SEROLOGICAL CHANGES AGAINST HEPATITIS B SURFACE ANTIGEN IN CHILDREN AND ADOLESCENTS RECEIVING CHEMOTHERAPY FOR ACUTE LEUKEMIA
Main Article Content
Keywords
Chemotherapy; Hematological malignancy; Hepatitis B vaccine; Hepatitis B virus
Abstract
Background: Vaccination for hepatitis B virus (HBV) after chemotherapy among pediatric patients with acute leukemia is still a debated issue. We investigated HBV immunity before and after chemotherapy and assessed immune response to re-vaccination after chemotherapy.
Methods: We retrospectively analyzed data of children and adolescents aged <19 years requested for vaccination after chemotherapy for acute leukemia to evaluate hepatitis B surface antibody (HBsAb) status before and after chemotherapy and to identify factors related to HBsAb positivity after chemotherapy.
Results: Of 89 enrolled patients, 61 (68.5%) with acute leukemia were HBsAb positive before chemotherapy. Of these 61 patients, 48 (78.7%) seroconverted to HBsAb negative status after chemotherapy; there were 76 (85.4%) HBsAb negative patients after chemotherapy. HBsAb positive patients when compared to HBsAb negative patients after chemotherapy had a significantly higher HBsAb positive rate (100.0% vs. 63.2%, p=0.008) before chemotherapy. Following HBsAb testing after one dose of the HBV vaccination, 33 (43.4%) of the 76 HBsAb negative patients seroconverted to a HBsAb positive status. HBsAb positive patients after a single dose of HBV vaccination had a significantly higher HBsAb positive rate at the time of diagnosis compared to HBsAb negative patients (84.8% vs. 48.8%, p=0.001).
Conclusions: Based on these results, HBV re-vaccination after chemotherapy is recommended for all children and adolescents with acute leukemia. In addition, further investigation is required to improve the immunogenicity of HBV re-vaccination.
Keywords: Acute Leukemia; Chemotherapy; Hepatitis B vaccine; Hepatitis B virus; Child.
Downloads
Abstract 796
PDF Downloads 586
HTML Downloads 141
References
2. World Health Organization. Hepatitis B vaccines: WHO position paper – July 2017. Wkly Epidemiol Rec. 2017;92:369-392.
3. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, Bousvaros A, Dhanireddy S, Sung L, Keyserling H, Kang I; Infectious Diseases Society of America. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58:e44-100.
4. Fioredda F, Plebani A, Hanau G, Haupt R, Giacchino M, Barisone E, Balbo L, Castagnola E. Re-immunisation schedule in leukaemic children after intensive chemotherapy: a possible strategy. Eur J Haematol. 2005;74:20-23.
5. Fayea NY, Kandil SM, Boujettif K, Fouda AE. Assessment of hepatitis B virus antibody titers in childhood cancer survivors. Eur J Pediatr. 2017;176:1269-1273.
6. Viana SS, Araujo GS, Faro GB, da Cruz-Silva LL, Araujo-Melo CA, Cipolotti R. Antibody responses to Hepatitis B and measles-mumps-rubella vaccines in children who received chemotherapy for acute lymphoblastic leukemia. Rev Bras Hematol Hemoter. 2012;34:275-279.
7. Zignol M, Peracchi M, Tridello G, Pillon M, Fregonese F, D'Elia R, Zanesco L, Cesaro S. Assessment of humoral immunity to poliomyelitis, tetanus, hepatitis B, measles, rubella, and mumps in children after chemotherapy. Cancer. 2004;101:635-641.
8. Mikulska M, Cesaro S, de Lavallade H, Di Blasi R, Einarsdottir S, Gallo G, Rieger C, Engelhard D, Lehrnbecher T, Ljungman P, Cordonnier C; European Conference on Infections in Leukaemia group. Vaccination of patients with haematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019;19:e188-199.
9. Choung JM, Kim JC, Eun SH, Hwang PH, Nyhambat B, Kilgore P, Kim JS. Study on vaccination state in children : Jeonbuk province, 2000. Korean J Pediatr. 2002;45:1234-1240.
10. Kim YJ, Li P, Hong JM, Ryu KH, Nam E, Chang MS. A Single Center Analysis of the Positivity of Hepatitis B Antibody after Neonatal Vaccination Program in Korea. J Korean Med Sci. 2017;32:810-816.
