Abstract
Objective
To determine anti-HBs antibody levels in multi-transfused children with beta-thalassemia major who had received primary hepatitis B vaccination ≥5 years ago, and to document their antibody response to a booster dose of hepatitis B vaccine.
Methods
We included 85 children each of beta-thalassemia major and age-matched healthy controls, who had completed primary hepatitis B vaccination ≥5 years ago. Participants were assessed for anti-HBs titres, and those with beta-thalassemia major who were seronegative (titres<10 mIU/mL) were administered a single booster dose of hepatitis B vaccine. CD4 counts, serum levels of IL-2 and IFN-γ, and anti-HBs titres were evaluated at baseline and following booster dose of vaccine.
Results
Seroprotection rates for hepatitis B after an average (SD) duration of 10.8 (3.8) years of completion of primary immunization were significantly higher among children with beta thalassemia major compared to healthy controls (72.9% vs. 52.9%, P=0.007). All the 23 seronegative children with beta-thalassemia major achieved seroprotection after a single booster dose of hepatitis B vaccine.
Conclusion
A single booster dose of hepatitis B vaccine after 5 years of primary immunization is adequate to provide seroprotection to multi-transfused children with beta-thalassemia major.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Di Marco V, Capra M, Angelucci E, et al.; Italian Society for the Study of Thalassemia and Haemoglobinopathies; Italian Association for the Study of the Liver. Management of Chronic Viral Hepatitis in Children with Thalassemia: Recommendations from an International Panel. Blood. 2010;116:2875–83.
Singh H, Pradhan M, Singh RL, et al. High frequency of hepatitis B virus infection in children with beta-thalassemia receiving multiple transfusions. Vox Sang. 2003;84:292–9.
Gharagozloo M, Karimi M, Amirghofran Z. Double-faced cell-mediated immunity in beta-thalassemia major: Stimulated phenotype versus suppressed activity. Ann Hematol. 2009;88:21–7.
Dwyer J, Wood C, McNamara J, et al. Abnormalities in the immune system of children with beta-thalassaemia major. Clin Exp Immunol. 1987;68:621–9.
Pardalos G, Kanakoudi-Tsakalidis F, Malaka-Zafiriu M, et al. Iron-related disturbances of cell-mediated immunity in multitransfused children with thalassemia major. Clin Exp Immunol. 1987;68:138–45.
Bao W, Zhong H, Li X, et al. Immune regulation in chronically transfused allo-antibody responder and nonresponder patients with sickle cell disease and beta-thalassemia major. Am J Hematol. 2011;86:1001–6.
Amin A, Jalali S, Amin R, Aale-yasin S, Jamalian N, Karimi M. Evaluation of the serum levels of immunoglobulin and complements factors in Beta thalassemia major patients in southern Iran. Iran J Immunol. 2005;2:220–5.
Soliman HH, Kabbash IA, El-Shanshory MR, Nagy HM, Abdou SH. Evaluation of immune status against hepatitis B in children with thalassemia major in Egypt: A single center study. J Microbiol Infect Dis. 2012;2. Accessed June 3, 2019. Available from: https://dergipark.org.tr/download/articlefile/104992.
Azarkar Z, Sharifzadeh G. Efficacy of HBV vaccination in children with thalassemia major, South Khorasan, Iran. Iran Red Crescent Med J. 2009;1:318.
Vahidi AA, Varesvazirian M, Shamsadini A, Shamsadini S. Determination of hepatitis B surface antibody titer in vaccinated children with major thalassemia in Kerman, Iran. Iran J Immunol. 2006;3:30–4.
Dentico P, Buongiorno R, Volpe A, Zavoianni A, De Mattia D, Sabato V. Long-term persistence of anti-HBs after hepatitis B immunization in thalassaemic patients. Infection. 1992;20:276–8.
Yazdanpanah B, Safari M, Yazdanpanah S. Persistence of HBV vaccine’s protection and response to hepatitis B booster immunization in 5- to 7-year-old children in the Kohgiloyeh and Boyerahmad Province, Iran. Hepat Mon. 2010;10:17–21.
Chang MH. Impact of hepatitis B vaccination on hepatitis B disease and nucleic acid testing in high-prevalence populations. J Clin Virol. 2006;36:S45–50.
Gulati S, Marwaha RK, Dilawari JB, Midha U, Walia BN. Serological responses to hepatitis B virus infection in multi-transfused thalassemic children. Indian Pediatrics. 1992;29:73–7.
Ramrakhyani K, Dilawari JB, Verma S, et al. Hepatitis B viral markers and liver disease in haemophiliacs: A study in an Indian population. J Gastroenterol Hepatol. 1988;3: 437–9.
Acknowledgements
Mrs. Jyotsana, technician in Department of Gastroenterology in GB Pant Hospital, Delhi.
Author information
Authors and Affiliations
Corresponding author
Additional information
Ethics Clearance
Institutional Ethics Committee — Human Research of University College of Medical Sciences; dated November 27, 2013.
Contributors
SG, PD, RY: study concept and its design; ASP, VGR: provided laboratory support; RY: data collection; RY, PD, SG, VG, ASP: data analysis and its interpretation; RY, PD: drafted the initial manuscript; SG, ASP, VG: critical inputs. All authors approved the final manuscript.
Funding
Intra-mural research grant for post-graduate thesis by University College of Medical Sciences.
Competing Interest
None stated.
Rights and permissions
About this article
Cite this article
Gomber, S., Yadav, R., Dewan, P. et al. Requirement of a Booster Dose of Hepatitis B Vaccine in Children With Thalassemia After 5 Years of Primary Vaccination: A Prospective Study. Indian Pediatr 58, 237–240 (2021). https://doi.org/10.1007/s13312-021-2162-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13312-021-2162-1