title: Randomized trial to determine safety and immunogenicity of two strategies for hepatitis B vaccination in healthy urban adolescents in the United States.
abstract: BACKGROUND
  Multiple studies have shown excellent response rates after hepatitis B immunization in youth; however, one previous study conducted in urban youth demonstrated poor responses.
  
  
  METHODS
  Urban youth, ages 12 to 17 years, at participating Adolescent Medicine Trials Network for HIV/AIDS Interventions Clinical/Research sites were randomized to receive either 2 doses of Recombivax HB (10 microg hepatitis B surface antigen) or Twinrix (20 microg hepatitis B surface antigen and 720 EL.U hepatitis A antigen) at 0 and 24 weeks. Safety data were collected and antibody measures performed at 0, 28, and 76 weeks.
  
  
  RESULTS
  A total of 123 subjects were enrolled and 102 had week 28 serum samples available for antibody measure. A positive response (serum antibody > or =10 mIU/mL) to hepatitis B antigen was documented in 41 of 47 (87.2%; 95% confidence interval [CI] 74.3%-95.2%) Recombivax HB recipients and in 52 of 55 (94.6%; 95% CI, 84.9%-98.9%) Twinrix recipients (P = 0.295). In an adjusted analysis, those identified as Hispanic ethnicity (N = 86) were more likely to have a positive response (odds ratio 7.38, 95% CI, 1.56-34.95; P = 0.0018); whereas those who identified as not heterosexual (N = 9) were less likely to respond (odds ratio = 0.12, 95% CI, 0.02-0.74). The majority of youth in the Twinrix arm were hepatitis A antibody positive at baseline (26/51; 51%); however, 24 of 25 hepatitis A antibody negative youth responded to the hepatitis A component. Both vaccines were safe.
  
  
  CONCLUSIONS
  Response rate to 2 doses of Recombivax HB in urban youth is lower than previous studies suggest. The factors associated with diminished response are not known.
authors.affiliation: Department of Pediatrics, Duke, Durham, NC, USA. coleen.cunningham@duke.edu
authors.forename: Coleen K
authors.initials: CK
authors.lastname: Cunningham
authors.forename: Bret J
authors.initials: BJ
authors.lastname: Rudy
authors.forename: Jiahong
authors.initials: J
authors.lastname: Xu
authors.forename: James
authors.initials: J
authors.lastname: Bethel
authors.forename: Bill G
authors.initials: BG
authors.lastname: Kapogiannis
authors.forename: Sushma
authors.initials: S
authors.lastname: Ahmad
authors.forename: Craig M
authors.initials: CM
authors.lastname: Wilson
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flynn
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D022362:Hepatitis A Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D016037:Single-Blind Method; D014481:United States; D014505:Urban Population; D017778:Vaccines, Combined / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D014614:Vaccines, Synthetic / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology
chemical_list: D022362:Hepatitis A Vaccines; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; C075655:Recombivax HB; D017778:Vaccines, Combined; D014614:Vaccines, Synthetic; C433226:twinrix