Szczepionka przeciwko wirusowemu zapaleniu wątroby typu b
Rokowania, prognozy i postęp choroby
Szczepionka przeciwko wirusowemu zapaleniu wątroby typu B (WZW B) jest jedną z najbezpieczniejszych i najskuteczniejszych szczepionek, z ponad miliardem podanych dawek globalnie. Długoterminowe badania kohortowe wykazały 85% ochronę (95% CI: 82-88) po 6,5 roku od szczepienia, co sugeruje, że u osób immunokompetentnych nie jest konieczne podawanie dawek przypominających. Odpowiedź immunologiczna jest osłabiona u osób starszych oraz pacjentów z chorobami zapalnymi jelit (IBD) leczonych anty-TNF, gdzie wskaźnik odpowiedzi (anty-HBs ≥10 IU/l) wynosił odpowiednio 59% i 46%. Zastosowanie dwóch kolejnych cykli szczepień (każdy po trzy dawki) może poprawić skuteczność u tych grup. Szczepionka Heplisav-B, zatwierdzona przez FDA w 2017 roku, oferuje dwudawkowy schemat dla dorosłych, co stanowi istotną alternatywę dla tradycyjnych trzydawkowych schematów. Szczepionka jest bezpieczna także w ciąży, bez zwiększonego ryzyka wad wrodzonych czy poronień, co potwierdzają dane z badania DV2-HBV-28.
- Wprowadzenie do szczepionki przeciwko wirusowemu zapaleniu wątroby typu B
- Skuteczność szczepionki przeciwko WZW B i trwałość ochrony
- Przewidywanie odpowiedzi na szczepienie przeciwko WZW B
- Szczepienie przeciwko WZW B w grupach specjalnych
- Zalecenia dotyczące szczepień przeciwko WZW B
- Bezpieczeństwo i działania niepożądane
- Podsumowanie rokowania i przyszłe kierunki
Wprowadzenie do szczepionki przeciwko wirusowemu zapaleniu wątroby typu B
Szczepionka przeciwko wirusowemu zapaleniu wątroby typu B jest uznawana za jedną z najbezpieczniejszych i najskuteczniejszych szczepionek, jakie kiedykolwiek opracowano. Podano już ponad miliard dawek tej szczepionki na całym świecie, co świadczy o jej szerokim zastosowaniu i akceptacji.1 Jest ona również określana jako pierwsza szczepionka przeciwnowotworowa, ponieważ zapobiega zakażeniu HBV, które jest główną przyczyną raka wątroby na świecie.2 Mimo spadku częstości występowania wirusowego zapalenia wątroby typu B w wielu krajach, w tym w Chinach, obciążenie chorobą pozostaje wysokie, co podkreśla znaczenie szczepień jako kluczowej strategii profilaktycznej.3
Skuteczność szczepionki przeciwko WZW B i trwałość ochrony
Badania długoterminowe wykazują wysoką skuteczność szczepionki przeciwko wirusowemu zapaleniu wątroby typu B. W badaniu kohortowym obejmującym 462 zdrowych osób zaszczepionych w latach 1990-1992, odsetek ochrony po 6,5 latach od szczepienia wynosił 85% (95% CI: 82-88). Co istotne, badacze doszli do wniosku, że w populacji immunokompetentnej nie jest konieczne podawanie dawki przypominającej po 6,5 latach od szczepienia przeciwko WZW B.4 Wyniki te potwierdzają długotrwałą skuteczność szczepionki i wskazują, że pełny cykl szczepień może zapewnić ochronę na całe życie u większości zdrowych osób.
Czynniki wpływające na odpowiedź na szczepionkę
Odpowiedź immunologiczna na szczepionkę przeciwko WZW B może być różna w zależności od wielu czynników. W szczególności starszy wiek jest związany z osłabioną odpowiedzią na szczepionkę (hiporesponsywnością), co zostało potwierdzone w licznych badaniach.5 Analiza transkryptomiczna wykazała, że zwiększona ekspresja genów wzmacniających odpowiedź limfocytów B oraz wyższe częstości występowania komórek B pamięci korelują z silniejszą odpowiedzią na szczepionkę przeciwko WZW B. Natomiast wyższe poziomy transkryptów odpowiedzi zapalnej i zwiększone częstości występowania prozapalnych komórek wrodzonych korelują ze słabszą odpowiedzią na tę szczepionkę.6
Co ciekawe, tzw. BioAge score (marker wieku biologicznego) okazał się lepszym predyktorem odpowiedzi na szczepionkę przeciwko WZW B niż wiek chronologiczny i był niezależny od płci.7 Badania wskazują również, że zwiększona liczba erytrocytów i odpowiedź indukowana hemem korelują ze słabą odpowiedzią na szczepionkę przeciwko WZW B.8
Rola stanu zapalnego i szlaków interferonu typu I
Badania integrujące profile cytometryczne i cytokiny podkreślają rolę elementów odpowiedzi prozapalnej, która jest negatywnie skorelowana z produkcją przeciwciał. Zwiększone częstości aktywowanych komórek odporności wrodzonej były związane z sygnaturami transkrypcyjnymi i cytokinami, które przewidywały słabą odpowiedź przeciwciał.9 Łącznie wyniki te podkreślają znaczenie interferonu typu I i innych szlaków prozapalnych w rozwoju słabej odpowiedzi na szczepionkę przeciwko WZW B.10
Przewidywanie odpowiedzi na szczepienie przeciwko WZW B
