Response to Hepatitis B Vaccine in Preterm Infants: Four-Dose Schedule

ABSTRACT

The objective of this study is to test a four-dose Hepatitis B vaccine schedule in premature infants (PI) and assess the immunogenicity of the vaccine with this schedule. We studied 29 PI who received the vaccine against Hepatitis B at birth, 1, 5, and 9 months of age. Antibodies against surface antigen (Anti-HBs) were measured before the third and fourth doses and 12 weeks after the fourth dose. Levels higher than 10 mIU/mL were considered protective, whereas more than 100 mIU/mL was an excellent response. Twenty-nine PI were studied. The average weight at the time of the initial dose was 1398 g, gestational age of 32.5 weeks, and a postnatal age of 9 days. Since the initial measurement, protective levels were achieved in all patients. The response was excellent in 24.1, 75.9, and 89.7%, after the second, third, and fourth doses, respectively. No correlation was found between the type of response and the infants' weight or the postnatal age. The Anti-HBs geometrical levels were 51.9, 133, and 133 mIU/mL after the second, third, and fourth doses, respectively. The favorable results obtained might be due to: the four-dose schedule itself, the dose we used (10 μg), the time interval between the doses, and even a race factor. Our schedule seems to be useful for PI infants and probably is no longer necessary to delay the vaccination, although this should be confirmed by further studies.

KEYWORD

Hepatitis B vaccine - premature infants - new vaccine schedule

REFERENCES

• 1 Jonas M M, Schiff E F, O'Sullivan M J. Failure of the centers for disease control criteria to identify hepatitis B infection in a large municipal obstetrical population.  Ann Intern Med . 1987;  107 335-337
• 2 Alter M J, Haddler S C, Margelis H S. Changing epidemiology of hepatitis B in the United States: need of alternative vaccination strategies.  JAMA . 1990;  263 1218-1222
• 3 Committee of Infectious Diseases. American Academy of Pediatrics. Universal hepatitis B immunization.  Pediatrics . 1992;  89 795-800
• 4 McMahon B J, Rhoades E R, Heyward W L. A comprehensive program to reduce the incidence of hepatitis B infections and its sequelae in Alaskan natives.  Lancet . 1987;  2 1134-1136
• 5 Tan K L, Goh K T, Oon C J, Chan S H. Immunogenicity of recombinant yeast-derived hepatitis B vaccine in nonresponders to perinatal immunization.  JAMA . 1994;  271 859-861
• 6 West D J. Clinical experience with hepatitis B vaccines.  Am J Infect Control . 1989;  17 172-180
• 7 Grosheide P M, del Canho R, Heijtink R A. Passive-active immunization in infants of hepatitis B antigen-positive mothers.  AJDC . 1993;  147 1316-1320
• 8 Committee of Infectious Diseases. Update of timing of hepatitis B vaccination for premature infants and for children with lapsed immunization.  Pediatrics . 1994;  94 403-404
• 9 Lau Y L, Tam A YC, Ng K W. Response of preterm infants to hepatitis B vaccine.  J Pediatr . 1992;  121 962-965
• 10 Chirico G, Belloni C, Gasparoni A. Hepatitis immunization in infants of hepatitis B surface antigen-negative mothers.  Pediatrics . 1993;  92 717-719
• 11 Belloni C, Chirico G, Pistorio A, Orsolini F, Tinelli C, Rondini G. Immunogenicity of Hepatitis B vaccine in term and preterm infants.  Acta Paediatr . 1998;  87 336-338
• 12 Blondheim D, Bader D, Abend M. Immunogenicity of hepatitis B vaccine in preterm infants.  Arch Dis Child . 1998;  3 F206-F208
• 13 Capurro H, Konichezky S, Fonseca D, Caldeyro-Barcia R. A simplified method for diagnosis of gestacional age in the newborn infant.  J Pediatr . 1978;  93 120-122
• 14 Patel D M, Butler J, Feldman S, Graves G R, Rhodes P G. Immunogenicity of hepatitis B vaccine in healthy very low birth weight infants.  J Pediatr . 1997;  130 641-643
• 15 Dawson-Saunders B, Trapp R G. Bioestadística Médica.  2nd ed. México, D.F.: Manual Moderno 1997: 105-276
• 16 Committee of Infectious Diseases. American Academy of Pediatrics. Report of the committee of infectious disease. In: Peter G, ed. 1997 Red Book, 24th ed. Elk Grove Village, IL: American Academy of Pediatrics 1997: 325-340
• 17 Losonsky G A, Wasserman S S, Stephens I. Hepatitis B vaccination of premature infants: a reassessment of current recommendations of delayed immunization.  Pediatrics . 1999;  103 8-14
• 18 West D J, Calandra G B, Ellis R W. Vaccination of infants and childrens against hepatitis B.  Pediatr Clin North Am . 1990;  37 585-601
• 19 Golebiowska M, Kardas-Sobantka D, Chlebna-Sokol D, Sabanty W. Hepatitis B vaccination in preterm infants.  Eur J Pediatr . 1999;  158 293-297
• 20 Kim S, Chang E, Hodinka R. Immunogenicity of hepatitis B vaccine in preterm infants.  Pediatrics . 1997;  99 534-536
• 21 Huang F Y, Lee P I, Huang L M, Chang L Y, Liu S C. Hepatitis B vaccination in preterm infants.  Arch Dis Child . 1997;  77 F135-F138
• 22 Tomas H C. The hepatitis B virus and the host response.  J Hepatol . 1990;  11 S83-S89
• 23 Landa L. Seroepidemiología de la Hepatitis B.  Gac Med Méx . 1976;  11 85-90
• 24 Ortiz-Ibarra F, Lara-Sánchez J, Figueroa-Damián M, Arredondo-García J, Ahued-Ahued J. Prevalencia de marcadores serológicos de los virus de la Hepatitis A, B, C, y D en embarazadas.  Sal Pub Mex . 1996;  38 317-322
• 25 Hernández-Arriaga J, Ramírez-Crespo A, De Anda-Gómez M, Castellanos-Martínez J. Marcadores serológicos de Hepatitis B en la etapa perinatal.  Bol Med Hosp Infant Mex . 2000;  57 10-9