BACKGROUND: The duration of protection after hepatitis B vaccination of infants is unknown. METHODS: We determined antibody to hepatitis B surface antigen (anti-HBs) at 4-13 years of age in 363 low risk children who had been vaccinated starting at birth with hepatitis B vaccine. Those with nonprotective titers ( or = 10 mIU/mL) of anti-HBs at 9 and 13 years, respectively. Of those who did not have protective antibody titers, 61% (33 of 54) and 67% (8 of 12), respectively, responded to a booster dose. In children of HBsAg-positive mothers, 31% retained protective anti-HBs at 12 years, and 90% (9 of 10) with nonprotective titers responded to a booster. In low risk children initially receiving a recombinant vaccine, 12.5% (26 of 208) and none (0 of 36) retained protective anti-HBs titers at 5 and 7 years of age, respectively. Of those who did not have protective titers, 90% (120 of 134) and 91% (32 of 35), respectively, responded to a booster. CONCLUSIONS: Anti-HBs disappeared by 5 years of age in most children who were vaccinated with hepatitis B vaccine from birth. Although most children showed immunologic memory, one-third failed to demonstrate an anamnestic response to a booster dose. Additional long term studies of low risk infants are needed to determine duration of protection and the necessity for or timing of booster doses.
Scientific evidence documenting the effectiveness of immunization delivery methods was summarized using the generic approach developed by the Community Health Practice Guidelines Working Group. The delivery methods examined were those for the adult and childhood vaccines of influenza, pneumococcal infection, hepatitis B, measles-mumps-rubella and diphtheria-pertussis-tetanus-polio. Based on a critical appraisal of 54 eligible comparative studies, the effects of different interventions were obtained and pooled effects were calculated for delivery methods oriented to the client, the provider and the system. The results indicate those interventions found to be most effective for each vaccine. This review of the scientific evidence of the effectiveness of immunization delivery methods provides a base for policy development and assists in the planning of resource allocation.
An outbreak of hepatitis B originating in a family day nursery affected several children with Somali background. The transmission chain was confirmed by sequence analysis of the S gene. In Africa hepatitis B is often spread horizontally among children of pre-school age, a pattern of transmission that was retained in this outbreak. To limit the outbreak 126 children in the nursery and 50 members of staff had to be vaccinated. The total cost for this intervention was estimated to about 300,000 SEK. Considering the great number of immigrants in Sweden from areas highly endemic for hepatitis B the inclusion of vaccination in the general child immunisation program seems to be the most cost effective measure for long term prevention not only of hepatitis B transmission among children but also of venereal spread in early adulthood.
Hepatitis B vaccine is effective in preventing infection with hepatitis B virus (HBV), but its duration of protection is unknown. To examine the effect of exposure to HBV on an immunized population, data were analyzed from a cohort of Alaska Natives who were immunized and then followed up annually for 10 years. A boost in antibody to hepatitis B surface antigen (anti-HBs) was defined as a fourfold rise in levels to > or = 20 mIU/mL that was not accompanied by the presence of antibody to hepatitis B core antigen or attributable to interim vaccination. During 10 years of follow-up, 8.2% of 1,595 vaccines had boosts in anti-HBs. Persons with boosts did not differ significantly from those without boosts in terms of age, gender, village, initial level of anti-HBs, or level of anti-HBs before the boost. These results underscore the continued exposure to HBV among vaccinees and the continued protection against disease that the vaccine provides.
BACKGROUND: The World Health Organisation, WHO, recommends that most countries should vaccinate all children against hepatitis B. Sweden has chosen not to do so, but the issue is reassessed regularly. The objective of this survey was to assess knowledge and attitudes towards hepatitis B vaccine for children among parents living in Sweden, and to compare distribution of responses and response rate between parents answering a postal questionnaire and those responding via the Internet. METHODS: A population-based cross-sectional survey, where the sampling frame consisted of all parents to a child born 2002 living in Sweden. Two independent samples of 1001 parents in each sample were drawn. All parents were contacted by postal mail. The parents in the first sample were invited to participate by answering a paper questionnaire. The parents in the second sample were given an individual user name along with a password, and asked to log on to the Internet to answer an identical electronic questionnaire. RESULTS: A total of 1229 questionnaires were analysed. The overall response rate for paper questionnaires was 55%, and 15% for the web version. Knowledge of the disease hepatitis B was overall high (90%). A higher degree of knowledge was seen among parents with education beyond high school (p = 0.001). This group of parents also had a higher tendency to reply via the Internet (p = 0.001). The willingness to accept hepatitis B vaccine for their child was correlated to the acceptance of the present childhood vaccination programme (p = 0.001). CONCLUSION: The results reveal a high level of knowledge of the disease and a positive attitude to having their children vaccinated. This study also displays that the conventional postal method of surveying still delivers a higher response rate than a web-based survey.
Infectious disease screening of migrants at increased risk is a feature of national infection prevention and control measures. Asylum seekers in Finland are offered screening of tuberculosis (TB), hepatitis B, human immunodeficiency virus infection (HIV) and syphilis based on individual risk assessment. We aimed to evaluate the public health response to a large influx of asylum seekers to Finland in 2015-2016 with respect to national guidelines on initial health services and infectious disease screening.
We used immigration and healthcare procurement data for all 38,134 asylum seekers to Finland during 2015-2016 to assess the implementation, timing and yields of infectious disease screening.
The coverage of pulmonary TB screening was 71.6% [95% CI 71.1-72.0%] and that of hepatitis B, HIV or syphilis 60.6% [60.1-61.1%] among those eligible for screening. The estimated average delay from arrival to pulmonary TB screening was 74 days for adults and 43 days for children. Delay to hepatitis B, HIV and syphilis screening was 91 days for adults and 47 days for children. The seroprevalence of hepatitis B surface antigen positivity was 1.4% [95% CI 1.3-1.6%], HIV 0.3% [95% CI 0.1-0.4%] and Treponema pallidum specific antibodies 1.0% [95% CI 0.8-1.1%]. Data did not allow assessment of yields of pulmonary TB screening.
Up to one third of asylum seekers were not reached by screening and screenings were delayed from target timeframes. Children, as a vulnerable population, were screened earlier than adults. To ensure higher screening coverage, infectious disease risks should be reassessed and screening completed at contacts to healthcare during the post-asylum phase of integration. The large influx of asylum seekers to Finland in 2015-2016 tested the country's public health preparedness. After action reviews of the public health response to the large migrant influx such as screening implementation can be used for evidence-based improvement of public health preparedness and guidelines for initial health services and infectious disease screening.
Cites: BMC Med Ethics. 2018 Mar 2;19(1):16 PMID 29499693
Cites: Trop Med Int Health. 2016 Feb;21(2):210-8 PMID 26610271
In October 1997, the Advisory Committee on Immunization Practices (ACIP) expanded its hepatitis B vaccination recommendations to include all unvaccinated children aged 0-18 years and made hepatitis B vaccine available through the Vaccines for Children program (VFC) for persons aged 0-18 years who are eligible for VFC. ACIP priorities for hepatitis B vaccination of children remain unchanged and include all infants; children in populations at high risk for hepatitis B virus (HBV) infection (e.g., Alaska Natives, Pacific Islanders, and children who reside in households of first-generation immigrants from countries where HBV infection is moderately or highly endemic); previously unvaccinated children aged 11-12 years; and older adolescents and adults in defined risk groups.