Rozwijane są nowe metody pozwalające przewidywać odpowiedź na szczepionkę przeciwko WZW B przed jej podaniem. Badania z wykorzystaniem profilowania transkrypcyjnego pozwoliły zidentyfikować przed szczepieniem, choć z umiarkowaną dokładnością, uczestników, którzy wykształcą słabą odpowiedź na szczepionkę przeciwko WZW B. Opracowana sygnatura podkreśla wzajemne oddziaływanie między wrodzonymi szlakami zapalnymi a komórkami B w odpowiedzi na szczepionkę.11
Wyniki badań wykazały, że zwiększone częstości komórek T CD4+, które mogą zapewniać pomoc komórkom B w białych krwinkach, są związane z wyższymi mianami anty-HBsAg.12 Zastosowanie modeli uczenia maszynowego, takich jak Borderline-SMOTE XGBoost, pozwala przewidywać zakażenie HBV z lepszą dokładnością niż tradycyjne modele regresji logistycznej, osiągając AUC 0,782 (95% CI: 0,771, 0,793) i ogólną dokładność 70,2%.13
Zastosowanie kliniczne modeli predykcyjnych
Modele predykcyjne mają istotne zastosowanie kliniczne. Mogą być wykorzystywane do dokładnego identyfikowania populacji wysokiego ryzyka zakażenia wirusem zapalenia wątroby typu B, które powinny podjąć odpowiednie środki lecznicze w odpowiednim czasie.14 Przyjęcie strategii oceny ryzyka może zapewnić lepsze zrozumienie częstości występowania HBV i zidentyfikować największą liczbę pacjentów do badań antygenowych.15 Model ten może również pomóc w opracowaniu planu alokacji zasobów medycznych, co ma istotne znaczenie aplikacyjne i społeczno-ekonomiczne, szczególnie w krajach o ograniczonych zasobach.16
Szczepienie przeciwko WZW B w grupach specjalnych
Pacjenci z chorobami zapalnymi jelit
Pacjenci z chorobami zapalnymi jelit (IBD) stanowią szczególną grupę, w której odpowiedź na szczepionkę przeciwko WZW B może być obniżona. W badaniu obejmującym 241 zaszczepionych pacjentów z IBD, miano anty-HBs ≥10 IU/l osiągnęło 59%, a ≥100 IU/l 39% pacjentów. Wskaźnik odpowiedzi (anty-HBs ≥10 IU/l) był niższy wśród pacjentów poddawanych terapii anty-TNF: 46% vs 62%. W analizie wieloczynnikowej wykazano niższy wskaźnik odpowiedzi u starszych pacjentów i tych otrzymujących leki anty-TNF. Interesujące jest, że leczenie immunosupresyjne nie wpływało na skuteczność szczepionki.17
Badanie wykazało również, że wskaźnik odpowiedzi (anty-HBs ≥100 IU/l) po powtórnym szczepieniu wynosił 42%. Oznacza to, że znaczący, choć niewystarczający wskaźnik sukcesu można uzyskać, gdy podaje się dwa kolejne cykle szczepień, każdy składający się z trzech dawek.18
Kobiety w ciąży
Szczepionka przeciwko WZW B jest również bezpieczna dla kobiet w ciąży. Poszczepieniowe obserwacyjne badanie kohortowe (DV2-HBV-28) obejmowało 75 ciąż z znanymi wynikami, w tym 10 wśród osób, które otrzymały Heplisav-B dwukrotnie w okresie od 28 dni przed poczęciem do końca ciąży. Wśród 75 ciężarnych narażonych na Heplisav-B przed lub w trakcie ciąży, 44 otrzymały Heplisav-B w ciągu 28 dni przed poczęciem, 24 w pierwszym trymestrze, 6 w drugim trymestrze i 1 w trzecim trymestrze. Nie zidentyfikowano żadnych poważnych wad wrodzonych, a ryzyko poronienia było poniżej szacowanego ryzyka tła.19
Te dostępne dane, głównie dla osób, które otrzymały 1 dawkę Heplisav-B w ciągu 28 dni przed poczęciem lub podczas ciąży, nie sugerują zwiększonego ryzyka zarówno poważnych wad wrodzonych, jak i poronień.20 Zatwierdzenie przez FDA aktualizacji ulotki Heplisav-B o dane z badania DV2-HBV-28 pozwala na stosowanie Heplisav-B do szczepienia ciężarnych wymagających szczepienia przeciwko WZW B.21
Zalecenia dotyczące szczepień przeciwko WZW B
Światowa Organizacja Zdrowia (WHO) zaleca szczepionkę przeciwko zapaleniu wątroby typu B wszystkim noworodkom, dzieciom do 18 roku życia oraz wszystkim dorosłym o podwyższonym ryzyku zakażenia.22 W Stanach Zjednoczonych Centra Kontroli i Zapobiegania Chorobom (CDC) zalecają szczepionkę przeciwko zapaleniu wątroby typu B wszystkim noworodkom, dzieciom do 18 roku życia, dorosłym w wieku 19-59 lat oraz dorosłym w wieku 60 lat i starszym, którzy są narażeni na wysokie ryzyko zakażenia.23
Szczepionka przeciwko WZW B jest także zalecana dorosłym chorującym na cukrzycę oraz osobom o wysokim ryzyku zakażenia ze względu na pracę, styl życia, sytuację mieszkaniową lub kraj urodzenia.24 Ponieważ każda osoba może być narażona na ryzyko zakażenia wirusem zapalenia wątroby typu B w ciągu życia, wszystkie osoby powinny rozważyć zaszczepienie się.25
Dostępne szczepionki i schematy szczepień
W listopadzie 2017 r. FDA zatwierdziła nową szczepionkę do stosowania w USA. Heplisav-B (Dynavax) jest dwudawkową szczepionką zatwierdzoną do stosowania u dorosłych w wieku 18 lat i starszych.26 Jest to istotna alternatywa dla tradycyjnych trzydawkowych schematów szczepień.
