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Seroprotection for hepatitis B in children with nephrotic syndrome

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Abstract

Background

Children with nephrotic syndrome have been shown to have lower seroconversion to various vaccines due to immune dysregulation, prolonged immunosuppressive treatment and recurrent prolonged proteinuria.The primary aim of this study was to determine hepatitis B surface antibody (anti-HBs) titers in children with nephrotic syndrome who had been previously vaccinated against hepatitis B. The secondary aim was to study the association of anti-HBs titers with type of disease, schedule and dose of vaccination, and type of immunosuppressive therapy.

Methods

This cross-sectional study was conducted in the Department of Pediatrics in a tertiary care hospital between January 2011 and January 2012). All children (aged 1–18 years) with nephrotic syndrome who tested negative for hepatitis B surface antigen and who had previously been vaccinated against hepatitis B, with the last dose being at least 1 month prior to being included in the study. A form consisting of history and clinical details was filled in, and the schedule and dose of vaccination(s) received was noted. A blood sample was taken from all patients for biochemical assessment and determination of anti-HBs titer.

Results

The patient cohort comprised 75 children (51 males; 24 females) of whom 42 (56 %) had steroid-resistant nephrotic syndrome (SRNS) and 33 (44 %) had steroid-sensitive nephrotic syndrome (SSNS). Most patients enrolled in the study (96 %) were in remission at the time of the biochemical and serological assessment. Twenty-one (28 %) patients had received only steroids, while 72 % also received other immunosuppressants. Forty-six (61.3 %) patients had received a double dose of vaccine. Of the 75 children enrolled, 36 (48 %) and 39 (52 %) had an anti-HBs titer of ≥10 mIU/mL (seroprotected) and <10 mIU/mL (unprotected), respectively. The mean titer among all patients was 143.58 mIU/mL. The seroprotection rates were 63.6 % in SSNS patients and 35.7 % in SRNS subjects (P = 0.016).

Conclusions

Based on our results, we conclude that children with SRNS are less likely to seroconvert with vaccination. A higher dose (double) of hepatitis B vaccine should be used for vaccinating such patients. Anti-HBs titers should be monitored in SRNS patients post-vaccination, and a booster should be given if titers fall to <10 mIU/mL.

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References

  1. Bagga A, Mantan M (2005) Nephrotic syndrome in children. Indian J Med Res 122:13–28

    PubMed  Google Scholar 

  2. Eddy AA, Symons JM (2003) Nephrotic syndrome in childhood. Lancet 362:629–639

    Article  PubMed  Google Scholar 

  3. Bakkali L, Pereira RR, Kuik D, Ket JCR, Wijk J (2011) Nephrotic syndrome in The Netherlands: a population-based cohort study and a review of the literature. Pediatr Nephrol 26:1241–1246

    Article  PubMed  Google Scholar 

  4. Kemper MJ, Altrogge H, Gansehow R, Wiefel DE (2002) Serum levels of immunoglobulins and IgG subclasses in steroid sensitive nephrotic syndrome. Pediatr Nephrol 17:413–417

    Article  PubMed  Google Scholar 

  5. Han JW, Lee KY, Hwang JY, Koh DK, Lee J (2010) Antibody status in children with steroid-sensitive nephrotic syndrome. Yonsei Med J 51:239–243

    Article  PubMed  CAS  Google Scholar 

  6. La Manna A, Polito C, Foglia AC, Di Toro A, Cafaro MR, Del Gado R (1992) Reduced response to hepatitis B virus vaccination in boys with steroid-sensitive nephrotic syndrome. Pediatr Nephrol 6:251–253

    Article  PubMed  Google Scholar 

  7. Grzesiowski P, Tańska A, Sieniawska M (1995) The influence of hepatitis B vaccine dose on direct results of hepatitis B vaccination in children with nephrotic syndrome. Pediatr Pol 70:25–28

    PubMed  CAS  Google Scholar 

  8. Szajner-Milart I, Zajaczkowska M, Zinkiewicz Z, Borzecka H, Majewski M (2003) Efficacy of vaccination against viral hepatitis type B in children with the nephrotic syndrome. Ann Univ Mariae Curie Sklodowska Med 58:402–408

