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Hepatitis B – No Significant Decrease In Hep B Despite Vaccination

Testing of participants in 2 national surveys demonstrates no significant decrease in hepatitis B virus infection, despite the availability of hepatitis B vaccine.

Source: AM J Public Health. 1999;89:14-18.

VAN UK’s Comment: Hepatitis B is a sexually transmitted disease. It CANNOT be caught by newborn babies unless the mother has the disease, which most mothers don’t. Despite this, all babies in the US and Ireland are routinely vaccinated.

Acute Hepatitis B In A Vaccinated Healthcare Worker Who Had Received FIVE Hep B Vaccines!

CASE REPORT: Here, we describe an acute hepatitis B infection in a patient who received five hepatitis B vaccinations. Although his initial response to vaccination was moderate, he finally reached an excellent hepatitis B surface antibody level (anti-HBs) titres of more than 1000 IU/l in response to a booster vaccination with a recombinant DNA vaccine. Nevertheless, he developed full-blown acute hepatitis due to an HBV infection 14years after this booster vaccination. A DNA analysis of the surface protein encoding region followed by phylogenetic analysis showed that our patient was infected with a normal HBV strain that is circulating among men who have sex with men. To our knowledge, this is the first report of a genuine hepatitis B vaccination failure in someone who acquired a high anti-HBs level in response to a recombinant DNA hepatitis B vaccine. CONCLUSION: Healthcare workers whose response to the initial hepatitis B vaccination is moderate might be vulnerable to hepatitis B virus infection.

Source: J Hepatol. 2008 Dec 6.

Immunity to hepatitis B vaccine among health care workers – More and More Vaccines Required for ‘Immunity’

The aim of this study was to determine the level of anti-HBsAg (hepatitis B surface antigen) in vaccinated high risk group. We measured anti-HBsAg concentration in blood sera of adult students aged from 19 to 37 years old. Five milliliters (5 ml) of blood sample was taken from 210 cases four months after the second dose and 126 out of 210 cases three months after the third dose of hepatitis B vaccination. All blood samples were analyzed for anti-HBsAg by ELISA method. 125 out of 210 samples (59.5%) showed anti-HBsAg concentrations higher than 20 mIu/ml and considered immune after the second dose of hepatitis B vaccination. Also, 99.2% of samples had anti-HBsAg higher than 20 mIu/ml three months after the third dose of the vaccination. Non-immune cases in males were more than females (41.2% vs.40.1%). In conclusions, our results reinforce the importance of hepatitis B vaccine in adolescents and suggest that three dose of hepatitis B vaccine is necessary to increase the seropositive rate of anti-HBsAg in adults.

Source: Vaccine,Volume 29, Issue 15, 24 March 2011, Pages 2727-2729.

Hepatitis B in Three Vaccinated Children

In the recent past, we encountered 3 cases with jaundice, who were investigated for HBsAg and turned out to be positive. All the three had received the 3 doses of hepatitis B vaccine within 5 years of presentation (presented after 1 year, 1½ years and 6 months after 3rd dose). There was a mixed opinion among pediatricians that the HBsAg was positive because of vaccine, vaccine failure, or reinfection. In this context I seek the following clarifications:

Does the Hepatitis B vaccine result in positive HBsAg in a child, if so for how long after immunization.

Does seroconversion after vaccination mean the conversion of HBsAg positive (positivity due to vaccination) to negative as the antibody tests are not available all the time.

After the 3rd dose, if a patient comes with jaundice and is positive for HBsAg on investigation, should it be taken as vaccine failure due to the vaccine per se, or a new infection.

Source: Indian Pediatrics 2000;37: 1388-1389. http://www.indianpediatrics.net/dec2000/dec-1388-1389.htm

Hep B Virus is in the Blood of Vaccinated Children

In his reply to the above questions, a medical scientist says this:

1. Does HB vaccination make a child HBsAg positive?

The HB vaccine consists of purified HBsAg, which is injected into the child’s tissues. Therefore, the child’s body now contains HBsAg. However, since the injected dose is minute, in the range of 10 micrograms, the antigen will not be picked up in an HBsAg ELISA (or another test) of the peripheral blood specimen.

VAN UK’s Comment: His argument is, the amount of Hep B is too small to cause infection, but all this says is, the current tests cannot pick it up in the blood. That doesn’t mean it can’t cause infection.

Babies of Hep B Positive Mother’s Still Getting Hep B Despite Vaccination

About 10 percent of babies born to mothers with the hepatitis B e antigen (HBeAg) will become HB carriers, even with vaccination, a pediatrician said Saturday.

Since the HB vaccine does not guarantee full protection against infection, it is important to keep track of high risk children, said Chen Hui-ling, a pediatrician at National Taiwan University Hospital.

Citing a study of some 2,000 some children, Chen said that infants born to HBeAg mothers have a higher chance of becoming carriers, even if a rigorous vaccination scheme is implemented 24 hours after birth.

Source: Focus Taiwan News Channel, 21st July 2012.

Chronic hepatitis B infection in adolescents who received primary infantile vaccination

Abstract

Hepatitis B virus (HBV) infection is a global health issue. Universal infantile hepatitis B (HB) vaccination is very efficacious. However, HBV infections among those immunized subjects have been reported. The long-term efficacy of postnatal passive-active HB vaccination in high-risk subjects is not well explored. A total of 8,733 senior high school students who were born after July 1987 were assayed for hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs). The overall HBsAg and anti-HBs-positive rates were 1.9% and 48.3%, respectively. The HBsAg-positive rate was 15% in HB immunoglobulin (HBIG) recipients (adjusted odds ratio [OR]: 15.63; 95% confidence interval [CI]: 10.99-22.22). Among students who did not receive HBIG, there was a significantly negative association between HB vaccination dosage and HBsAg-positive rate (P for trend = 0.011). Adjusted ORs for those who received 4, 3, and 1 to 2 doses were 1.00, 1.52 (95% CI: 0.91-2.53), and 2.85 (95% CI: 1.39-5.81), respectively. Among HBIG recipients, the HBsAg-positive rate was significantly higher in subjects with maternal hepatitis B e antigen (HBeAg) positivity and who received HBIG off-schedule. A booster dose of HB vaccination was administered to 1974 HBsAg- and anti-HBs-negative subjects. Prebooster and a postbooster blood samples were drawn for anti-HBs quantification. The proportions of postbooster anti-HBs titer <10 mIU/mL was 27.9%. Subjects with prebooster anti-HBs titers of 1.0-9.9 mIU/mL had significantly higher postbooster anti-HBs titers than those with prebooster anti-HBs titers of <1.0 mIU/mL (P < 0.0001). Conclusion: Having maternal HBeAg positivity is the most important determinant for HBsAg positivity in adolescents who received postnatal passive-active HB vaccination 15 years before. A significant proportion of complete vaccinees may have lost their immunological memories against HBsAg. (HEPATOLOGY 2013)

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