Ważne jest, aby pamiętać, że wszystkie dawki szczepionki są wymagane, aby być w pełni chronionym przed wirusowym zapaleniem wątroby typu B.27 Aby upewnić się, że jesteś chroniony przed wirusowym zapaleniem wątroby typu B, warto poprosić o proste badanie krwi w celu sprawdzenia miana przeciwciał, które potwierdzi, czy szczepienie było skuteczne.28 W przypadku szczepienia noworodków urodzonych przez zakażone matki, pierwsza dawka szczepionki musi być podana na sali porodowej lub w ciągu pierwszych 12 godzin życia.29
Bezpieczeństwo i działania niepożądane
Szczepionki przeciwko wirusowemu zapaleniu wątroby typu B wykazały bezpieczeństwo, immunogenność i skuteczność w ciągu ostatnich 4 dekad.30 Najczęstsze działania niepożądane po szczepionce przeciwko wirusowemu zapaleniu wątroby typu B mogą obejmować bolesność, obrzęk i zaczerwienienie w miejscu wstrzyknięcia.31 Te łagodne reakcje miejscowe zazwyczaj ustępują samoistnie w ciągu kilku dni.
Szczepionka jest przeciwwskazana u osób z historią ciężkiej reakcji alergicznej (np. anafilaksji) po poprzedniej dawce lub po jakimkolwiek składniku szczepionki. Osoby z aktualnym zakażeniem HBV (HBsAg pozytywne) lub po przebytym zakażeniu HBV nie odniosą korzyści z serii szczepień, ani szczepionka nie wyeliminuje wirusa. Jednakże szczepionka może zapewnić dożywotnią ochronę dla bliskich, którzy nie mają wirusowego zapalenia wątroby typu B i otrzymają szczepionkę tak szybko, jak to możliwe.32
Podsumowanie rokowania i przyszłe kierunki
Rokowanie po szczepieniu przeciwko WZW B jest generalnie bardzo dobre, z długotrwałą ochroną utrzymującą się u większości zaszczepionych osób. U osób z prawidłową odpowiedzią immunologiczną, poziom ochrony utrzymuje się przez wiele lat, a w wielu przypadkach przez całe życie, bez konieczności stosowania dawek przypominających.33
Przyszłe kierunki badań mogą obejmować dalsze doskonalenie modeli predykcyjnych odpowiedzi na szczepienie, co pozwoli na bardziej spersonalizowane podejście do szczepień. Zastosowanie zaawansowanych technik, takich jak uczenie maszynowe, może poprawić wykrywalność zakażeń HBV w populacji ogólnej, promować wczesną diagnozę i terminowe leczenie grup wysokiego ryzyka oraz poprawić wykorzystanie zasobów medycznych, szczególnie w krajach o niskich zasobach.34
W przypadku pacjentów z obniżoną odpowiedzią immunologiczną, takich jak osoby starsze czy pacjenci z IBD leczeni lekami anty-TNF, mogą być potrzebne alternatywne schematy szczepień, takie jak podwójne dawki czy cykle przypominające. Badania pokazują, że znaczący wskaźnik sukcesu można uzyskać, gdy podaje się dwa kolejne cykle szczepień.35
Zrozumienie mechanizmów immunologicznych związanych z odpowiedzią na szczepionkę przeciwko WZW B, szczególnie roli stanu zapalnego i szlaków interferonu typu I, może prowadzić do rozwoju nowych strategii poprawiających skuteczność szczepień, zwłaszcza w grupach wysokiego ryzyka słabej odpowiedzi.36
Kolejne rozdziały
Zapraszamy do dalszego czytania naszego leksykonu.
Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.
Materiały źródłowe
- #1 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
To be certain that you are protected against hepatitis B, ask for a simple blood test to check your antibody titers that will confirm whether the vaccination was successful. […] In November 2017, a vaccine was approved by the FDA for use in the U.S. Heplisav-B (Dynavax) is a two-dose vaccine approved for use in adults aged 18 and older. […] More than 1 billion doses of the hepatitis B vaccine have been given worldwide and it is considered one of the safest and most effective vaccines ever made. […] Common side effects from the hepatitis B vaccine may include soreness, swelling and redness at the injection site.
- #2 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
It takes only a few shots to protect yourself and your loved ones against hepatitis B for a lifetime. […] The hepatitis B vaccine is a safe and effective vaccine that is recommended for all infants at birth and for children up to 18 years. […] The hepatitis B vaccine is also recommended for adults living with diabetes and those at high risk for infection due to their jobs, lifestyle, living situations, or country of birth. […] Since everyone is at some risk, all adults should seriously consider getting the hepatitis B vaccine for a lifetime protection against a preventable chronic liver disease. […] The hepatitis B vaccine is also known as the first anti-cancer vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide. […] If you have a current HBV infection (HBsAg positive) or have recovered from a past HBV infection, the hepatitis B vaccine series will not benefit you or clear the virus. However, the vaccine can provide a lifetime of protection for loved ones who do not have hepatitis B and get the vaccine as soon as possible.
- #3 Predicting Hepatitis B Virus Infection Based on Health Examination Data of Community Populationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6926879/
Despite a decline in the prevalence of hepatitis B in China, the disease burden remains high. […] The prediction model can be used to accurately identify populations at high risk of hepatitis B infection that should adopt timely appropriate medical treatment measures. […] A large proportion of people unaware of HBV infection missed the ideal treatment time, resulting in treatment difficulties and poor prognosis. […] Thus, it is necessary to improve the detection probability of HBV infected patient. […] Therefore, the XGBoost model can be applied to assess the prevalence of HBV in the general population, promote early diagnosis and timely treatment of high-risk groups, and improve the utilization of medical resources, particularly in low resource countries. […] Our findings revealed that the Borderline-SMOTE XGBoost combined model outperformed the other models with desirable performance and may help identify individuals in need of HBsAg testing.
- #4 Assessment of long-term efficacy of hepatitis B vaccine – PubMedhttps://pubmed.ncbi.nlm.nih.gov/11599689/
In a healthy cohort of 462 subjects in which hepatitis B vaccine was administered between 1990 and 1992 a follow-up study was carried out to determine the duration of protection. […] The proportion of protection 6.5 years after vaccination was 85% (95% CI: 82-88). […] We conclude that in immunocompetent population it is not necessary to administer a booster dose 6.5 years after hepatitis B vaccination.
- #5 Pre-vaccination inflammation and B-cell signalling predict age-related hyporesponse to hepatitis B vaccination | Nature Communicationshttps://www.nature.com/articles/ncomms10369
Aging is associated with hyporesponse to vaccination, whose mechanisms remain unclear. In this study hepatitis B virus (HBV)-naive older adults received three vaccines, including one against HBV. Here we show, using transcriptional and cytometric profiling of whole blood collected before vaccination, that heightened expression of genes that augment B-cell responses and higher memory B-cell frequencies correlate with stronger responses to HBV vaccine. In contrast, higher levels of inflammatory response transcripts and increased frequencies of pro-inflammatory innate cells correlate with weaker responses to this vaccine. Increased numbers of erythrocytes and the haem-induced response also correlate with poor response to the HBV vaccine. A transcriptomics-based pre-vaccination predictor of response to HBV vaccine is built and validated in distinct sets of older adults. This moderately accurate (area under the curve65%) but robust signature is supported by flow cytometry and cytokine profiling. This study is the first that identifies baseline predictors and mechanisms of response to the HBV vaccine.
- #6 Pre-vaccination inflammation and B-cell signalling predict age-related hyporesponse to hepatitis B vaccination | Nature Communicationshttps://www.nature.com/articles/ncomms10369
Aging is associated with hyporesponse to vaccination, whose mechanisms remain unclear. In this study hepatitis B virus (HBV)-naive older adults received three vaccines, including one against HBV. Here we show, using transcriptional and cytometric profiling of whole blood collected before vaccination, that heightened expression of genes that augment B-cell responses and higher memory B-cell frequencies correlate with stronger responses to HBV vaccine. In contrast, higher levels of inflammatory response transcripts and increased frequencies of pro-inflammatory innate cells correlate with weaker responses to this vaccine. Increased numbers of erythrocytes and the haem-induced response also correlate with poor response to the HBV vaccine. A transcriptomics-based pre-vaccination predictor of response to HBV vaccine is built and validated in distinct sets of older adults. This moderately accurate (area under the curve65%) but robust signature is supported by flow cytometry and cytokine profiling. This study is the first that identifies baseline predictors and mechanisms of response to the HBV vaccine.
- #7 Pre-vaccination inflammation and B-cell signalling predict age-related hyporesponse to hepatitis B vaccination | Nature Communicationshttps://www.nature.com/articles/ncomms10369
Here we first identified a mRNA signature of aging that associated with the seroresponse to the hepatitis B virus (HBV) surface antigen (anti-HBsAg) in naive older adults. Then transcriptomics, polychromatic FCM and serum cytokine profiling were used to generate an integrated model to inform on potential involvement of specific cellular and molecular pathways in nascent anti-HBsAg responses in older adults. […] We determined if different BioAge scores correlated with different responses to HBV vaccination. Both the BioAge score and the two groups of elderly identified by the BioAge signature were associated with the rate of response to the HBV vaccine. Importantly, in a multivariate analysis including available clinical parameters, the BioAge was both a better predictor of the HBV response than chronological age and independent of gender.
- #8 Pre-vaccination inflammation and B-cell signalling predict age-related hyporesponse to hepatitis B vaccination | Nature Communicationshttps://www.nature.com/articles/ncomms10369
Aging is associated with hyporesponse to vaccination, whose mechanisms remain unclear. In this study hepatitis B virus (HBV)-naive older adults received three vaccines, including one against HBV. Here we show, using transcriptional and cytometric profiling of whole blood collected before vaccination, that heightened expression of genes that augment B-cell responses and higher memory B-cell frequencies correlate with stronger responses to HBV vaccine. In contrast, higher levels of inflammatory response transcripts and increased frequencies of pro-inflammatory innate cells correlate with weaker responses to this vaccine. Increased numbers of erythrocytes and the haem-induced response also correlate with poor response to the HBV vaccine. A transcriptomics-based pre-vaccination predictor of response to HBV vaccine is built and validated in distinct sets of older adults. This moderately accurate (area under the curve65%) but robust signature is supported by flow cytometry and cytokine profiling. This study is the first that identifies baseline predictors and mechanisms of response to the HBV vaccine.
- #9 Pre-vaccination inflammation and B-cell signalling predict age-related hyporesponse to hepatitis B vaccination | Nature Communicationshttps://www.nature.com/articles/ncomms10369
Collectively these results show for the first time that transcriptional profiling allows the identification before vaccination, albeit with a moderate accuracy, of participants that will mount a poor response to the HBV vaccine. This signature highlights the interplay between the innate inflammatory pathways and B cells in the response to the HBV vaccine. […] Our results show that increased frequencies of CD4+ T cells, which can provide help to B cells in white blood cells, are associated with higher anti-HBsAg titres. […] Integration of FCM and cytokine profiles highlights the role of elements of the pro-inflammatory response, which is negatively correlated to antibody production. Increased frequencies of activated innate immune cells were associated with transcriptional signatures and cytokines that predicted the poor Ab response. […] Collectively our results highlight the importance of type I interferon and other pro-inflammatory pathways in the development of a poor response to HBV vaccine.