    PubMed  Google Scholar 

  9. Batham A, Narula D, Toteja T, Sreenivas V, Puliyel J (2007) Systematic review and meta-analysis of prevalence of hepatitis B in India. Indian Pediatrics 44:663–674

    PubMed  Google Scholar 

  10. Ahmad B, Grover R, Ratho RK, Mahajan RC (2001) Prevalence of hepatitis B virus infection in Chandigarh over a six year period. Trop Gastroenterol 22:18–19

    PubMed  CAS  Google Scholar 

  11. Mast E, Mahoney FJ, Kane M, Margolis H (2004) Hepatitis B vaccine. In: Plotkin SA, Orenstein WA (eds) Vaccines, 4th edn. W.B. Saunders, Philadelphia, pp 299–337

    Google Scholar 

  12. Centers for Disease Control and Prevention (1993) Recommendations of the Advisory Committee on Immunization Practices (ACIP): use of vaccines and immune globulins in persons with altered immunocompetence. MMWR 42 (No. RR-4)

  13. [No authors listed] (1981) The primary nephrotic syndrome in children: Identification of patients with minimal change nephrotic syndrome from initial response to prednisolone. A report of the International Study of Kidney Disease in Children J Pediatr 98:56–564

    Google Scholar 

  14. European Consensus Group on Hepatitis B immunity (2000) Are booster immunizations needed for lifelong hepatitis B immunity? Lancet 355:561–565

    Google Scholar 

  15. West DJ, Calandra GB (1996) Vaccine induced immunologic memory for hepatitis B surface antigen: implications for policy on booster vaccination. Vaccine 14:1019–1027

    Article  PubMed  CAS  Google Scholar 

  16. Baytan B, Gunes AM, Gunay U (2008) Efficacy of primary hepatitis B immunization in children with acute lymphoblastic leukemia. Indian Pediatr 45:265–270

    PubMed  Google Scholar 

  17. Crosnier J, Jungers P, Courouce AM, Benhamou E, Degos F, Lacour B, Prunet P, Cerisier Y, Guesry P (1981) Randomized placebo-controlled trial of hepatitis B surface antigen vaccine in French hemodialysis units. I Medical staff. Lancet 317:455–459

    Article  Google Scholar 

  18. Bruguera M, Cremades M, Salinas R, Costa J, Grau M, Sans J (1992) Impaired response to recombinant hepatitis B vaccine in HIV infected persons. J Clin Gastroenterol 14:27–30

    Article  PubMed  CAS  Google Scholar 

  19. Jack AD, Hall AJ, Maine N, Mendy M, Whittle HC (1999) What level of hepatitis B antibody is protective? J Infect Dis 179:489–492

    Article  PubMed  CAS  Google Scholar 

  20. Zuckerman JN (2006) Protective efficacy, immunotherapeutic potential, and safety of hepatitis B vaccines. J Med Virol 78:169–177

    Article  PubMed  CAS  Google Scholar 

  21. Foster WQ, Murphy A, Vega DJ, Smith AL, Hott BJ, Book WM (2006) Hepatitis B vaccination in heart transplant candidates. J Heart Lung Transplant 25:106–109

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Maulana Azad Medical College and Associated Hospitals, University of Delhi, Delhi, 110002, India

    Mukta Mantan, Nagaraj Pandharikar, Sangeeta Yadav & Gulshan Rai Sethi

  2. Department of Microbiology, Maulana Azad Medical College and Associated Hospitals, University of Delhi, Delhi, 110002, India

    Anita Chakravarti

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  1. Mukta Mantan
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  2. Nagaraj Pandharikar
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  3. Sangeeta Yadav
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  4. Anita Chakravarti
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  5. Gulshan Rai Sethi
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Correspondence to Mukta Mantan.

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Mantan, M., Pandharikar, N., Yadav, S. et al. Seroprotection for hepatitis B in children with nephrotic syndrome. Pediatr Nephrol 28, 2125–2130 (2013). https://doi.org/10.1007/s00467-013-2538-0

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  • DOI: https://doi.org/10.1007/s00467-013-2538-0

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