Response to hepatitis b vaccination in at-risk group patients
e202603013
Keywords:
Vaccination, Vaccine schedules, Immunization programs, Immunity, Hepatitis B vaccines, Hepatitis B antibodies, HIV, Chronic renal insufficiency, Inmunosupressive agents, NeoplasmsAbstract
BACKGROUND // It is known that between 5-10% of individuals vaccinated against hepatitis B virus (HBV) do not develop protective antibody levels. Several factors negatively influence the immune response. The aim of this paper was to evaluate the immunological response to HBV vaccination in at-risk populations and analyze its variation according to the type of vaccination schedule (primary vaccination or booster dose), age, sex, and risk group.
METHODS // A longitudinal descriptive study was conducted on patients between 04/11/2021-15/06/2023 at the Preventive Medicine vaccination clinic at Hospital Infanta Leonor (Madrid, Spain). Patients from risk groups who had completed a full vaccination schedule (high-dose or adjuvant vaccine) or received a booster dose were included. Criteria for exclusion were incomplete vaccination schedules and absence of post-vaccination serology. A non-probabilistic convenience sampling was used, including all available patients who met the inclusion criteria. The sample size was 77 patients. Variables considered were: age, sex, risk pathology, and HBsAbs levels at 1 to 2 months post-vaccination. The immune response (HBsAbs ≥10 mUI/ml) was analyzed according to the collected variables using chi-square and logistic regression.
RESULTS // Out of 572 patients that were assessed, 97 had received vaccination. Serology data was available for 77 patients: primary vaccination (n=51), booster dose (n=24), and revaccination (n=2). Mean age was 43.7 (15.7) years, 76.6% were men. Distribution by risk group was: 59.7% HIV, 28.6% immunosuppression, 11.7% chronic kidney disease. Among the 77 patients included in the study, 87% (95% CI: 77.4-93.6) responded to vaccination, with differences in response evident in the age ranges: 96.8% (95% CI: 83.3-99.9) of those under fourty years of age responded adequately compared to 50% (95% CI: 18.7–81.3) of those over fifty-five years (p=0.002). In the primary vaccinated group, those patients that were over fifty-five years of age had a 96% lower probability of mounting an adequate immune response compared to those under fourty years, adjusted for other variables (OR=0.04, 95%CI: 0.002; 0.70) (p=0.028).
CONCLUSIONS // Most individuals vaccinated against HBV show an adequate immune response, although older age is associated with a reduction in response to the vaccination. Maintaining complete and updated vaccination schedules is essential, especially in older patients, to ensure effective protection.
Downloads
References
1. Wu WL, Yan BY, Lyu JJ, Liu JY, Feng Y, Chen SY et al. [Antibody persistence following primary vaccination with hepatitis B vaccine among normal and high-responder adults: a 5-year follow-up study]. Zhonghua Yu Fang Yi Xue Za Zhi. 2016;50(6):484-490. https://doi.org/10.3760/cma.j.issn.0253-9624.2016.06.003
2. Meier MA, Berger CT. A simple clinical score to identify likely hepatitis B vaccination non-responders-data from a retrospective single center study. BMC Infect Dis. 2020;20(1). https://doi.org/10.1186/s12879-020-05634-y
