title: Effect of Tetanus-diphtheria Vaccine on Immune Response to Hepatitis B Vaccine in Low-responder Individuals.
abstract: BACKGROUND
  Conventional hepatitis B virus (HBV) vaccination fails to achieve efficient protection in about 5-10% of the world population. Hence, different strategies have been adopted to ameliorate HBV antibody titers. This study aimed to evaluate the concurrent application of tetanus-diphtheria (Td) and HBV vaccination on hepatitis B surface (HBs) antibody titer in low-responder healthy individuals.
  
  
  METHODS
  This was a randomized clinical trial, which was implemented among 140 of medical staff working as health-care workers assumed as low-responders. The subjects were randomly allocated to either control or interventional groups. The control and interventional groups received HBV recombinant vaccine while the latter group was also vaccinated through Td. Enzyme-linked immunosorbent assay was applied to measure HBs antibody (HBsAb) titers just before and 6 months after the last vaccination. All data were entered into SPSS software. Independent t-test, paired t-test, and Chi-square or Fisher's exact test were applied for data comparison.
  
  
  RESULTS
  Antibody titers of the subjects in the intervention and control groups soared from 49.08 ± 20.08 IU/L to 917.78 ± 204.80 IU/L and from 46.95 ± 18.55 to 586.81 ± 351.77 IU/L, respectively (both P < 0.001); nevertheless, by comparison with control group, variation of antibody titer in the interventional group was significantly higher (P < 0.001).
  
  
  CONCLUSIONS
  Concurrent application of Td and HBV vaccine could effectively enhance protective levels of HBsAb titers in low-responder individuals.
authors: Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Abbas
authors: A
authors: Haghighat
authors: Acquired Immunodeficiency Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mohammad
authors: M
authors: Moafi
authors: Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
authors: Jalil
authors: J
authors: Sharifian
authors: Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Hassan
authors: H
authors: Salehi
authors: Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Roya
authors: R
authors: Taleban
authors: Department of Oral Pathology, School of Dentistry, Islamic Azad University (Khorasgan Branch), Isfahan, Iran.
authors: Nader
authors: N
authors: Kalbasi
authors: Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Marzieh
authors: M
authors: Salehi
authors: Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mohammad Mahdi
authors: MM
authors: Salehi
authors: Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Maryam
authors: M
authors: Salehi
keywords: Hepatitis B vaccine; low responders; tetanus-diphtheria vaccine