Hepatitis B Immunity and Response to Booster Vaccination in Children With Inflammatory Bowel Disease Treated With Infliximab

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Am J Gastroenterol. 2011 Aug 30. doi: 10.1038/ajg.2011.295. [Epub ahead of

print]

Hepatitis B Immunity and Response to Booster Vaccination in Children With

Inflammatory Bowel Disease Treated With Infliximab.

Moses J, Alkhouri N, A, Raig K, R, Danziger-Isakov L, Feldstein

AE, Zein NN, Wyllie R, -Kent C.

Source

Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, Ohio,

USA.

Abstract

OBJECTIVES:

Hepatitis B virus (HBV) reactivation has been described in patients treated with

infliximab for inflammatory bowel disease (IBD). This has resulted in a " black

box " warning. Although universal vaccination against hepatitis B was implemented

in the United States in 1991, up to 10% of vaccine recipients fail to respond

with adequate anti-hepatitis B surface antibodies (anti-HBs) levels after a

primary series of vaccinations. In addition, anti-HBs levels are expected to

decline with time. The objectives of this study were to determine HBV immunity

in children with IBD on infliximab therapy and to determine response to a

booster dose of the HBV vaccine in patients who were found to be non-immune.

METHODS:

This was a prospective cross-sectional, single-center study that included 100

pediatric IBD patients on infliximab. Serologic specimens were tested for

hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), and

anti-HBs. Patients with an anti-HBs level ≥10 mIU/ml were considered to be

immune. One booster dose was given to non-immune patients and a serum sample was

collected after 4 weeks to assess the presence of anamnestic response (anti-HBs

level ≥10 mIU/ml after booster).

RESULTS:

The mean age of the patients was 17.9 (±4.0) years. None of the patients were

positive for HBsAg or anti-HBc. In all, 87 patients were vaccinated against HBV

and 49/87 (56%) had immunity to HBV as defined by anti-HBs level ≥10 mIU/ml.

The mean concentration of anti-HBs levels in immune patients was 295.6 (±350.6)

mIU/ml. Older age, lower albumin levels, and the presence of pancolitis were

associated with the absence of protective antibodies; however, infliximab dose,

frequency, duration, and the concurrent use of immunomodulators were not

significantly different between immune and non-immune patients. Thirty-four

patients received booster immunization and 26/34 (76%) had an anamnestic

response. Interestingly, non-responders were given infliximab with higher

frequency (every 5.9±1.2 weeks vs. every 7.1±1.8 weeks, P=0.01). Overall,

75/87 (86%) of previously immunized patients were considered immune against HBV

infection.

CONCLUSIONS:

In pediatric IBD patients seen at a large, urban tertiary care facility in the

United States, a significant minority (13%) have not been vaccinated against

HBV. Nearly one-half of all patients (and 44% of previously vaccinated patients)

did not have protective anti-HBs levels. Moreover, of those previously

vaccinated, a significant minority (14%) appear at risk for HBV because

protective anti-HBs levels were absent and could not be elicited through booster

immunization. Given the high risk for severe HBV infection in this group,

efforts should be made to screen for HBV immunity at the time of IBD diagnosis.

Booster immunization should be considered in patients without protective

antibodies.Am J Gastroenterol advance online publication, 30 August 2011;

doi:10.1038/ajg.2011.295.

PMID: 21876562 [PubMed - as supplied by publisher]