- #10 Pre-vaccination inflammation and B-cell signalling predict age-related hyporesponse to hepatitis B vaccination | Nature Communicationshttps://www.nature.com/articles/ncomms10369
Collectively these results show for the first time that transcriptional profiling allows the identification before vaccination, albeit with a moderate accuracy, of participants that will mount a poor response to the HBV vaccine. This signature highlights the interplay between the innate inflammatory pathways and B cells in the response to the HBV vaccine. […] Our results show that increased frequencies of CD4+ T cells, which can provide help to B cells in white blood cells, are associated with higher anti-HBsAg titres. […] Integration of FCM and cytokine profiles highlights the role of elements of the pro-inflammatory response, which is negatively correlated to antibody production. Increased frequencies of activated innate immune cells were associated with transcriptional signatures and cytokines that predicted the poor Ab response. […] Collectively our results highlight the importance of type I interferon and other pro-inflammatory pathways in the development of a poor response to HBV vaccine.
- #11 Pre-vaccination inflammation and B-cell signalling predict age-related hyporesponse to hepatitis B vaccination | Nature Communicationshttps://www.nature.com/articles/ncomms10369
Collectively these results show for the first time that transcriptional profiling allows the identification before vaccination, albeit with a moderate accuracy, of participants that will mount a poor response to the HBV vaccine. This signature highlights the interplay between the innate inflammatory pathways and B cells in the response to the HBV vaccine. […] Our results show that increased frequencies of CD4+ T cells, which can provide help to B cells in white blood cells, are associated with higher anti-HBsAg titres. […] Integration of FCM and cytokine profiles highlights the role of elements of the pro-inflammatory response, which is negatively correlated to antibody production. Increased frequencies of activated innate immune cells were associated with transcriptional signatures and cytokines that predicted the poor Ab response. […] Collectively our results highlight the importance of type I interferon and other pro-inflammatory pathways in the development of a poor response to HBV vaccine.
- #12 Pre-vaccination inflammation and B-cell signalling predict age-related hyporesponse to hepatitis B vaccination | Nature Communicationshttps://www.nature.com/articles/ncomms10369
Collectively these results show for the first time that transcriptional profiling allows the identification before vaccination, albeit with a moderate accuracy, of participants that will mount a poor response to the HBV vaccine. This signature highlights the interplay between the innate inflammatory pathways and B cells in the response to the HBV vaccine. […] Our results show that increased frequencies of CD4+ T cells, which can provide help to B cells in white blood cells, are associated with higher anti-HBsAg titres. […] Integration of FCM and cytokine profiles highlights the role of elements of the pro-inflammatory response, which is negatively correlated to antibody production. Increased frequencies of activated innate immune cells were associated with transcriptional signatures and cytokines that predicted the poor Ab response. […] Collectively our results highlight the importance of type I interferon and other pro-inflammatory pathways in the development of a poor response to HBV vaccine.
- #13 Predicting Hepatitis B Virus Infection Based on Health Examination Data of Community Populationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6926879/
The combined model of preprocessing samples with Borderline-SMOTE can solve the problem of data imbalance and improve the overall prediction performance of the model. […] The variable importance plot of the XGBoost model showed that age was of high importance to predict HBV infection, which was consistent with a previous study. […] Our predictive model can be used to improve the positive detection rate of HBV in areas with limited budget and resources. […] The top-performing algorithm, Borderline-SMOTE XGBoost, achieved an AUC of 0.782 (95% CI: 0.771,0.793), and overall accuracy of 70.2%, nearly a four percent higher AUC than that of the traditional LR model. […] Adopting risk assessment strategies can provide a greater understanding of HBV prevalence and identify the greatest number of patients for antigen testing. […] The model can also help to develop a medical resource allocation plan, which has important application value and socioeconomic significance.
- #14 Predicting Hepatitis B Virus Infection Based on Health Examination Data of Community Populationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6926879/
Despite a decline in the prevalence of hepatitis B in China, the disease burden remains high. […] The prediction model can be used to accurately identify populations at high risk of hepatitis B infection that should adopt timely appropriate medical treatment measures. […] A large proportion of people unaware of HBV infection missed the ideal treatment time, resulting in treatment difficulties and poor prognosis. […] Thus, it is necessary to improve the detection probability of HBV infected patient. […] Therefore, the XGBoost model can be applied to assess the prevalence of HBV in the general population, promote early diagnosis and timely treatment of high-risk groups, and improve the utilization of medical resources, particularly in low resource countries. […] Our findings revealed that the Borderline-SMOTE XGBoost combined model outperformed the other models with desirable performance and may help identify individuals in need of HBsAg testing.
- #15 Predicting Hepatitis B Virus Infection Based on Health Examination Data of Community Populationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6926879/
The combined model of preprocessing samples with Borderline-SMOTE can solve the problem of data imbalance and improve the overall prediction performance of the model. […] The variable importance plot of the XGBoost model showed that age was of high importance to predict HBV infection, which was consistent with a previous study. […] Our predictive model can be used to improve the positive detection rate of HBV in areas with limited budget and resources. […] The top-performing algorithm, Borderline-SMOTE XGBoost, achieved an AUC of 0.782 (95% CI: 0.771,0.793), and overall accuracy of 70.2%, nearly a four percent higher AUC than that of the traditional LR model. […] Adopting risk assessment strategies can provide a greater understanding of HBV prevalence and identify the greatest number of patients for antigen testing. […] The model can also help to develop a medical resource allocation plan, which has important application value and socioeconomic significance.
- #16 Predicting Hepatitis B Virus Infection Based on Health Examination Data of Community Populationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6926879/
The combined model of preprocessing samples with Borderline-SMOTE can solve the problem of data imbalance and improve the overall prediction performance of the model. […] The variable importance plot of the XGBoost model showed that age was of high importance to predict HBV infection, which was consistent with a previous study. […] Our predictive model can be used to improve the positive detection rate of HBV in areas with limited budget and resources. […] The top-performing algorithm, Borderline-SMOTE XGBoost, achieved an AUC of 0.782 (95% CI: 0.771,0.793), and overall accuracy of 70.2%, nearly a four percent higher AUC than that of the traditional LR model. […] Adopting risk assessment strategies can provide a greater understanding of HBV prevalence and identify the greatest number of patients for antigen testing. […] The model can also help to develop a medical resource allocation plan, which has important application value and socioeconomic significance.
- #17https://journals.lww.com/ajg/Fulltext/2012/10000/Efficacy_of_Hepatitis_B_Vaccination_and.3.aspx?generateEpub=Article%7Cajg:2012:10000:00003%7C10.1038/ajg.2012.79%7C
We assessed the effectiveness of hepatitis B virus (HBV) vaccine in inflammatory bowel disease (IBD) patients, evaluated the impact of immunosuppressors and antitumor necrosis factor (anti-TNF) agents, and assessed the effectiveness of revaccination. […] Of 241 vaccinated patients, anti-HBs was 10 IU/l in 59% and 100 IU/l in 39%. The response rate (anti-HBs 10 IU/l) was lower among patients under anti-TNF therapy: 46% vs. 62%. In the multivariate analysis, a lower response rate was demonstrated in older patients and those receiving anti-TNFs. The response rate (anti-HBs 100 IU/l) after revaccination was 42%. […] The response rate to the HBV vaccination even with a double-dose schedule is very low in IBD patients, mainly in those receiving anti-TNFs. However, treatment with immunosuppressors did not affect the efficacy of the vaccine. A considerable albeit insufficient success rate may be obtained when two consecutive vaccination courses, each with a three-dose vaccine series, are administered.
- #18https://journals.lww.com/ajg/Fulltext/2012/10000/Efficacy_of_Hepatitis_B_Vaccination_and.3.aspx?generateEpub=Article%7Cajg:2012:10000:00003%7C10.1038/ajg.2012.79%7C
We assessed the effectiveness of hepatitis B virus (HBV) vaccine in inflammatory bowel disease (IBD) patients, evaluated the impact of immunosuppressors and antitumor necrosis factor (anti-TNF) agents, and assessed the effectiveness of revaccination. […] Of 241 vaccinated patients, anti-HBs was 10 IU/l in 59% and 100 IU/l in 39%. The response rate (anti-HBs 10 IU/l) was lower among patients under anti-TNF therapy: 46% vs. 62%. In the multivariate analysis, a lower response rate was demonstrated in older patients and those receiving anti-TNFs. The response rate (anti-HBs 100 IU/l) after revaccination was 42%. […] The response rate to the HBV vaccination even with a double-dose schedule is very low in IBD patients, mainly in those receiving anti-TNFs. However, treatment with immunosuppressors did not affect the efficacy of the vaccine. A considerable albeit insufficient success rate may be obtained when two consecutive vaccination courses, each with a three-dose vaccine series, are administered.
- #19 Updated Recommendation for Universal Hepatitis B Vaccination in Adults Aged 19â59 Years â United States, 2024 | MMWRhttps://www.cdc.gov/mmwr/volumes/73/wr/mm7348a3.htm
Hepatitis B (HepB) vaccines have demonstrated safety, immunogenicity, and efficacy during the past 4 decades. […] A postlicensure observational retrospective cohort study (DV2-HBV-28)* included 75 pregnancies with known outcomes, including 10 among persons who received Heplisav-B twice during the period from 28 days before conception through the end of pregnancy. Among 75 pregnant persons with exposure to Heplisav-B before or during pregnancy, 44 received Heplisav-B during the 28 days before conception, 24 during the first trimester, six during the second trimester, and one during the third trimester. No major birth defects were identified, and the risk for miscarriage was below the estimated background risk. These available data, primarily for persons who received 1 dose of Heplisav-B during the 28 days before conception, or during pregnancy, do not suggest an increased risk for both major birth defects and miscarriage.
- #20 Updated Recommendation for Universal Hepatitis B Vaccination in Adults Aged 19â59 Years â United States, 2024 | MMWRhttps://www.cdc.gov/mmwr/volumes/73/wr/mm7348a3.htm
Hepatitis B (HepB) vaccines have demonstrated safety, immunogenicity, and efficacy during the past 4 decades. […] A postlicensure observational retrospective cohort study (DV2-HBV-28)* included 75 pregnancies with known outcomes, including 10 among persons who received Heplisav-B twice during the period from 28 days before conception through the end of pregnancy. Among 75 pregnant persons with exposure to Heplisav-B before or during pregnancy, 44 received Heplisav-B during the 28 days before conception, 24 during the first trimester, six during the second trimester, and one during the third trimester. No major birth defects were identified, and the risk for miscarriage was below the estimated background risk. These available data, primarily for persons who received 1 dose of Heplisav-B during the 28 days before conception, or during pregnancy, do not suggest an increased risk for both major birth defects and miscarriage.
- #21 Updated Recommendation for Universal Hepatitis B Vaccination in Adults Aged 19â59 Years â United States, 2024 | MMWRhttps://www.cdc.gov/mmwr/volumes/73/wr/mm7348a3.htm
Approval by the Food and Drug Administration under section 351(a) of the Public Health Service Act for Hepatitis B Vaccine (Recombinant), Adjuvanted (HEPLISAV-B), to update the package insert to include data from study DV2-HBV-28, allows for use of Heplisav-B to vaccinate pregnant persons needing HepB vaccination.
- #22 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
The World Health Organization (WHO) recommends the hepatitis B vaccine for all newborns, children up to 18 years of age, and all adults at higher risk for infection. […] The U.S. Centers for Disease Control and Prevention (CDC) recommends the hepatitis B vaccine for all newborns, children up to age 18, adults 19-59 years of age, and adults 60 and older who are at high-risk for infection. […] Every person may be at some risk for a hepatitis B infection during their lifetime, so all people should consider getting the hepatitis B vaccine. […] The hepatitis B vaccine is available at your doctor’s office and local health department or clinic. […] All doses of the vaccine are required in order to be fully protected against hepatitis B. […] It is important to remember that babies born to infected mothers must receive the first dose of hepatitis B vaccine in the delivery room or within the first 12 hours of life.
- #23 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
The World Health Organization (WHO) recommends the hepatitis B vaccine for all newborns, children up to 18 years of age, and all adults at higher risk for infection. […] The U.S. Centers for Disease Control and Prevention (CDC) recommends the hepatitis B vaccine for all newborns, children up to age 18, adults 19-59 years of age, and adults 60 and older who are at high-risk for infection. […] Every person may be at some risk for a hepatitis B infection during their lifetime, so all people should consider getting the hepatitis B vaccine. […] The hepatitis B vaccine is available at your doctor’s office and local health department or clinic. […] All doses of the vaccine are required in order to be fully protected against hepatitis B. […] It is important to remember that babies born to infected mothers must receive the first dose of hepatitis B vaccine in the delivery room or within the first 12 hours of life.
- #24 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
It takes only a few shots to protect yourself and your loved ones against hepatitis B for a lifetime. […] The hepatitis B vaccine is a safe and effective vaccine that is recommended for all infants at birth and for children up to 18 years. […] The hepatitis B vaccine is also recommended for adults living with diabetes and those at high risk for infection due to their jobs, lifestyle, living situations, or country of birth. […] Since everyone is at some risk, all adults should seriously consider getting the hepatitis B vaccine for a lifetime protection against a preventable chronic liver disease. […] The hepatitis B vaccine is also known as the first anti-cancer vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide. […] If you have a current HBV infection (HBsAg positive) or have recovered from a past HBV infection, the hepatitis B vaccine series will not benefit you or clear the virus. However, the vaccine can provide a lifetime of protection for loved ones who do not have hepatitis B and get the vaccine as soon as possible.
- #25 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
The World Health Organization (WHO) recommends the hepatitis B vaccine for all newborns, children up to 18 years of age, and all adults at higher risk for infection. […] The U.S. Centers for Disease Control and Prevention (CDC) recommends the hepatitis B vaccine for all newborns, children up to age 18, adults 19-59 years of age, and adults 60 and older who are at high-risk for infection. […] Every person may be at some risk for a hepatitis B infection during their lifetime, so all people should consider getting the hepatitis B vaccine. […] The hepatitis B vaccine is available at your doctor’s office and local health department or clinic. […] All doses of the vaccine are required in order to be fully protected against hepatitis B. […] It is important to remember that babies born to infected mothers must receive the first dose of hepatitis B vaccine in the delivery room or within the first 12 hours of life.
- #26 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
To be certain that you are protected against hepatitis B, ask for a simple blood test to check your antibody titers that will confirm whether the vaccination was successful. […] In November 2017, a vaccine was approved by the FDA for use in the U.S. Heplisav-B (Dynavax) is a two-dose vaccine approved for use in adults aged 18 and older. […] More than 1 billion doses of the hepatitis B vaccine have been given worldwide and it is considered one of the safest and most effective vaccines ever made. […] Common side effects from the hepatitis B vaccine may include soreness, swelling and redness at the injection site.
- #27 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
The World Health Organization (WHO) recommends the hepatitis B vaccine for all newborns, children up to 18 years of age, and all adults at higher risk for infection. […] The U.S. Centers for Disease Control and Prevention (CDC) recommends the hepatitis B vaccine for all newborns, children up to age 18, adults 19-59 years of age, and adults 60 and older who are at high-risk for infection. […] Every person may be at some risk for a hepatitis B infection during their lifetime, so all people should consider getting the hepatitis B vaccine. […] The hepatitis B vaccine is available at your doctor’s office and local health department or clinic. […] All doses of the vaccine are required in order to be fully protected against hepatitis B. […] It is important to remember that babies born to infected mothers must receive the first dose of hepatitis B vaccine in the delivery room or within the first 12 hours of life.
- #28 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
To be certain that you are protected against hepatitis B, ask for a simple blood test to check your antibody titers that will confirm whether the vaccination was successful. […] In November 2017, a vaccine was approved by the FDA for use in the U.S. Heplisav-B (Dynavax) is a two-dose vaccine approved for use in adults aged 18 and older. […] More than 1 billion doses of the hepatitis B vaccine have been given worldwide and it is considered one of the safest and most effective vaccines ever made. […] Common side effects from the hepatitis B vaccine may include soreness, swelling and redness at the injection site.
- #29 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
The World Health Organization (WHO) recommends the hepatitis B vaccine for all newborns, children up to 18 years of age, and all adults at higher risk for infection. […] The U.S. Centers for Disease Control and Prevention (CDC) recommends the hepatitis B vaccine for all newborns, children up to age 18, adults 19-59 years of age, and adults 60 and older who are at high-risk for infection. […] Every person may be at some risk for a hepatitis B infection during their lifetime, so all people should consider getting the hepatitis B vaccine. […] The hepatitis B vaccine is available at your doctor’s office and local health department or clinic. […] All doses of the vaccine are required in order to be fully protected against hepatitis B. […] It is important to remember that babies born to infected mothers must receive the first dose of hepatitis B vaccine in the delivery room or within the first 12 hours of life.