11. Qawasmi M, Samuh M, Glebe D, Gerlich WH, Azzeh M. Age-dependent decrease of anti-HBs titers and effect of booster doses using 2 different vaccines in Palestinian children vaccinated in early childhood. Hum Vaccin Immunother. 2015;11:1717-1724.
12. Schonberger K, Riedel C, Ruckinger S, Mansmann U, Jilg W, Kries RV. Determinants of long-term protection after hepatitis B vaccination in infancy: a meta-analysis. Pediatr Infect Dis J. 2013;32:307-313.
13. Alavi S, Rashidi A, Arzanian MT, Shamsian B, Nourbakhsh K. Humoral immunity against hepatitis B, tetanus, and diphtheria following chemotherapy for hematologic malignancies: a report and review of literature. Pediatr Hematol Oncol. 2010;27:188-194.
14.Keskin Yildirim Z, Buyukavci M. Assessment of humoral immunity to hepatitis B, measles, rubella, and mumps in children after chemotherapy. J Pediatr Hematol Oncol. 2018;40:e99-102.
15. Baytan B, Gunes AM, Gunay U. Efficacy of primary hepatitis B immunization in children with acute lymphoblastic leukemia. Indian Pediatr. 2008;45:265-270.
16. Karaman S, Vural S, Yildirmak Y, Urganci N, Usta M. Assessment of hepatitis B immunization status after antineoplastic therapy in children with cancer. Ann Saudi Med. 2011;31:573-576.
17. Chaves SS, Fischer G, Groeger J, Patel PR, Thompson ND, Teshale EH, Stevenson K, Yano VM, Armstrong GL, Samandari T, Kamili S, Drobeniuc J, Hu DJ. Persistence of long-term immunity to hepatitis B among adolescents immunized at birth. Vaccine. 2012;30:1644-1649.
18. Wu JS, Hwang LY, Goodman KJ, Beasley RP. Hepatitis B vaccination in high-risk infants: 10-year follow-up. J Infect Dis. 1999;179:1319-1325.
19. Dentinger CM, McMahon BJ, Butler JC, Dunaway CE, Zanis CL, Bulkow LR, Bruden DL, Nainan OV, Khristova ML, Hennessy TW, Parkinson AJ. Persistence of antibody to hepatitis B and protection from disease among Alaska natives immunized at birth. Pediatr Infect Dis J. 2005;24:786-792.
20. Bagheri-Jamebozorgi M, Keshavarz J, Nemati M, Mohammadi-Hossainabad S, Rezayati MT, Nejad-Ghaderi M, Jamalizadeh A, Shokri F, Jafarzadeh A. The persistence of anti-HBs antibody and anamnestic response 20 years after primary vaccination with recombinant hepatitis B vaccine at infancy. Hum Vaccin Immunother. 2014;10:3731-3736.
21. Van Der Meeren O, Behre U, Crasta P. Immunity to hepatitis B persists in adolescents 15-16 years of age vaccinated in infancy with three doses of hepatitis B vaccine. Vaccine. 2016;34:2745-2749.
22. Zanetti AR, Mariano A, Romano L, D'Amelio R, Chironna M, Coppola RC, Cuccia M, Mangione R, Marrone F, Negrone FS, Parlato A, Zamparo E, Zotti C, Stroffolini T, Mele A; Study Group. Long-term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study. Lancet. 2005;366:1379-1384.
23. Bialek SR, Bower WA, Novak R, Helgenberger L, Auerbach SB, Williams IT, Bell BP. Persistence of protection against hepatitis B virus infection among adolescents vaccinated with recombinant hepatitis B vaccine beginning at birth: a 15-year follow-up study. Pediatr Infect Dis J. 2008;27:881-885.
24. van Tilburg CM, van Gent R, Bierings MB, Otto SA, Sanders EA, Nibbelke EE, Gaiser JF, Janssens-Korpela PL, Wolfs TF, Bloem AC, Borghans JA, Tesselaar K. Immune reconstitution in children following chemotherapy for haematological malignancies: a long-term follow-up. Br J Haematol. 2011;152:201-210.
25. Saco TV, Strauss AT, Ledford DK. Hepatitis B vaccine nonresponders: Possible mechanisms and solutions. Ann Allergy Asthma Immunol. 2018;121:320-327.