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Hepatitis B vaccination in preterm infants
M Gołebiowska1, D Kardas-Sobantka, D Chlebna-Sokół
1Department of Paediatrics, Lódź, Poland.
Insights
Hepatitis B vaccination is safe and effective for preterm infants, with 98.4% developing protective antibodies. Lower birth weight infants showed a weaker response, but a booster dose improved antibody levels.
Area of Science:
- Neonatal immunology
- Vaccinology
- Pediatric infectious diseases
Background:
- Preterm infants, particularly those with very low birth weight, face increased risks of hepatitis B virus infection.
- These infants often undergo invasive procedures and require prolonged hospitalization, heightening their susceptibility.
- Hepatitis B vaccination is therefore crucial for this vulnerable population.
Purpose of the Study:
- To evaluate the immunogenicity and safety of hepatitis B vaccination in preterm infants.
- To determine the antibody response based on birth weight and timing of vaccination.
- To assess the efficacy of a booster dose in non-responsive infants.
Main Methods:
- A cohort of 64 preterm infants (gestational age 25-36 weeks, birth weight 700-2460 g) received a 10 microg dose of recombinant hepatitis B vaccine (Engerix-B) at 0, 1, 2, and 12 months.
- Vaccination timing varied, with 49.2% receiving the first dose on day 1 of life.
- Anti-hepatitis B surface antigen (HBs) antibody levels were measured one month after the final dose.
Main Results:
- 98.4% of preterm infants achieved protective antibody levels (> 10 mIU/ml) after vaccination.
- Infants with birth weight > 2000 g demonstrated significantly higher antibody levels compared to those < 1000 g.
- One infant (birth weight 2300 g) contracted hepatitis B despite vaccination; one showed no response and three had a poor response, which improved significantly after a 20 microg booster dose.
Conclusions:
- Hepatitis B vaccination elicits a protective immune response in the majority of preterm infants.
- Lower birth weight (< 1000 g) is associated with a weaker antibody response.
- Monitoring antibody levels and administering booster doses may be beneficial for extremely preterm infants or those with suboptimal responses.
Unlabelled:
Preterm infants, especially those with very low birth weight, are at risk of hepatitis B virus infection. They often require invasive diagnostic methods in their first weeks of life, intensive treatment and long-term hospitalisation. Therefore, hepatitis B vaccination is particularly justified in these patients. Our aim was to determine the reaction of preterm children to hepatitis B vaccination. The study comprised 64 preterm children whose birth weight ranged from 700 g to 2460 g (mean 1776.6 g +/- 480.4 g) and whose gestational age was between 25 and 36 weeks. A 10 microg dose of the recombinant vaccine Engerix-B (SmithKline Beecham) was given at intervals of 0, 1, 2 and 12 months. In 49.2% of the children vaccination was administered on the 1st day of life, and in the remaining cases between the 2nd and 119th days post delivery. One month after vaccination completion the levels of anti-hepatitis B surface antigen (HBs) antibodies were evaluated. In 98.4% of the vaccinated preterm infants the level of antibodies was > 10 mIU/ml. Mean level of anti-HBs antibodies in the group of children with birth weight < or = 2000 g was 2431.4 mIU/ml, while in those with birth weight >2000 g it was 4803.9 mIU/ml. In children with a birth weight < or = 1000 g, the mean level of anti-HBs antibodies was significantly lower than in those with birth weight >2000 g. The level of anti-HBs antibodies in children who started vaccination > 1 st day of life was significantly lower in preterm children with a birth weight < or = 2000 g than in those with a birth weight >2000 g. Although vaccination was started on the 1st day of his life, one child with birth weight of 2300 g developed a hepatitis B virus infection. One child did not respond to vaccination (anti-HBs < 10 mIU/ml) and in three cases the response was very poor (11 100 mIU/ml). These patients were given a supplementary booster double dose of Engerix B (20 microg). After 1 month the level of anti-HBs antibodies was evaluated again and high values of 657 mIU/ml to 14520 mIU/ml were observed. In the group of children with a birth weight < or = 1000 g the response to vaccination was weaker as compared to children with a birth weight >2000 g (P < 0.05). In systematic mass vaccination programmes, monitoring of antibody levels is not recommended unless the patient is at risk. However, in extremely preterm infants (< 1000 g at birth), especially after very serious infections, monitoring the level of anti-HBs antibodies after complete immunisation should be considered. In preterm infants who show very low postvaccination levels of anti-HBs antibodies, stimulation with an additional double booster dose of vaccine gives positive results.
Conclusion:
The majority of preterm infants (98.4%) responded well to hepatitis B vaccination given at intervals of 0, 1, 2 and 12 months and developed a protective level of antibodies. The level of anti-hepatitis B surface antigen antibodies in children with a birth weight >2000 g was higher than in those with a birth weight < or = 1000 g.