Abstract
Hepatitis B virus (HBV) infection continues to be a serious global health problem. During the course of HBV vaccination, we observed C-reactive protein (CRP) elevation in term infants without sepsis. Therefore, we prospectively studied interleukin-6 (IL-6) and CRP responses to HBV immunization. In 70 healthy term infants without signs and symptoms of sepsis and sepsis risk factors, IL-6, CRP, and white blood cell count levels were determined before and 24 h after immunization. Significant increases in CRP levels were seen 24 h after vaccination (p < 0.001). Although CRP levels of 22 infants at second evaluation were above the cutoff level for sepsis (4.82 mg/L), they had no clinical signs and symptoms of sepsis. After 48–72 h, CRP levels of these infants returned to normal levels with no blood culture positivity. Conclusion: our study showed that HBV vaccine is responsible for CRP elevation in term infants after vaccination at birth. To the best of our knowledge, this is the first study evaluating CRP response to HBV vaccine at birth in term infants. We suggest that this response should be considered in differentiation of early neonatal sepsis to avoid unnecessary antibiotic use.
References
Balkundi DR, Nycyk JA, Cooke RW (1994) Immunisation and C reactive protein in infants on neonatal intensive care units. Arch Dis Child 71:F149
Celik IH, Demirel FG, Uras N et al (2010) What are the cut-off levels for IL-6 and CRP in neonatal sepsis? J Clin Lab Anal 24:407–412
Demirjian A, Levy O (2009) Safety and efficacy of neonatal vaccination. Eur J Immunol 39:36–46
Erdeve O, Celik IH, Uras N et al (2011) CRP as a predictive of neonatal sepsis and its role in differentiating the aetiologies. Acta paediatr 100:160–161
Keating GM, Noble S (2003) Recombinant hepatitis B vaccine (Engerix-B): a review of its immunogenicity and protective efficacy against hepatitis B. Drugs 63:1021–1051
Kirmani KI, Lofthus G, Pichichero ME et al (2002) Seven-year follow-up of vaccine response in extremely premature infants. Pediatrics 109:498–504
Korczowski B (2004) Procalcitonin and C-reactive protein in vaccination-associated adverse reactions. Pediatr Infect Dis J 23:283
Posthouwer D, Voorbij HA, Grobbee DE et al (2004) Influenza and pneumococcal vaccination as a model to assess C-reactive protein response to mild inflammation. Vaccine 23:362–365
Pourcyrous M, Bada HS, Korones SB et al (1993) Significance of serial C-reactive protein responses in neonatal infection and other disorders. Pediatrics 92:431–435
Pourcyrous M, Korones SB, Arheart KL et al (2007) Primary immunization of premature infants with gestational age <35 weeks: cardiorespiratory complications and C-reactive protein responses associated with administration of single and multiple separate vaccines simultaneously. J Pediatr 151:167–172
Pourcyrous M, Korones SB, Crouse D et al (1998) Interleukin-6, C-reactive protein, and abnormal cardiorespiratory responses to immunization in premature infants. Pediatrics 101:E3
Van Herck K, Van Damme P (2008) Benefits of early hepatitis B immunization programs for newborns and infants. Pediatr Infect Dis J 27:861–869
Venters C, Graham W, Cassidy W (2004) Recombivax-HB: perspectives past, present and future. Expert Rev Vaccines 3:119–129
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Celik, I.H., Demirel, G., Canpolat, F.E. et al. Inflammatory responses to hepatitis B virus vaccine in healthy term infants. Eur J Pediatr 172, 839–842 (2013). https://doi.org/10.1007/s00431-013-1946-2
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DOI: https://doi.org/10.1007/s00431-013-1946-2