title: Vaccine induced Hepatitis A and B protection in children at risk for cystic fibrosis associated liver disease.
abstract: OBJECTIVE
  Hepatitis A (HAV) and Hepatitis B (HBV) infections can cause serious morbidity in patients with liver disease, including cystic fibrosis associated liver disease (CFALD). HAV and HBV vaccinations are recommended in CFALD, and maintenance of detectable antibody levels is also recommended with chronic liver disease. A better understanding of factors predicting low HAV and HBV antibodies may help physicians improve protection from these viruses in CFALD patients.
  
  
  METHODS
  We examined HAV and HBV vaccine protection in children at risk for CFALD. Clinical and vaccine histories were reviewed, and HAV and HBV antibody titers measured. Those with no vaccination history or low HAV or HBV titers received primary or booster vaccinations, and responses were measured.
  
  
  RESULTS
  Thirty-four of 308 children were at risk for CFALD per project criteria. Ten had previous HAV vaccination, of which 90% had positive anti-HAV antibodies. Thirty-three of 34 had previously received primary HBV vaccination (most in infancy), but only 12 (35%) had adequate anti-HBs levels (≥10mIU/mL). Children with adequate anti-HBs levels were older at first HBV vaccine (median 2.3 vs. 0.1 years, p<0.01), and at final HBV vaccine (median 4.0 vs. 0.8 years, p=0.01). Fourteen of 19 (74%) responded to HBV boosters. Z-scores for BMI at HBV booster were significantly lower in booster non-responders (p=0.04).
  
  
  CONCLUSIONS
  Children at increased risk of CFALD have inadequate HAV and HBV antibody levels, and HBV antibody protection can be enhanced through vaccine boosters. HBV antibody titers should be assessed in CFALD patients with a history of vaccination, particularly in those who received HBV vaccines in infancy or who are malnourished.
authors.affiliation: Montreal Children's Hospital, McGill University, Pediatric Respiratory Medicine, 2300 Rue Tupper, Montreal, Quebec, Canada. adam.shapiro@muhc.mcgill.ca
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Shapiro
authors.forename: Charles R
authors.initials: CR
authors.lastname: Esther
authors.forename: Margaret W
authors.initials: MW
authors.lastname: Leigh
authors.forename: Elisabeth P
authors.initials: EP
authors.lastname: Dellon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications*; D005260:Female; D006506:Hepatitis A / Q000517:prevention & control*; D035922:Hepatitis A Antibodies / Q000097:blood*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D007223:Infant; D008297:Male; D016036:Seroepidemiologic Studies; D055815:Young Adult
chemical_list: D035922:Hepatitis A Antibodies; D022362:Hepatitis A Vaccines; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines