JOURNAL CLUB

DR. SHAHEEN SIDDIQUA AMRIN, PG

MODERATOR: DR SUDHA RANI, PROFESSOR
OSMANIA MEDICAL COLLEGE
Evaluation of Immune Response to
Hepatitis B Vaccine in Healthcare
Workers at a Tertiary Care Hospital

PRAVEENA BASIREDDY, SUREKHA AVILELI1 ,

NAGAJYOTHI BELDONO1 , SWARNA LATHA
GUNDELA1 DEPARTMENT OF MICROBIOLOGY,
GOVERNMENT MEDICAL COLLEGE,
ANANTAPURAMU, 1 DEPARTMENT OF
MICROBIOLOGY, KURNOOL MEDICAL
COLLEGE, KURNOOL, ANDHRA PRADESH, IND
INDIAN J MED MICROBIOL 2018;36:397-400
TAXONOMY & MORPHOLOGY
HEPATITIS B VIRUS (HBV)
GEOGRAPHIC DISTRIBUTION
STRUCTURE
PATHOGENESIS
MODES OF TRANSMISSION
HIGH RISK GROUPS
SEROLOGICAL RESPONSE
DIAGNOSIS
 PASSIVE IMMUNIZATION

 Hepatitis B immunoglobulin (HBIG) is prepared from pooled

plasma with high titers of Hepatitis-B surface antibody (anti-
HBs).
 . HBIG confers temporary passive immunity in certain pre
and post exposure situations.
 A single or two injections of HBIG (0.06 mL/kg I.M) given
one month apart have shown protection against both clinical
disease and subclinical infection both, for sexual contact and
accidental needle prick exposure.
 Passive active immunization in the form of a single dose of 0.5
mL HBIG at birth or within 12-24 hrs of exposure in
conjunction with three doses of 10 µgms of hepatitis B vaccine
at 1, 2 and 6 months resulted in better and long term
protection
 OBJECTIVES

 Evaluate immune response to HbsAg vaccination in

HCWs
 Factors associated with decreased immune response

STUDY DETAILS
 Cross-sectional study conducted from April 2013 to
2014 ON 85 HCWs in a tertiary care hospital in
KURNOOL
INCLUSION CRITERION
 All HCWs, who have received the complete
standard course of intramuscular HBsAg vaccination.

EXCLUSION CRITERION
 Known HBsAg positive HCWs
 METHODOLOGY

 The anti-HBs level was measured in the collected

serum samples using a commercially available ELISA
(New Medical Biological Service, S. R. L., Opera,
Milano, Italy).
 Data were analysed categorically for gender, age,
time elapsed since the last dose of vaccination,
smoking habit and body mass index (BMI) against
anti-HBs levels using SPSS 20 software.
 RESULTS

 96.5% of the vaccinated HCWs developed protective

immunsity to hepatitis B.
 20.0% had an anti-HBs titrebetween 10 and 100
mIU/ml
 (76.5%) had an anti-HBs titre of >100 mIU/ml.
 3.5% of the vaccinated HCWs did not develop a
sufficient anti-HBs response
 The anti-HBs response was similar in both males
and females
 Decline in immune response as the age increased.
 Greater the time elapsed between the last dose of
vaccination and the time of assessment of anti-HBs
lesser the immunity
 The anti-HBs response declined with smoking habit
and with increasing BMI
 The anti-HBs response was not affected by the
vaccination schedule (0, 1 and 6 schedule or 0, 1, 2
and 12 months’ schedule) and number of booster
doses
 DISCUSSION

study % of HCWs with protective

immunity

Present study 96.5%

Varshochi et al 98.54%

Thomas et al 98.89%

Chakrabarthy et al 100%

Chathuranga et al 91.1%

Nagamani et al. 100%

 Smoking is strongly associated with a poor response
rate to hepatitis B vaccine as shown by this study and
others like varshochi M et al.
 This study shows that the anti-HBs level significantly
declines with time which was similar to whittle et al
 Poor anti-HBs response was seen as the age was
increased from as low as 35 years in our study
concurrence with zeeshan m et al
 With increased BMI from >25, the immune response
was decreased in the current study similar to
averhoff et al.
 Protective immune response to hepatitis B vaccine
among HCWs is 96.5%.
 Factors associated with decreased protective
immune response to hepatitis B.
Increasing age
increasing duration since vaccination
smoking habit
Increased BMI