3. Rosic I, Malicevic S, Medic S. The significance of age and sex for the absence of immune response to hepatitis B vaccination. Srp Arh Celok Lek. 2008;136(1-2):33-37. https://doi.org/10.2298/sarh0802033r
4. Di Lello FA, Martínez AP, Flichman DM. Insights into induction of the immune response by the hepatitis B vaccine. World J Gastroenterol. 2022;28(31):4249-4262. https://doi.org/10.3748/wjg.v28.i31.4249
5. Koc ÖM, Menart C, Theodore J, Kremer C, Hens N, Koek GH et al. Ethnicity and response to primary three-dose hepatitis B vaccination in employees in the Netherlands, 1983 through 2017. J Med Virol. 2020;92(3):309-316. https://doi.org/10.1002/jmv.25610
6. Yang S, Tian G, Cui Y, Ding C, Deng M, Yu C et al. Factors influencing immunologic response to hepatitis B vaccine in adults. Sci Rep. 2016;6:27251. https://doi.org/10.1038/srep27251
7. Tahir A, Shinkafi SH, Alshrari AS, Yunusa A, Umar MT, Hudu SA et al. A Comprehensive Review of Hepatitis B Vaccine Nonresponse and Associated Risk Factors. Vaccines Basel. 2024;12(7):710. https://doi.org/10.3390/vaccines12070710
8. Khafagy A, AlJahdaly I, Goweda R. Hepatitis B Vaccine: Assessment of Immunologic Response, Coverage Rate, and Factors Influencing Seroreactivity. Clin Lab. 2020;66(7). https://doi.org/10.7754/Clin.Lab.2019.191202
9. Qiu J, Zhang S, Feng Y, Su X, Cai J, Chen S et al. Efficacy and safety of hepatitis B vaccine: an umbrella review of meta-analyses. Expert Rev Vaccines. 2024;23(1):69-81. https://doi.org/10.1080/14760584.2023.2289566
10. Trevisan A, Giuliani A, Scapellato ML, Anticoli S, Carsetti R, Zaffina S et al. Sex Disparity in Response to Hepatitis B Vaccine Related to the Age of Vaccination. Int J Environ Res Public Health. enero de 2020;17(1):327. https://doi.org/10.3390/ijerph17010327
11. Tsaneva-Damyanova DT, Ivanova LI, Pavlova SN, Todorova SB, Popova TK. Evaluation of Anti-HBs Antibody Immune Response against Hepatitis B virus in Vaccinated People in a North-eastern Bulgaria Region. Folia Med Plovdiv. 2019;61(4):572-578. https://doi.org/10.3897/folmed.61.e47760
12. Hoebe CJPA, Vermeiren APA, Dukers-Muijrers NHTM. Revaccination with Fendrix® or HBVaxPro® results in better response rates than does revaccination with three doses of Engerix-B® in previous non-responders. Vaccine. 2012;30(48):6734-6737. https://doi.org/10.1016/j.vaccine.2012.08.074
13. Mena G, Llupià A, García-Basteiro AL, Díez C, León A, García F et al. Assessing the immunological response to hepatitis B vaccination in HIV-infected patients in clinical practice. Vaccine. 2012;30(24):3703-3709. https://doi.org/10.1016/j.vaccine.2012.03.018
14. Tian Y, Hua W, Wu Y, Zhang T, Wang W, Wu H et al. Immune Response to Hepatitis B Virus Vaccine Among People Living With HIV: A Meta-Analysis. Front Immunol. 2021;12:745541. https://doi.org/10.3389/fimmu.2021.745541
15. Irungu E, Mugo N, Ngure K, Njuguna R, Celum C, Farquhar C et al. Immune response to hepatitis B virus vaccination among HIV-1 infected and uninfected adults in Kenya. J Infect Dis. 2013;207(3):402-410. https://doi.org/10.1093/infdis/jis695
16. Zerdali E, Nakir IY, Surme S, Yildirim M. Hepatitis B virus prevalence, immunization and immune response in people living with HIV/AIDS in Istanbul, Turkey: a 21-year data analysis. Afr Health Sci. 2021;21(4):1621-1628. https://doi.org/10.4314/ahs.v21i4.16
17. Seremba E, Ocama P, Ssekitoleko R, Mayanja-Kizza H, Adams SV, Orem J et al. Immune response to the hepatitis B vaccine among HIV-infected adults in Uganda. Vaccine. 2021;39(8):1265-1271. https://doi.org/10.1016/j.vaccine.2021.01.043
18. Chakvetadze C, Bani-Sadr F, Le Pendeven C, Lescure FX, Fontaine C, Galperine T et al. Serologic response to hepatitis B vaccination in HIV-Infected patients with isolated positivity for antibodies to hepatitis B core antigen. Clin Infect Dis Off Publ Infect Dis Soc Am. 2010;50(8):1184-1186. https://doi.org/10.1086/651422
19. Lee JH, Hong S, Im JH, Lee JS, Baek JH, Kwon HY. Systematic review and meta-analysis of immune response of double dose of hepatitis B vaccination in HIV-infected patients. Vaccine. 2020;38(24):3995-4000. https://doi.org/10.1016/j.vaccine.2020.04.022
20. Potsch DV, Camacho LA, Tuboi S, Villar LM, Miguel JC, Ginuíno C et al. Vaccination against hepatitis B with 4-double doses increases response rates and antibodies titers in HIV-infected adults. Vaccine. 2012;30(41):5973-5977. https://doi.org/10.1016/j.vaccine.2012.07.028
21. Udomkarnjananun S, Takkavatakarn K, Praditpornsilpa K, Nader C, Eiam-Ong S, Jaber BL et al. Hepatitis B virus vaccine immune response and mortality in dialysis patients: a meta-analysis. J Nephrol. 2020;33(2):343-354. https://doi.org/10.1007/s40620-019-00668-1
22. Jodłowska-Siewert E, Jagodzinski PP, Grzegorzewska AE. Titers of antibodies to the surface antigen of hepatitis B virus after vaccination in relation to immunity-related gene variants. A prospective study among hemodialysis patients. Pol Arch Intern Med. 2017;127(7-8):481-489. https://doi.org/10.20452/pamw.4074
23. Pereira ZTV, Mendoza-Sassi RA. Respuesta inmunitaria a la vacuna de la hepatitis B en pacientes hemodializados en Brasil y sus factores asociados. Rev Med Chile. 2012;140(7):882-888. https://doi.org/10.4067/s0034-98872012000700008
24. Erdogdu HI, Atalay E, Gürsoy G, Canbakan B, Aktürk S, Yazıcı C et al. Factors affecting inadequate response to HBV vaccine in hemodialysis patients: northeast anatolia survey with six hemodialysis centers. Clin Exp Nephrol. 2019;23(4):530-536. https://doi.org/10.1007/s10157-018-1676-x
25. Lacson E, Teng M, Ong J, Vienneau L, Ofsthun N, Lazarus JM. Antibody response to Engerix-B and Recombivax-HB hepatitis B vaccination in end-stage renal disease. Hemodial Int Int Symp Home Hemodial. 2005;9(4):367-375. https://doi.org/10.1111/j.1492-7535.2005.01155.x
26. Ibrahim S, El-Din S, Bazzal I. Antibody level after hepatitis-B vaccination in hemodialysis patients: impact of dialysis adequacy, chronic inflammation, local endemicity and nutritional status. J Natl Med Assoc. 2006;98(12):1953-1957. https://pmc.ncbi.nlm.nih.gov/articles/PMC2569692/
27. DaRoza G, Loewen A, Djurdjev O, Love J, Kempston C, Burnett S et al. Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: earlier is better. Am J Kidney Dis. 2003;42(6):1184-1192. https://doi.org/10.1053/j.ajkd.2003.08.019
28. Calendario de vacunación para toda la vida [Internet]. Madrid: Comunidad de Madrid; 2022 [consultado 3 de diciembre de 2024]. Disponible en: https://www.comunidad.madrid/servicios/salud/vacunas
29. Calendario de vacunación para toda la vida actualizado 2023 [Internet]. Madrid: Comunidad de Madrid; 2023 [consultado 3 de diciembre de 2024]. Disponible en: https://www.comunidad.madrid/servicios/salud/vacunas
30. Kakisaka K, Sakai A, Yoshida Y, Miyasaka A, Takahashi F, Sumazaki R et al. Hepatitis B Surface Antibody Titers at One and Two Years after Hepatitis B Virus Vaccination in Healthy Young Japanese Adults. Intern Med. 2019;58(16):2349-2355. https://doi.org/10.2169/internalmedicine.2231-18
31. Lu IC, Jean MCY, Lin CW, Chen WH, Perng DS, Lin CW et al. Predictive factors for anti-HBs status after 1 booster dose of hepatitis B vaccine. Med Baltim. 2016;95(39):e5023. https://doi.org/10.1097/MD.0000000000005023
32. Kim HN, Harrington RD, Van Rompaey SE, Kitahata MM. Independent clinical predictors of impaired response to hepatitis B vaccination in HIV-infected persons. Int J STD AIDS. 2008;19(9):600-604. https://doi.org/10.1258/ijsa.2007.007197
33. Siddiqui S, Malik A, Shukla I, Rizvi M, Haque SF. Seroprotection after hepatitis B vaccination in chronic kidney disease patients with modified schedule and dosage. J Infect Dev Ctries. 2010;4(06):389-392. https://doi.org/10.3855/jidc.147
34. Svác J, Skladaný L, Sekerková Z, Javorský P, Leskova L, Mizla P et al. Peritoneal dialysis is the better therapy choice for successful anti-hepatitis B vaccination. Adv Perit Dial Conf Perit Dial. 2005;21:151-153. https://pubmed.ncbi.nlm.nih.gov/16686308/
35. Richi P, Alonso O, Martín MD, González-Hombrado L, Navío T, Salido M et al. Evaluation of the immune response to hepatitis B vaccine in patients on biological therapy: results of the RIER cohort study. Clin Rheumatol. 2020;39(9):2751-2756. https://doi.org/10.1007/s10067-020-05042-2
36. Fabrizi F, Dixit V, Martin P, Messa P. Meta-analysis: the impact of diabetes mellitus on the immunological response to hepatitis B virus vaccine in dialysis patients. Aliment Pharmacol Ther. 2011;33(7):815-821. https://doi.org/10.1111/j.1365-2036.2011.04589.x
Downloads
Additional Files
Published
How to Cite
License
Copyright (c) 2026 Victoria García Martín, Eva Jiménez González de Buitrago, Bárbara Arana Aragón, Laura Moratilla Monzó, Inés Fernández Jiménez
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Usted es libre de:
Compartir — copiar y redistribuir el material en cualquier medio o formato.
La licenciante no puede revocar estas libertades en tanto usted siga los términos de la licencia.
Bajo los siguientes términos:
Atribución — Usted debe dar crédito de manera adecuada , brindar un enlace a la licencia, e indicar si se han realizado cambios. Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugiera que usted o su uso tienen el apoyo de la licenciante.
NoComercial — Usted no puede hacer uso del material con propósitos comerciales.
SinDerivadas — Si remezcla, transforma o crea a partir del material, no podrá distribuir el material modificado.
No hay restricciones adicionales — No puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otras a hacer cualquier uso permitido por la licencia.
Avisos:
No tiene que cumplir con la licencia para elementos del material en el dominio público o cuando su uso esté permitido por una excepción o limitación aplicable.
No se dan garantías. La licencia podría no darle todos los permisos que necesita para el uso que tenga previsto. Por ejemplo, otros derechos como publicidad, privacidad, o derechos morales pueden limitar la forma en que utilice el material.
![¿Cómo evaluar para la RESP? [PARA REVISORES]](https://ojs.sanidad.gob.es/public/site/images/rmartinb/pastilla-revisores-0eaa113abcbc4fc554c7c6c7840ca4c6.jpg)
![¿Cómo recibir avisos sobre nuevos artículos de la RESP? [PARA LECTORES]](https://ojs.sanidad.gob.es/public/site/images/rmartinb/pastilla-lectores-aa689338e95aab07df45b4b0d583188f.jpg)