- #30 Updated Recommendation for Universal Hepatitis B Vaccination in Adults Aged 19â59 Years â United States, 2024 | MMWRhttps://www.cdc.gov/mmwr/volumes/73/wr/mm7348a3.htm
Hepatitis B (HepB) vaccines have demonstrated safety, immunogenicity, and efficacy during the past 4 decades. […] A postlicensure observational retrospective cohort study (DV2-HBV-28)* included 75 pregnancies with known outcomes, including 10 among persons who received Heplisav-B twice during the period from 28 days before conception through the end of pregnancy. Among 75 pregnant persons with exposure to Heplisav-B before or during pregnancy, 44 received Heplisav-B during the 28 days before conception, 24 during the first trimester, six during the second trimester, and one during the third trimester. No major birth defects were identified, and the risk for miscarriage was below the estimated background risk. These available data, primarily for persons who received 1 dose of Heplisav-B during the 28 days before conception, or during pregnancy, do not suggest an increased risk for both major birth defects and miscarriage.
- #31 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
To be certain that you are protected against hepatitis B, ask for a simple blood test to check your antibody titers that will confirm whether the vaccination was successful. […] In November 2017, a vaccine was approved by the FDA for use in the U.S. Heplisav-B (Dynavax) is a two-dose vaccine approved for use in adults aged 18 and older. […] More than 1 billion doses of the hepatitis B vaccine have been given worldwide and it is considered one of the safest and most effective vaccines ever made. […] Common side effects from the hepatitis B vaccine may include soreness, swelling and redness at the injection site.
- #32 Hepatitis B Foundation: Hepatitis B Vaccinationhttps://www.hepb.org/prevention-and-diagnosis/vaccination/
It takes only a few shots to protect yourself and your loved ones against hepatitis B for a lifetime. […] The hepatitis B vaccine is a safe and effective vaccine that is recommended for all infants at birth and for children up to 18 years. […] The hepatitis B vaccine is also recommended for adults living with diabetes and those at high risk for infection due to their jobs, lifestyle, living situations, or country of birth. […] Since everyone is at some risk, all adults should seriously consider getting the hepatitis B vaccine for a lifetime protection against a preventable chronic liver disease. […] The hepatitis B vaccine is also known as the first anti-cancer vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide. […] If you have a current HBV infection (HBsAg positive) or have recovered from a past HBV infection, the hepatitis B vaccine series will not benefit you or clear the virus. However, the vaccine can provide a lifetime of protection for loved ones who do not have hepatitis B and get the vaccine as soon as possible.
- #33 Assessment of long-term efficacy of hepatitis B vaccine – PubMedhttps://pubmed.ncbi.nlm.nih.gov/11599689/
In a healthy cohort of 462 subjects in which hepatitis B vaccine was administered between 1990 and 1992 a follow-up study was carried out to determine the duration of protection. […] The proportion of protection 6.5 years after vaccination was 85% (95% CI: 82-88). […] We conclude that in immunocompetent population it is not necessary to administer a booster dose 6.5 years after hepatitis B vaccination.
- #34 Predicting Hepatitis B Virus Infection Based on Health Examination Data of Community Populationhttps://pmc.ncbi.nlm.nih.gov/articles/PMC6926879/
Despite a decline in the prevalence of hepatitis B in China, the disease burden remains high. […] The prediction model can be used to accurately identify populations at high risk of hepatitis B infection that should adopt timely appropriate medical treatment measures. […] A large proportion of people unaware of HBV infection missed the ideal treatment time, resulting in treatment difficulties and poor prognosis. […] Thus, it is necessary to improve the detection probability of HBV infected patient. […] Therefore, the XGBoost model can be applied to assess the prevalence of HBV in the general population, promote early diagnosis and timely treatment of high-risk groups, and improve the utilization of medical resources, particularly in low resource countries. […] Our findings revealed that the Borderline-SMOTE XGBoost combined model outperformed the other models with desirable performance and may help identify individuals in need of HBsAg testing.
- #35https://journals.lww.com/ajg/Fulltext/2012/10000/Efficacy_of_Hepatitis_B_Vaccination_and.3.aspx?generateEpub=Article%7Cajg:2012:10000:00003%7C10.1038/ajg.2012.79%7C
We assessed the effectiveness of hepatitis B virus (HBV) vaccine in inflammatory bowel disease (IBD) patients, evaluated the impact of immunosuppressors and antitumor necrosis factor (anti-TNF) agents, and assessed the effectiveness of revaccination. […] Of 241 vaccinated patients, anti-HBs was 10 IU/l in 59% and 100 IU/l in 39%. The response rate (anti-HBs 10 IU/l) was lower among patients under anti-TNF therapy: 46% vs. 62%. In the multivariate analysis, a lower response rate was demonstrated in older patients and those receiving anti-TNFs. The response rate (anti-HBs 100 IU/l) after revaccination was 42%. […] The response rate to the HBV vaccination even with a double-dose schedule is very low in IBD patients, mainly in those receiving anti-TNFs. However, treatment with immunosuppressors did not affect the efficacy of the vaccine. A considerable albeit insufficient success rate may be obtained when two consecutive vaccination courses, each with a three-dose vaccine series, are administered.
- #36 Pre-vaccination inflammation and B-cell signalling predict age-related hyporesponse to hepatitis B vaccination | Nature Communicationshttps://www.nature.com/articles/ncomms10369
Collectively these results show for the first time that transcriptional profiling allows the identification before vaccination, albeit with a moderate accuracy, of participants that will mount a poor response to the HBV vaccine. This signature highlights the interplay between the innate inflammatory pathways and B cells in the response to the HBV vaccine. […] Our results show that increased frequencies of CD4+ T cells, which can provide help to B cells in white blood cells, are associated with higher anti-HBsAg titres. […] Integration of FCM and cytokine profiles highlights the role of elements of the pro-inflammatory response, which is negatively correlated to antibody production. Increased frequencies of activated innate immune cells were associated with transcriptional signatures and cytokines that predicted the poor Ab response. […] Collectively our results highlight the importance of type I interferon and other pro-inflammatory pathways in the development of a poor response to HBV vaccine.