Improving Hepatitis B Vaccination Rates in Nephrology Patients with Chronic Kidney Disease: A QI Initiative

Hepatitis B vaccination is an important health maintenance preventative measure for patients with chronic kidney disease (CKD) Prior to initiating dialysis, hepatitis B vaccination administration is proven to be more effective than waiting until patients begin dialysis treatments. Efficacy and immune response of the hepatitis B vaccine is greater when kidney function is greater To better improve hepatitis B vaccine administration among the CKD stage 4 population, education measures and Epic modifiers will be implemented to achieve change Nursing knowledge and hepatitis B vaccine administration will improve after implementation of these measureshttps://digitalcommons.centracare.com/nursing_posters/1136/thumbnail.jp

The cost-effectiveness of introducing hepatitis B vaccine into infant immunization services in Mozambique

Objective: To estimate the cost-effectiveness of introducing hepatitis B vaccine into routine infant immunization services in Mozambique, which took place in the year 2001. Methods: A decision analytic model was used to estimate the impact of hepatitis B vaccination. This model was developed for the WHO to estimate the global burden of disease from hepatitis B. Cost data of vaccine delivery and medical treatment related to hepatitis B infection were collected for the analysis. Findings: The introduction of hepatitis B vaccine has increased the annual budget for immunization services by approximately 56%. It is predicted that more than 4000 future deaths are averted annually by the intervention. In the base case scenario, the incremental costs per undiscounted deaths averted amount to US$436, and the costs per undiscounted DALY averted amount to US$36. Since the major impact of hepatitis B vaccination will not start to be evident for at least another 40 years (deaths from hepatitis B mainly occur between 40-60 years of age), the cost per DALY averted rises to US$47, when using a discount rate of 3% on health effects. We found that the monovalent hepatitis B vaccine was considerably more cost-effective than the hepatitis B vaccine in combination with DTP. Interpretation: If policy makers value future health benefits equal to current benefits, the cost-effectiveness of infant hepatitis B vaccination is in the range of other primary health care interventions for which similar analysis has been undertake

Hepatitis B Vaccination Rate Among Medical Students At The University Of Port Harcourt Teaching Hospital (UPTH), Nigeria

Background Hepatitis B virus (HBV) infection causes significant morbidity and mortality worldwide.  Occupational exposure of health care workers and medical students increases their risk of acquiring HBV infection, and many authorities recommend vaccination. However, significant proportions of health care workers do not receive HBV immunization, and remain at increased risk to HBV infection. The objective of this study was to determine the hepatitis B vaccination rate among Medical students at the University of Port Harcourt Teaching Hospital (UPTH) and to determine their knowledge of HBV infection.Methods Three hundred and sixteen medical students at UPTH completed Selfadministered  questionnaires which included questions about demographic characteristics, HBV vaccination status, knowledge of hepatitis B vaccine and reasons for not receiving the vaccine.Results All (100%) of the respondents had heard of hepatitis B vaccine. 7Wo hundred and twenty two  (70.2%) of them thought they were at risk of acquiring hepatitis. 7Wo hundred and seventy (85.4%) had received at least one dose of hepatitis B vaccine while 46 (14.6%) had never received the vaccine. One hundred and ten of the respondents had received 3 doses of hepatitis B vaccine, giving a vaccination rate of 34.8%. One hundred and sixteen (36. 7%) had received 2 doses, while 44 (13.9%) had received one  dose. There was a statistical significant relationship between marital status( p=0.01), clinical level  (p=0.02) and hepatitis B vaccine uptake.Conclusion The hepatitis B vaccination rate among medical students at the University of Port Harcourt Teaching Hospital is low. National and institutional legislation for adult vaccination against Hepatitis B should be promulgated for those at higher risk.Keywords Hepatitis B, vaccination rate, Medical students; Nigeria

Randomized, Controlled Trial of the Long Term Safety, Immunogenicity and Efficacy of RTS,S/AS02(D) Malaria Vaccine in Infants Living in a Malaria-Endemic Region.

The RTS,S/AS malaria candidate vaccine is being developed with the intent to be delivered, if approved, through the Expanded Programme on Immunization (EPI) of the World Health Organization. Safety, immunogenicity and efficacy of the RTS,S/AS02(D) vaccine candidate when integrated into a standard EPI schedule for infants have been reported over a nine-month surveillance period. This paper describes results following 20 months of follow up. This Phase IIb, single-centre, randomized controlled trial enrolled 340 infants in Tanzania to receive three doses of RTS,S/AS02(D) or hepatitis B vaccine at 8, 12, and 16 weeks of age. All infants also received DTPw/Hib (diphtheria and tetanus toxoids, whole-cell pertussis vaccine, conjugated Haemophilus influenzae type b vaccine) at the same timepoints. The study was double-blinded to month 9 and single-blinded from months 9 to 20. From month 0 to 20, at least one SAE was reported in 57/170 infants who received RTS,S/AS02(D) (33.5%; 95% confidence interval [CI]: 26.5, 41.2) and 62/170 infants who received hepatitis B vaccine (36.5%; 95% CI: 29.2, 44.2). The SAE profile was similar in both vaccine groups; none were considered to be related to vaccination. At month 20, 18 months after completion of vaccination, 71.8% of recipients of RTS,S/AS02(D) and 3.8% of recipients of hepatitis B vaccine had seropositive titres for anti-CS antibodies; seroprotective levels of anti-HBs antibodies remained in 100% of recipients of RTS,S/AS02(D) and 97.7% recipients of hepatitis B vaccine. Anti-HBs antibody GMTs were higher in the RTS,S/AS02(D) group at all post-vaccination time points compared to control. According to protocol population, vaccine efficacy against multiple episodes of malaria disease was 50.7% (95% CI: -6.5 to 77.1, p = 0.072) and 26.7% (95% CI: -33.1 to 59.6, p = 0.307) over 12 and 18 months post vaccination, respectively. In the Intention to Treat population, over the 20-month follow up, vaccine efficacy against multiple episodes of malaria disease was 14.4% (95% CI: -41.9 to 48.4, p = 0.545). The acceptable safety profile and good tolerability of RTS,S/AS02(D) in combination with EPI vaccines previously reported from month 0 to 9 was confirmed over a 20 month surveillance period in this infant population. Antibodies against both CS and HBsAg in the RTS,S/AS02(D) group remained significantly higher compared to control for the study duration. Over 18 months follow up, RTS,S/AS02(D) prevented approximately a quarter of malaria cases in the study population. CLINICAL TRIALS: Gov identifier: NCT00289185

Immunogenicity of two different dosages (10 and 5 μg) of recombinant DNA hepatitis B vaccine in healthy neonates

The immunogenicity of a half (5 μg) and a full (10 μg) dosage of recombinant DNA yeast-derived hepatitis B vaccine (HB-Vax-DNA) in healthy neonates was assessed in order to compare two candidate dosages of vaccine. After randomization 174 newborns of HBsAg-negative mothers entered the study. Neonates received four doses of either 10 or 5 μg hepatitis B vaccine, according to the DTP polio immunization schedule at months 3, 4, 5 and 11. No serious adverse reactions were observed; 15.5% of vaccinated newborns suffered mild transient local symptoms. The vaccine was highly immunogenic irrespective of dosage of vaccine; all infants developed anti-HBs levels ⩾ 10 IUl−1, 99% ⩾ 100 IUl−1. A dosage of 10 μg hepatitis B vaccine produced higher antibody levels than 5 μg hepatitis B vaccine after primary vaccination (first three doses) but not after booster vaccination (fourth dose) (p = 0.06 and 0.75, respectively). Either vaccine dosage can be recommended for incorporation in the Expanded Programme on Immunization in the Netherlands

Hepatitis B vaccine : what you need to know

Hepatitis B is a serious disease that affects the liver. It is caused by the hepatitis B virus. Hepatitis B can cause mild illness lasting a few weeks, or it can lead to a serious, lifelong illness.Hepatitis B virus infection can be either acute or chronic.hep-b.pdf1. Why get vaccinated? -- 2. Hepatitis B vaccine -- 3. Some people should not get this vaccine -- 4. Risks of a vaccine reactio -- 5. What if there is a serious problem? -- 6. The National Vaccine Injury Compensation Program -- 7. How can I learn more?201

Hepatitis B vaccine : what you need to know

Hepatitis B is a serious disease that affects the liver. It is caused by the hepatitis B virus. Hepatitis B can cause mild illness lasting a few weeks, or it can lead to a serious, lifelong illness.Hepatitis B virus infection can be either acute or chronic.hep-b.pdf1. Why get vaccinated? -- 2. Hepatitis B vaccine -- 3. Some people should not get this vaccine -- 4. Risks of a vaccine reactio -- 5. What if there is a serious problem? -- 6. The National Vaccine Injury Compensation Program -- 7. How can I learn more?Supersede

Safety and Preliminary Immunogenicity of Recombinant Hepatitis B (Bio Farma) Vaccine in Adults and Children: A Phase 1 Clinical Trial

Background: In order to fulfil the requirements of the national immunization program and sustain the production capacity of the monovalent Hepatitis B vaccine, this study aimed to assess the safety and immunogenicity of the recombinant Hepatitis B Vaccine (Bio Farma) using the new Hepatitis B bulk. Methods: This study was an experimental, randomized, double-blinded, and controlled Phase I clinical trial, with 100 healthy subjects divided into 50 adults and 50 adolescents. Subjects were randomly assigned to receive either the Bio Farma registered Recombinant Hepatitis B Vaccine (group A) or a new source of Hepatitis B bulk (group B). Subjects received one or three doses of vaccine, depending on the baseline anti-Hbs titer. Subjects were given diary cards to record solicited and unsolicited adverse events for 28 days following vaccination. Vaccine immunogenicity was assessed by measuring the level of HBsAg antibody titer elevation.Results: No serious adverse events were reported during clinical trials. The frequencies of adverse events were not significantly different between the two vaccine-randomized groups. The most immediately observed local reaction was local pain, reported by 35.7–42.8% of adults and 24.0–26.3% of adolescents, without any systemic reactions. Seroconversion in adults in group B reached 100% and 78.5% in group A, meanwhile in adolescent subjects in both groups it reached 100%. A substantial increase in geometric mean titer (GMT) was observed in the majority of subjects after immunization.Conclusion: Recombinant Hepatitis B Vaccine with a new source of HBsAg B bulk is safe, well tolerated, and highly immunogenic

Hepatitis B Vaccination for Patients with Chronic Renal Failure

Background Chronic renal failure patients are at particular risk of hepatitis B virus infection. Early studies have demonstrated that renal failure patients benefit from vaccination; however, not all studies have consistently shown benefit. Objectives To determine the beneficial and harmful effects of hepatitis B vaccine and of a reinforced vaccination series in chronic renal failure patients. Search methods We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Renal Group Controlled Trials Register, The Cochrane Controlled Trials Register on The Cochrane Library (Issue 1, 2002), PubMed/MEDLINE (1966 to July 2003), EMBASE (1985 toNovember 2003), Current Clinical Practice Guidelines (Canadian Immunization Guide and Vaccine Preventable Diseases Surveillance Manual), and Science Citation Index as well as journals, published abstracts, and reference lists of articles. Selection criteria Randomised clinical trials comparing plasma vaccine with placebo, recombinant vaccine with placebo, recombinant vaccine with plasma vaccine, and a reinforced vaccination series (ie, more than three inoculations) with three inoculations of vaccine in chronic renal failure patients. Data collection and analysis Primary outcome measures included incidence of patients developing hepatitis B virus antibodies and infections while secondary outcomes included adverse events, liver-related morbidity, and mortality. Random effects models were used and reported relative risks and 95% confidence intervals (RR and 95% CI). Main results We included seven randomised clinical trials. None of them had high quality. Plasma vaccine was significantly more effective than placebo in achieving hepatitis B antibodies (RR 23.0, 95% CI 14.39 to 36.76, 3 trials). We found no statistically significant difference between plasma vaccine or placebo regarding hepatitis B virus infections (RR 0.50, 95% CI 0.20 to 1.24). We found no statistically significant differences between recombinant vaccine and plasma vaccine in achieving hepatitis B antibodies (RR 0.65, 95% CI 0.28 to 1.53, 2 trials). Heterogeneity was significant and appeared to be attributable to the dose of vaccine. Two trials examined a reinforced recombinant vaccine strategy, which was not statistically more effective than three inoculations of recombinant vaccine regarding development of hepatitis B antibodies (RR 1.36, 95% CI 0.85 to 2.16). Authors’ conclusions Plasma derived vaccines are more effective than placebo in achieving hepatitis B antibodies, while no statistically significant difference was found between recombinant and plasma vaccines. No statistically significant difference of effectiveness was observed between a reinforced vaccination series versus routine vaccinations of three inoculations of recombinant vaccine

Integrating Viral Hepatitis Screening and Prevention Services into an Urban Chemical Dependency Treatment Facility for American Indians and Alaska Natives

American Indian/Alaska Natives (AI/AN) patients at an urban residential chemical dependency treatment center participated in a viral hepatitis prevention project. Project activities integrated into patients’ treatment programs included viral hepatitis and human immunodeficiency virus (HIV) risk factor screening, education and counseling, laboratory testing, and hepatitis A and B vaccination. Of 928 AI/AN admissions, 585 (63%) completed risk factor screening assessment. Of these, 436 (75%) received at least one vaccination, viral hepatitis testing, or both. Of 322 patients tested, 91 (28%) were hepatitis C virus (HCV) antibody positive. Lack of pre-existing immunity to vaccine-preventable viral hepatitis infection was common: 132 (45%) were susceptible to hepatitis A and 224 (70%) were susceptible to hepatitis B infection. Chemical dependency treatment centers serving urban AI/AN provide important opportunities for implementing viral hepatitis prevention programs for high-risk populations and for improving ongoing efforts to reduce the disparate impact of chronic liver disease in AI/ AN people