title: Accelerated schedule of hepatitis B vaccination in patients with hemophilia.
abstract: Early development of immunity after hepatitis B vaccination is particularly important for patients such as hemophiliacs, at high risk for acquiring hepatitis B from potentially infectious plasma-derived concentrates. The purpose of this study was to evaluate whether or not protective antibody titers could be achieved quickly and maintained in hemophiliacs by an accelerated vaccination schedule. A yeast-recombinant hepatitis B vaccine (Engerix B, SKF Ritt) was given subcutaneously in the deltoid region and repeated 2 and 6 weeks later to 85 hemophiliacs negative for hepatitis B virus (HBV) markers. After the first 22 patients had been enrolled, a modification of the schedule involving a fourth booster dose 24 weeks after the first dose of vaccine was applied to the next 63 consecutive vaccines. Fifty-three percent of vaccinees had antibody titers to hepatitis B surface antigen (anti-HBs > or = 10 mlU/ml) by week 6, even though the mean titers of anti-HBs were somewhat lower than those achieved historically in normal individuals. The protection rate had increased to 87% by week 10, one month after the third dose of vaccine, and to 93% by week 24. One year after starting vaccination, the rate for the vaccinees who did not receive the fourth booster dose was 71%, and 96% for those who did receive the fourth dose, with only 2 patients not responding despite the booster dose. It is concluded that even though the accelerated schedule of immunization produced rapidly high rates of protective antibody titers, a booster dose is required to obtain higher titers and provide more persistent immunity.
authors.affiliation: Study Group of the Fondazione dell'Emofilia, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Santagostino
authors.forename: P M
authors.initials: PM
authors.lastname: Mannucci
authors.forename: A
authors.initials: A
authors.lastname: Gringeri
authors.forename: M G
authors.initials: MG
authors.lastname: Rumi
authors.forename: D
authors.initials: D
authors.lastname: Rafanelli
authors.forename: A
authors.initials: A
authors.lastname: Rocino
authors.forename: M
authors.initials: M
authors.lastname: Schiavoni
authors.forename: A
authors.initials: A
authors.lastname: Chistolini
authors.forename: E
authors.initials: E
authors.lastname: Di Bona
authors.forename: G
authors.initials: G
authors.lastname: Muleo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006467:Hemophilia A / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000096:biosynthesis; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines