title: Seroprotection after hepatitis a vaccination in patients with drug-induced immunosuppression.
abstract: BACKGROUND
  Increasing numbers of travelers using immunosuppressive drugs visit hepatitis A endemic countries. Data on protection rates after hepatitis A vaccination in this group are scarce.
  
  
  METHODS
  In this retrospective study, records of subjects with hepatitis A serology taken after vaccination were searched for in travel clinic databases. Relation between immunosuppressive drug use, age, gender, and time between vaccination and serology was evaluated.
  
  
  RESULTS
  Seroprotection rates within 4 weeks after primary vaccination (50%) are lower than after 4 weeks (64%). After the complete series of two vaccinations seroprotection rates reach 95% although success depends on the immunosuppressive drug being used. Subjects under anti-TNF alpha treatment have significantly lower seroprotection rates than subjects using classical immunosuppressive drugs after the second vaccination. There is no influence of age or gender on seroprotection rates.
  
  
  CONCLUSIONS
  Last-minute vaccination in subjects using immunosuppressive medication is not reliable, only 60% of our subjects had a protective antibody level after a single vaccination. When serology was done within 4 weeks after a single vaccination, seroprotection rates were only 50%, after 4 weeks this number rose to 64%. When persons visit a travel clinic in time for a complete vaccination series, satisfactory seroprotection rates can be reached. Seroprotection rate depends on the drug being used, persons using anti-TNF alpha are less protected.
authors.affiliation: Department of Infectious Diseases, Public Health Service (GGD) Gelre-IJssel, Apeldoorn, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: van den Bijllaardt
authors.forename: Helen M
authors.initials: HM
authors.lastname: Siers
authors.forename: Caroline
authors.initials: C
authors.lastname: Timmerman-Kok
authors.forename: Franciscus G
authors.initials: FG
authors.lastname: Pessers
authors.forename: Gerard
authors.initials: G
authors.lastname: Natrop
authors.forename: Joep F
authors.initials: JF
authors.lastname: van Baars
authors.forename: Nynke
authors.initials: N
authors.lastname: Nutma
authors.forename: Douwe
authors.initials: D
authors.lastname: van der Werf
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Gisolf
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006506:Hepatitis A / Q000276:immunology / Q000517:prevention & control; D022362:Hepatitis A Vaccines / Q000627:therapeutic use*; D017957:Hepatitis A Virus, Human / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects / Q000276:immunology; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000145:classification / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D014195:Travel; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014611:Vaccination / Q000379:methods / Q000706:statistics & numerical data
chemical_list: D022362:Hepatitis A Vaccines; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha