make the protective degree due to impaired immune response ( Indolefi P et Al, 1992 ; Mannan MA and Ghosh NK, 2003 ; Somjee S et Al, 1999 ) . We antecedently vaccinated 131 kids with malignant neoplastic diseases aged 2-15 old ages and 100 otherwise healthy kids of same age as control. All these kids were negative for hepatitis B markers. The dose and inoculation agenda used was 10 A ; micro ; gram for age A ; lt ; 10 old ages and 20 A ; micro ; gram for age A ; gt ; 10 old ages vaccinated at 0, 1 and 6 moths. The protective antibody degree ( A ; gt ; 10 IU/L ) measured 6 hebdomads after the last dosage was 10 % in the studied group compared to 98 % in the controls ( Mannan MA and Ghosh NK, 2003 ) . Several surveies have shown that utilizing the conventional dose of 10 and 20 A ; micro ; gram, a farther 4th, 5th or even 6th dose agenda as 0,1,2 and 6 ; 0,1,2,6 and 12 and 0,1,2,3,4 and 12 did non assist significantly to increase the antibody titre ( Mannan MA and Ghosh NK,2003 ; Drachman R et al,1989 ; Yetgin S et Al, 2001 ) . We, hence, decided to transport out the present survey with an escalated dose of 40 A ; micro ; gram of hepatitis B vaccinum ( Engerix B ) , irrespective of age, in childhood malignant neoplastic disease patients utilizing a agenda of 0, 1 and 2. Antibody titre was measured 6 hebdomads after disposal of the last dosage and if found amp ; gt ; 10 IU/L, was considered as protective. MATERIALS AND METHODS The survey was conducted at Bangabondhu Sheikh Mujib Medical University ( BSMMU ) , Dhaka from January to September 2006. Children go toing the Out-Patient and In-Patient Clinics of Pediatric Hematology and Oncology Department at BSMMU and a Private Clinic of a Pediatric Haemato-Oncology Specialist in Dhaka were recruited for the survey. The age bound was between 2 to 15 old ages with a diagnosing of either Leukemia or Lymphoma. All the kids recruited were in the care stage of chemotherapy and antecedently non vaccinated for hepatitis-B. Those with HBsAg positive every bit good as anti HBsAg positive were excluded. A entire figure of 60 kids were enrolled for the survey. An informed written consent was obtained from the parents. The households were besides informed that they would be able to retreat their kids from the survey at any clip they wanted ( Helsinki Declaration for Medical Research Involving Human Subjects 1964 ) . Inoculation plan: Recombinant hepatitis-B vaccinum was given intramuscularly at 40 mgm per dosage at 0, 1 and 2 months, irrespective of age. The generic merchandise of Glaxo-Smithkline Pharmacuticals Ltd. ( Engerix-B ) was used for the survey. Blood trial was performed utilizing Kit- ELISA method to mensurate antibody for HBsAg 6 hebdomads after disposal of the 3rd dosage. Antibody titre A ; gt ; 10 mIU/ml was considered as protective. Detail information about the kid, haematological malignance including type, phase, age at diagnosing, specific intervention for malignance and present wellness position were collected from the medical and research lab records. Inoculation day of the month and blood trial studies were recorded meticulously. All informations were plotted and analyzed utilizing the SPSS for Windows ( Version 10.2 ) . Descriptive analysis was performed that included chi-square trial, mean, average and SD. Cut off p-value or degree of significance was A ; lt ; 0.05. Consequence A sum of 60 patients of were enrolled into the survey. Five of them died of the disease before mensurating antibody degrees and 4 dropped out during follow up. Therefore, entire 51 patients remained for concluding analysis. The age bound was between 2 to 15 old ages ; 17 ( 33.3 % ) were below 5 old ages of age, 28 ( 54.9 % ) were between 5 to 10 old ages and the remainder 6 ( 11.8 % ) were above 10 old ages ( Table I ) . On the other manus, a sum of 40 ( 78 % ) patients were male, and merely 11 ( 22 % ) were female ( Fig 1 ) . Table I. No of per centum of patients by age ( n = 51 ) : Age ( yrs ) # % A ; lt ; 5 17 33.3 5 10 28 54.9 A ; gt ; 10 06 11.8 Average = ( 6.16 A ; plusmn ; 3.14 ) old ages ; scope = ( 2 15 ) old ages. Out of 51 patients, 29 ( 56.9 % ) were diagnosed as holding leukaemia and the remainder 22 ( 43.1 % ) had lymphoma. Out of those 29 with leukaemia, 26 ( 51 % of entire 51 ) had ALL and 3 ( 5.9 % of 51 ) had AML. On the other manus, out of 22 with lymphoma, 20 ( 39.2 % of 51 ) had non-Hodgkin s Lymphoma, and the remainder 2 ( 3.9 % of 51 ) had Hodgkin s lymphoma ( Table II ) . Table II. No of per centum of patients by diagnosing ( n = 51 ) : Diagnosis No % ALL 26 51.0 AML 03 5.9 Hodgkin s disease 02 3.9 Non-Hodgkin s lymphoma 20 39.2 Table III shows the per centum of patients by antibody response in the blood measured 6 hebdomads after disposal of 3rd dosage of hepatitis B vaccinum. Over 70 % of the patients demonstrated protective degree of antibody. The average antibody degree was 125.0 A ; plusmn ; 17.09 mIU/ml. Table III. No of per centum of patients by antibody response ( n = 51 ) : Antibody titre ( mIU/ml ) No % A ; lt ; 10 15 29.4 A ; sup3 ; 10 36 70.6 # Median = ( 125.0 A ; plusmn ; 17.09 ) mIU/ml. Table IV. Association between age and antibody response ( n = 51 ) : Age ( year ) Antibody titre ( mIU/ml ) p-value # A ; lt ; 10 ( n = 15 ) A ; sup3 ; 10 ( n = 36 ) A ; lt ; 5 5 ( 33.3 ) * 12 ( 33.3 ) 0.752 5 10 1 ( 6.7 ) 5 ( 13.9 ) A ; lt ; 10 9 ( 60.0 ) 19 ( 52.8 ) * s in the parentheses denote matching % . # Chi-square ( c2 ) Trial was done to analyse the information ; degree of significance was 0.05. Table IV shows the association of age with antibody response. No peculiar age group was found to be more immunogenic than the others to show antibody response following hepatitis B inoculation ( p A ; gt ; 0.05 ) . Table V. Association between sex and antibody response ( n = 51 ) : Sexual activity Antibody titre ( mIU/ml ) p-value # A ; lt ; 10 ( n = 15 ) A ; sup3 ; 10 ( n = 36 ) Male 14 ( 35.0 ) 26 ( 65.0 ) 0.093 Female 1 ( 9.1 ) 10 ( 90.9 ) * s in the parentheses denote matching % . # Fisher s Exact Test was done analyze the information ; degree of significance was 0.05. Table V demonstrates the association between sex and antibody response. The proportion of misss developing protective antibody was observed to be higher ( 90.9 % ) than that of male childs ( 65.0 % ) . However, the difference did non make the degree of significance ( p A ; gt ; 0.05 ) . Table VI. Association between diagnosing and antibody response ( n = 51 ) : Diagnosis Antibody titre ( mIU/ml ) p-value # A ; lt ; 10 ( n = 15 ) A ; sup3 ; 10 ( n = 36 ) Leukemia 11 ( 37.9 ) * 18 ( 62.1 ) 0.125 Lymphoma 4 ( 18.2 ) 18 ( 81.8 ) * s in the parentheses denote matching % . # Fisher s Exact Test was done analyze the information ; degree of significance was 0.05. Table VI demonstrates the antibody response of patients based on diagnosing. The patients with lymphoma exhibited a higher rate of protective antibody degree ( 81.8 % ) than the patients with leukaemia ( 62.1 % ) , although the difference did non turn to be important ( P A ; gt ; 0.05 ) . Table VII. Association between type of malignance and antibody titre ( n = 51 ) : Type of malignance Antibody titre ( mIU/ml ) p-value # A ; lt ; 10 ( n = 15 ) A ; sup3 ; 10 ( n = 36 ) ALL 10 ( 38.5 ) * 16 ( 61.5 ) 0.024 AML 1 ( 33.3 ) 2 ( 66.7 ) Hodgkin 2 ( 100.0 ) 00 Non-Hodgkin 2 ( 10.0 ) 18 ( 90.0 ) * s in the parentheses denote matching % . # Chi-square ( c2 ) Trial was done to analyse the information ; degree of significance was 0.05. Table VII demonstrates that 90 % of the non-Hodgkin s lymphoma had protective degree of antibody, while 61.5 % of ALL and 65.7 % of AML had protective degree of antibody. The association between non-Hodgkin s disease and antibody response against hepatitis B inoculation was found to be important ( p = 0.024 ) . Discussion Hepatitis B inoculation can bring on seroconversion in 65-95 % of healthy kids ( Jilg W et Al, 1989 ) . The present survey demonstrated that more than 70 % of the topics developed protective degree of antibody titre ( A ; gt ; 10 mIU/ml ) 6 hebdomads after disposal of 3rd dosage of 40 mgm of recombinant HBV vaccinum. No unwanted side-effects, except hurting and inflammation at the site of injection, were encountered by the topics. In our old survey where 10 mgm of vaccinum was used in kids A ; lt ; 10 old ages of age and 20 mgm in older kids at 0, 1 and 6 months, the protective degree of antibody in the malignant neoplastic disease group measured 6 hebdomads after the last dosage was merely 10 % compared to 98 % in the control opposite number ( p A ; lt ; 0.01 ) ( Mannan MA and Ghosh NK, 2003 ) . In the 2nd stage of the same survey, inoculation plan was rescheduled with figure of doses increased from 3 to 4 and were given at close intervals ( 0, 1, 2 and 6 months ) . The consequen ces obtained showed that protective antibody degree in malignant neoplastic disease group reached from enormously low 10 % to 57 % ( unpublished information ) . Three series of surveies therefore conducted show that escalated dose aid a considerable figure of immune-compromised kids grow protective degree of antibody against hepatitis B. Meral et Al utilizing an escalated dosage at 0, 1, 2 and 12 months achieved a serconversion rate of 75 % in patients with haematological malignances following first three doses and 86 % after completion of 4 doses bearing consistence with findings of the present survey. In the present survey a significantly higher proportion of lymphoma patients demonstrated higher degrees of protective antibody ( 90 % ) than that in leukaemia ( 61.5 % ) . Meral s survey, on the other manus, showed that patients with lymphoma had the least response compared to patients with leukaemia and solid tumours ( p = 0.0003, P = 0.0161 ) . The ground of this disagreement might be that in our survey bulk of the lymphoma patients had non-Hodgkin s disease, whereas in their survey most of the kids with lymphoma had Hodgkin s disease, which might play a function in the lessened response to inoculation owing to basic cellular immune upsets associated with the disease ( Goyal S et Al, 1998 ) . Furthermore, in their survey, the kids with lymphoma and solid tumours were vaccinated at diagnosing when they had the most intensive chemotherapy. This might do more immunosuppression in them. Pervious similar surveies besides demonstrated impaired immune response to active inoculation in ki ds with leukaemia during intensive chemotherapy ( Hudson MM and Donaldson SS, 1997 ; Berberoglu S et Al, 1995 ) . In the Meral s survey, 86 % of the to the full immunized kids ( 4 doses completed ) developed lasting anti-HBs positiveness. Serconversion rates with regard to diagnosis were 90.3 % in leukaemia, 74 % in lymphoma and 94.4 % in solid tumours. Serpositivity increased from 48 % to 74 % in lymphoma and from 77 % to 94 % in solid tumours after 4th dosage. Berberoglu et Al, besides demonstrated that seropositivity increased from 56 % at 6 months to 70.5 % at 12 months after the 4th dosage. A inoculation plan was conducted by Indolfi et Al, on 80 patients aged between 1-15 old ages, holding negative serology for hepatitis-B and with normal liver map utilizing a recombinant DNA hepatitis-B vaccinum at doses of 40 mgm at close intervals ( 0, 1, 2 months ) with a supporter dosage at one twelvemonth. A 4th dosage ( 40 mgm ) was given at the 4th month to patients who did non react to three doses. Sixty-one kids, 38 with diagnosing of leukemia/lymphoma and 23 with solid tumours, completed the scheduled class. Over half ( 52.45 % ) of the topics responded with anti-HBs titre of A ; gt ; 10 mIU/ml further stressing the significance of escalated dosage of HBV inoculation in immune-compromised kids. However, studies of low antibody response even after utilizing escalated dose and figure of inoculation is no less. Ramesh et Al, showed that merely 28.6 % of the topics mounted an antibody response making protective value of A ; gt ; 10 mIU/ml after four dual doses of recombinant hepatitis B vaccinum. Similar observations were in an earlier survey ( Hudson MM and Donaldson SS, 1997 ) where merely a 3rd ( 32 % ) of the paediatric malignant neoplastic disease patients on chemotherapy mounted a protective response with figure of respondents being similar in haematological and solid malignances. Rokicka-Milewska et Al, administered active immunisation in kids with leukaemia and lymphoma. They showed that antibody titres were much higher in patients vaccinated after surcease of chemotherapy than those vaccinated in the class of care intervention. Goyal et Al, vaccinated leukemic kids at diagnosing, and merely 10.5 % of them had protective antibody titres. In their survey, 48.8 % of kids were infected with HBV. Their informations demonstrated that inoculation during the intensive chemotherapy period was non effectual. This might be a consequence of immunosuppression induced by both the disease and the intervention with cytotoxic drugs that diminished the response to inoculation. Therefore inactive immunisation with hyper Ig followed by active immunisation after the surcease of intensive chemotherapy could be a better option in these kids. Pilecki O et Al, used both inactive and active immunisation in kids with haematological proliferative diseases. They besides reported that usage of both active and inactive immunisation helped cut downing the rate of HBV infection aggressively from 43.3 % to 2.56 % . Surveies sing hepatitis B inoculation in kids with malignant neoplastic disease have observed the effects of age, sex and tumour and vaccinum type on antibody response. This response has been reported to be better in kids younger than 10 old ages and in misss ( Berberoglu S et Al, 1995 and Hollinger BF, 1989 ) . Different surveies stated that highest antibody responses were obtained in solid tumour groups since impaired figure of maps of lymph cells cause hapless vaccinum response in lymphoreticular malignances ( Meral A et Al, 2000 ; Hudson MM and Donaldson SS, 1997 ; Lehmbecher T et Al, 1997 ) .Corapcioglu et Al, nevertheless, did non happen any consequence of age and sex vaccinum and tumour type on antibody response. In our survey, no important consequence of age on antibody response was revealed. However, protective degree of antibody was demonstrated to be higher among misss ( 90.9 % ) than that among male childs ( 65 % ) , although the difference did non make the degree of sign ificance ( p = 0.093 ) . As serconversion was compared in footings of tumour type, patients of non-Hodgkin s lymphoma were found to be in a better place to exhibit important degree of antibody, compared to the leukemic kids ( P = 0.024 ) . Decision This present survey concludes that haematological malignant neoplastic disease patients classified as A ; lsquo ; non-responders after being vaccinated with conventional doses are really non so. Rather, they need a higher dosage to excite their already compromised immune system, because most of these kids responded to the escalated dosage of the vaccinum. Mentions Berberoglu S, Buyukpamukco M, Sarialioglu F et Al. Hepatitis B inoculation in kids with malignant neoplastic disease. Pediatr Hematol Oncol 1995 ; 12: 171-78. 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Indian Pediatrics 2000 ; 37: 882-86. Rokicka-Milewska R, Jackoska T, Sopylo B et Al. Active immunisation of kids with leukaemia and lymphomas against infection by hepatitis B virus. Acta Pediatr Jpn 1993 ; 35: 400-3. Somjee S, Pai S, Kelkar R, Advani S. Hepatitis-B Vaccination in Children with Acute Lymphoblastic Leukemia: Consequences of an Intensified Immunization Schedule. Leuk Res 1999 ; 23 ( 4 ) : 365-67. Yetgin S, Tunc B, Koc A, Toksoy HB, Ceyham M, Kanra G. Two supporter dosage Hepatitis B virus inoculation in patients with leukaemia. Leukemia Research 2001 ; 25: 647-49.