HBV seroprevalence after 25 years of universal mass vaccination and management of non‐responders to the anti‐Hepatitis B vaccine: An Italian study among medical students

Abstract

According to international guidelines, healthcare workers and medical students immunized against HBV are periodically tested for anti-HBs IgG. Subjects who show an anti-HBs titre <10 mUI/mL must receive additional vaccine doses to induce a measurable antibody response. This study aimed to evaluate the long-time immunogenicity of anti-hepatitis B vaccination in a sample of medical students and residents of the University of Bari who attended the Hygiene Department for biological risk assessment (April 2014-June 2017). The strategy for the management of nonresponder subjects was evaluated. A total of 3676 students and residents were invited for testing according to a standardized protocol. Anti-HBs IgG was tested for in 3140 (85.4%) subjects: 1174/3140 (37.7%) subjects were negative. 14.6% (128/808) of subjects who received the vaccine during their 12th year of life and 45.8% (1056/2305) of subjects immunized during the first year of life (P < 0.0001) were negative. 1005/1174 (85.6%) seronegative subjects received a booster dose, and 903/1005 (89.9%) were tested for anti-HBs 1 month after the booster dose: 82/903 (9.1%) subjects were still negative. Of these, 56/82 (68.3%) received 2 additional doses of vaccine and 52/56 (92.9%) were tested 1 month after the third dose: 50/52 subjects (96.2%) developed a positive titre. In conclusion, several medical students, immunized at birth or at young age against HBV, did not develop protective titres against the virus. Our management strategy (booster retest; for negative subjects, 2 doses and retest) seems consistent with the purpose of evidencing immunological memory.

Long time persistence of antibodies against Mumps in fully MMR immunized young adults: an Italian retrospective cohort study

“…The Italian Ministry of Health indicated that the Medical Schools and University Hospital have to apply for students and residents the same procedures provided by Italian Law on the Occupational Health and Safety for HCWs. 20 According to these recommendations, in April 2014 the Hygiene Department of the Bari Policlinico University Hospital planned a biological risk prevention program for students and residents of the Medical School of the University of Bari. As part of the program, the susceptibility/ immunity against Mumps was assessed.…”

“…The vaccination status of each enrolled subject was assessed by the Regional Immunization Database (GIAVA). 20 For each enrolled participant, a 5 mL serum sample was collected to assess the immunity/susceptibility status for Mumps and tested by chemiluminescence (CLIA), using LIAISON® Measles IgG, a semiquantitative method, performed with a standardized commercial method (Diasorin). This method defines the subjects with an anti-Mumps IgG titer >11 AU/mL (Arbitrary Unit/mL) as seroprotected.…”

Kinetics of Anti-Hepatitis B Surface Antigen Titers in Nurse Students after a Two-Year Follow-Up

“…A vaccine against HBV has been available since 1981, and Italy was one of the first countries to introduce mandatory universal vaccination for newborns and 12-year-old adolescents in 1991 as well as adults belonging to high-risk groups [11]. The vaccination of adolescents was stopped in 2004, while the immunization of newborns was maintained, resulting in 24 cohorts of subjects being immunized against HBV in 12 years [11,12].…”

Discordance of hepatitis B vaccination policies for healthcare workers between the USA, the UK, and Germany

“…Because a robust anti‐HBs anamnestic immune response against HBV is observed in immunocompetent persons after a primary course of vaccination, a booster is considered unnecessary. The investigations of the anamnestic anti‐HBs response to a booster dose in individuals who had received a primary course of vaccination are shown in Table . The participants of these studies were vaccinated in a neonatal vaccination program or a catch‐up vaccination program.…”

“…Currently, adolescents and young adults who were born under a universal HB vaccine program have reached the age at which they become HCW trainees and HCWs in many countries. Two studies from Thailand and Italy evaluated the level of anti‐HBs and the effectiveness of booster doses in medical students who were immunized at birth or at young age against HBV (Table ). In Thailand, just 7% of the medical students had anti‐HBs levels ≥10 mIU/m.…”