Immunogenicity of hepatitis B vaccine in multi-transfused thalassemic patients with and without hepatitis C infection: a comparative study with healthy controls

Hepatitis C virus (HCV) infection is highly prevalent in thalassemic patients. This may decrease serum antibody response to hepatitis B virus (HBV) vaccine. There is also some alteration in the immune system of multi-transfused thalassemic patients as a consequence of iron overload. We deduced that HCV infection may reduce the effectiveness of HBV vaccine in multi-transfused thalassemic patients.

Subjects were cited and studied prospectively in three groups. Group 1:125 multi-transfused thalassemic patients with negative serum HCV antibody, Group 2:96 multi-transfused thalassemic patients with positive serum HCV antibody on at least 2 different occasions, and Group3:100 healthy subjects. Subjects in all groups had negative serum HBsAg, anti-HBc, and anti-HBs, and they received three 20-microg doses of recombinant HBV vaccine in months 0,1, and 6. The anti-HBs titer was obtained one month after the last dose of vaccine and was considered seroprotective if > or =10 IU/l.

The seroprotection rate was 83.2% in Group 1 and 80.2% in Group 2 (P = 0.74). It was 86% in healthy subjects, which didn't significantly differ from HCV-positive and -negative thalassemics (P = 0.56). Moreover, the mean values of ALT among the responder and non-responder thalassemic patients were 55.5 +/- 41.9 and 57.4 +/- 48.5 U/l, respectively (p = 0.802). During the vaccination periods, patients in all 3 groups did not show any significant adverse reactions.

Our study shows that three standard doses of HBV vaccine are immunogenic and safe in multi-transfused thalassemic patients with or without HCV infection.