[Vaccination against hepatitis B possibly indicated for elderly institutionalized mentally handicapped persons with isolated anti-HBc positivity of the prevaccination serum].
OBJECTIVE
To determine whether vaccination against hepatitis B may be omitted in persons with isolated positive anti-HBc.


METHODS
Prospective study using control groups. SETTING'S: Heeren Loo-Lozenoord, Ermelo, the Netherlands.


METHODS
Twenty-six older residents (group P) with isolated anti-HBc positivity (HBsAg negative and anti-HBs < 10 IU/l) were given hepatitis B vaccine (3 doses); 16 matched controls (group C1) lacking hepatitis B markers, received a primary vaccination (3 doses), 8 controls (group C2) with a immune status based on infection in the past received vaccination (3 doses) and 27 controls (group C3) were given a booster vaccination (1 dose) after vaccination 7 years earlier. The anti-HBs response was measured 0, 1 and 7 months after the first vaccine dose. An anamnestic response was defined as a fourfold rise of anti-HBs after one dose of vaccine or--in the absence of an anti-HBs titer in the prevaccination serum--a response > or = 10 IU/l after one dose of vaccine. A primary response was defined as an anti-HBs response > or = 10 IU/l after giving 3 vaccines, while the criteria for an anamnestic response were not met.


RESULTS
In the isolated anti-HBc group (P) and in the corresponding control group (C2) 15 and 12.5%, respectively, showed an anamnestic response; the majority reacted with a primary response or did not respond at all. The subjects given a primary vaccination (C1) responded in 62.5% with a primary response while those vaccinated earlier (C3) responded in 92.6% with a fourfold rise of anti-HBs.


CONCLUSIONS
The anti-HBs response to vaccination in older mentally handicapped persons is delayed and there is a reduced chance of development of a protective anti-HBs titer. The majority of individuals with isolated anti-HBc showed a primary response. In these persons vaccination should not be omitted, especially if there is a risk of hepatitis B.
Vrijmoeth
P
P
Erasmus Universiteit, afd. Virologie, Rotterdam.
Heijtink
R A
RA
Schreuder
H
H
Kroes
A C
AC
D000368:Aged; D003704:Dementia / Q000276:immunology*; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D006512:Hepatitis B Core Antigens / Q000302:isolation & purification; D017325:Hepatitis B Vaccines / Q000276:immunology; D006801:Humans; D008297:Male; D011446:Prospective Studies
D006512:Hepatitis B Core Antigens; D017325:Hepatitis B Vaccines