Hepatitis B and A vaccination in HIV-infected adults: A review

Hepatitis B and A account for considerable morbidity and mortality worldwide. Immunization is the most effective means of preventing hepatitis B and A. However, the immune response to both hepatitis vaccines seems to be reduced in HIV-infected subjects. The aim of this review was to analyze the immunogenicity, safety, long-term protection and current recommendations of hepatitis B and A vaccination among HIV-infected adults. The factors most frequently associated with a deficient level of anti-HBs or IgG anti-HAV after vaccination are those related to immunosuppression (CD4 level and HIV RNA viral load) and to the frequency of administration and/or the amount of antigenic load per dose. The duration of the response to both HBV and HAV vaccines is associated with suppression of the viral load at vaccination and, in the case of HBV vaccination, with a higher level of antibodies after vaccination. In terms of safety, there is no evidence of more, or different, adverse effects compared with HIV-free individuals. Despite literature-based advice on the administration of alternative schedules, revaccination after the failure of primary vaccination, and the need for periodic re-evaluation of antibody levels, few firm recommendations are found in the leading guidelines

Vaccinations in prisons: A shot in the arm for community health

From the first day of imprisonment, prisoners are exposed to and expose other prisoners to various communicable diseases, many of which are vaccine-preventable. The risk of acquiring these diseases during the prison sentence exceeds that of the general population. This excess risk may be explained by various causes; some due to the structural and logistical problems of prisons and others to habitual or acquired behaviors during imprisonment. Prison is, for many inmates, an opportunity to access health care, and is therefore an ideal opportunity to update adult vaccination schedules. The traditional idea that prisons are intended to ensure public safety should be complemented by the contribution they can make in improving community health, providing a more comprehensive vision of safety that includes public health

Vaccination behaviour influences self-report of influenza vaccination status: a cross-sectional study among health care workers.

Background Published influenza vaccination coverage in health care workers (HCW) are calculated using two sources: self-report and vaccination records. The objective of this study was to determine whether self-report is a good proxy for recorded vaccination in HCW, as the degree of the relationship is not known, and whether vaccine behaviour influences self-reporting. Methods A cross-sectional study was conducted using a self-administered survey during September 2010. Considering the vaccination record as the gold standard of vaccination, the properties of self-report as a proxy of the record (sensitivity, specificity, positive predictive value, negative predictive value) were calculated. Concordance between the vaccination campaigns studied (2007-2010) was made using the Kappa index, and discordance was analyzed using McNemar's test. Results 248 HCW responded. The 95% confidence intervals of coverage according to the vaccination record and to self-report overlapped, except for 2007, and the Kappa index showed a substantial concordance, except for 2007. McNemar's test suggested that differences between discordant cases were not due to chance and it was found that the proportion of unvaccinated discordant cases was higher than that of vaccinated discordant cases. Conclusions In our study population, self-reported influenza vaccination coverage in HCW in the previous two years is a good proxy of the vaccination record. However, vaccination behaviour influences the self-report and explains a trend to overestimate coverage in self-reporting compared to the vaccination record. The sources of coverage should be taken into account whenever comparisons are made

Immunogenicity and immunization costs of adjuvanted versus non-adjuvanted hepatitis B vaccine in chronic kidney disease patients

Hepatitis B virus (HBV) vaccination is recommended for all susceptible chronic pre-hemodialysis and hemodialysis patients. This study assessed the immunogenicity of HBV vaccines (adjuvanted and non-adjuvanted) in chronic kidney disease patients vaccinated at the Hospital Clinic of Barcelona (Spain) between January 2007 and July 2012. In addition, the costs for the health system were evaluated according to the proportion of vaccine responders after receiving either vaccine. Patients receiving three doses of hepatitis B adjuvanted vaccine were three times more likely to seroconvert than patients immunized with non-adjuvanted vaccines, OR 3.56 (95% CI 1.84-6.85). This resulted in fewer patients requiring a second course of HBV vaccination and fewer outpatient visits, saving more than euro9,500 per 100 patients. The higher immunogenicity of the adjuvanted HBV vaccine would counterbalance the lower costs associated with the non-adjuvanted vaccine

The social network around influenza vaccination in health care workers: a cross-sectional study

Background: Influenza vaccination coverage remains low among health care workers (HCWs) in many health facilities. This study describes the social network defined by HCWs’ conversations around an influenza vaccination campaign in order to describe the role played by vaccination behavior and other HCW characteristics in the configuration of the links among subjects. Methods: This study used cross-sectional data from 235 HCWs interviewed after the 2010/2011 influenza vaccination campaign at the Hospital Clinic of Barcelona (HCB), Spain. The study asked: “Who did you talk to or share some activity with respect to the seasonal vaccination campaign?” Variables studied included sociodemographic characteristics and reported conversations among HCWs during the influenza campaign. Exponential random graph models (ERGM) were used to assess the role of shared characteristics (homophily) and individual characteristics in the social network around the influenza vaccination campaign. Results: Links were more likely between HCWs who shared the same professional category (OR 3.13, 95% CI = 2.61–3.75), sex (OR 1.34, 95% CI = 1.09–1.62), age (OR 0.7, 95% CI = 0.63–0.78 per decade of difference), and department (OR 11.35, 95% CI = 8.17–15.64), but not between HCWs who shared the same vaccination behavior (OR 1.02, 95% CI = 0.86–1.22). Older (OR 1.26, 95% CI = 1.14–1.39 per extra decade of HCW) and vaccinated (OR 1.32, 95% CI = 1.09–1.62) HCWs were more likely to be named. Conclusions: This study finds that there is no homophily by vaccination status in whom HCWs speak to or interact with about a workplace vaccination promotion campaign. This result highlights the relevance of social network analysis in the planning of health promotion intervention

Rubella susceptibility in pregnant women and results of a postpartum immunization strategy in Catalonia, Spain

BACKGROUND: Elimination of congenital rubella syndrome depends not only on effective childhood immunization but also on the identification and immunization of rubella susceptible women. We assessed rubella susceptibility among pregnant women and evaluated the adherence and response to postpartum immunization with measles, mumps and rubella (MMR) vaccine. METHODS: Cross-sectional study of women who gave birth at the Hospital Clinic de Barcelona (Spain) between January 2008 and December 2013. Antenatal serological screening for rubella was performed in all women during pregnancy. In rubella-susceptible women, two doses of MMR vaccine were recommended following birth. We evaluated rubella serological response to MMR vaccination in mothers who complied with the recommendations. RESULTS: A total of 22,681 pregnant women were included in the study. The mean age was 32.3 years (SD 5.6), and 73.6% were primipara. The proportion of immigrants ranged from 43.4% in 2010 to 38.5% in 2012. The proportion of women susceptible to rubella was 5.9% (1328). Susceptibility to rubella declined with increasing maternal age. Immigrant pregnant women were more susceptible to rubella (7.6%) than women born in Spain (4.6%). Multivariate analyses showed that younger age (</=19 years) aOR 1.7 (95% CI 1.1-2.5), primiparas aOR 1.3 (95% CI 1.1-1.5) and immigrant women aOR 1.6 (95% CI 1.4-1.8) were more likely to be susceptible. The second dose of MMR vaccine was received by 57.2% (718/1256) of rubella-susceptible women, with the highest proportion being immigrant women compared with women born in Spain. After vaccination, all women showed rubella immunity. CONCLUSIONS: The higher rubella susceptibility found in the three youngest age groups and in immigrant women highlights the relevance of antenatal screening, in order to ensure identification and postpartum immunization. The postpartum immunization strategy is an opportunity to protect women of childbearing age and consequently prevent occurrence of CRS, and to increase vaccination coverage against rubella and other vaccine-preventable diseases

Pertussis vaccination during pregnancy: Antibody persistence in infants

Maternal pertussis vaccination is associated with higher levels of pertussis antibodies at birth. We assessed the persistence of pertussis antibodies until primary vaccination in infants whose mothers received Tdap (tetanus, diphtheria, acellular pertussis) vaccine during pregnancy. Infants were born at the Hospital Clinic of Barcelona (Spain) in November 2014. Anti-PT IgG was determined by ELISA at delivery, between the first and second month of life, and estimated at 2months of age. The study included 37 infants whose mothers received Tdap between 21 and 38weeks of gestation. Infants presented a decline in GMC of anti-PT IgG between peripartum and follow-up levels, 52.7 (95% CI 34.7-80.2) versus 7.5 (95% CI 4.2-13.3) at 2months of age (p<0.001). The median half-life of maternal antibodies was 47days. More than half (51.4%) the infants presented detectable anti-PT IgG before the start of primary infant vaccination

Consenso sobre la vacunación frente a la gripe en el personal sanitario

Health care workers (HCW) are included each year among risk groups for vaccination against influenza. However, vaccination coverage among this group in our country is very low, not exceeding 25%. Convinced that one of the best tools to increase this coverage among professionals in our country are the scientific evidence, 19 scientific societies and associations professionals bringing together health professionals more directly related to influenza as an health problem, and the General Nursing Council, met to discuss and develop this consensus document in order to inform HCW about the appropriateness of their vaccination against influenza and the benefits that flow from it for themselves, for their patients and for the rest of the population. This recommendation is based on 3 pillars: argument of necessity, ethics and exemplary

Hepatitis B en instituciones penitenciarias. Estrategias para su prevención

[spa] Estudios realizados en diversos países han llegado a la conclusión de que las personas ingresadas en prisión deben ser consideradas como grupos de riesgo de infección por virus de la hepatitis B (VHB). El objetivo fundamental del presente trabajo ha sido investigar la utilidad de las campañas de vacunación anti-hepatitis B en la población reclusa, considerando: l. La inmunogenicidad de la vacuna, y 2. La factibilidad del propio programa (aceptación del cribaje serológico prevacunal y adeherencia al calendario vacunal establecido). Los objetivos adicionales fueron: 1º. Esclarecer si la permanencia en prisión constituye en sí misma un factor de riesgo de infección por los virus de la hepatitis B y D. 2º. Describir el papel que juegan determinadas características personales y otros factores de riesgo de los reclusos sobre la infección por VHB. 3º. Valorar la importancia relativa del consumo de drogas por vía parenteral (CDVP) sobre la infección por VHB y virus de la hepatitis Delta (VHD), y 4º. Interpretar el significado de la presencia aislada de anti-HBc y de anti-HBs, en el examen prevacunal. Previamente a la vacunación, se ha estudiado la prevalencia de marcadores del VHB (HBsAg, anti-HBc y anti-HBs) en 1742 reclusos varones de tres centros penitenciarios (CP) de Cataluña de diferentes características. Ello representa más del 98% de la población total de estos CP (reclusos presentes el día de inicio del estudio, más nuevos ingresos durante un periodo de 4, 5 y 6 meses). En los casos simultáneamente positivos para HBsAg y anti-HBc, se determinó además anti-HBc-IgM, HBeAg, anti-HBe y anti-HD. La presencia de marcadores se ha re1acionado con una serie de vbriab1es (demográficas, penitenciarias y factores de riesgo de infección), obtenidas mediante entrevista personal dirigida. Los reclusos ca1ificados como susceptibles a la infección por VHB (n=705, inc1uyendo 68 casos anti-HBs positivo aislado), fueron vacunados con vacuna recombinante antihepatitis B (20 microgramos, pauta de 0, 1 y 6 meses), practicándose extracciones postvacunales (6º y 9º mes del inicio), para determinar el título de anti-HBs alcanzado. En el examen prevacunal, el 63% de los reclusos presentaron algún marcador del VHB, el 7'1% HBsAg. Tanto el análisis simple como el estratificado (Mantel-Haenszel), mostró que el consumo de drogas por vía parenteral (COVP) era, en cada CP, el factor más fuertemente asociado a la infección por VHB, (para el conjunto de CP, CDVP seropositivos 83'6%, no CDVP seropositivos 41%, OR cruda 7'35, IC 95% 5'84+9'27). Los distintos patrones sero1ógicos de los seropositivos (excepto la prevalencia aislada de anti-HBs), fueron significativamente más comunes en el grupo drogadicto. El 53'9% de los reclusos portadores de HBsAg presentaron anticuerpos anti-HB (65'3% los CDVP vs. 26'7% los no CDVP, OR 5.17). Se consigue vacunar con 2 dosis a 2/3, y con 3 dosis a 1/3 de los reclusos susceptibles, obteniéndose tasas de seroconversión (80% al 9º mes) y títulos de anti-HBs moderadamente más bajos a los logrados en grupos de población sana. Son causa de peor respuesta la mayor edad, el CDVP y la infección por VIH. No inf1uye la presencia previa, aislada, de anti-HBs. La baja adherencia vacunal es fundamentalmente debida a la excarcelación del recluso antes de completar la pauta establecida de 0, l y 6 meses, proponiéndose para mejorar esta adherencia el empleo de pautas flexibles, y la de 0, 1 y 2 meses como pauta de referencia. La vacunación antihepatitis B de los reclusos permite actuar sobre grupos de población muy poco accesibles, de otro modo, a las redes sanitarias convencionales, protegiendo a estas personas dentro de la cárcel y fuera de ella. Se concluye además que el estilo de vida antes, o durante el encarcelamiento, especialmente el CDVP, es la principal causa de propagación de la infección por VHB y VHD, y que el mayor riesgo de los reclusos gitanos se relaciona probablemente con transmisión vertical y horizontal precoz en la infancia.[eng] The fundamental purpose of this study was to investigate the usefulness of anti-hepatitis B vaccination campaigns in the prison population, considering: 1) the vaccine's immunogenicity and 2) the feasibility of the programme itself (acceptance of pre-vaccination serologic screening and compliance of the vaccination schedule). Prior to vaccination, the prevalence of hepatitis B virus (BBV) markers was studied in 1,742 male prisoners in 3 different types of prison centre (PC) in Catalonia. This number of prisoners represents over 98% of these PC's total population. Marker presence was related to a series of variables (demographic, prison and infection risk factors), obtained by means of personal guided interviews. In 63% of prisoners, some kind of HBV marker was detected, which was HBsAg in 7.1%. Parenteral drug consumption (POC) was the factor most strongly associated with BBV infection (raw OR 7.35, IC95% 5.84+9.27) .The different serologic patterns of the seropositive subjects (except the prevalence of anti-HBs alone), were more common in those practising PDC. It was possible to give two thirds of the prisoners 2 vaccine doses, and one-third 3 doses, obtaining seroconversion rates and anti-HBs titres moderately lower than those obtained in groups of healthy population. Advanced age, PDC and BIV infection cause a worse response. The prior presence of anti-HBs alone does not have any influence. Vaccination of prisoners against hepatitis B allows the conventional health networks to act on population groups that otherwise would be difficult to reach, thus protecting these people both inside and outside the prison. In order to improve vaccination schedule compliance, the use of flexible systems is suggested, 0, 1 and 2 months being the reference system

Hepatitis B and A vaccination in HIV-infected adults: A review

Hepatitis B and A account for considerable morbidity and mortality worldwide. Immunization is the most effective means of preventing hepatitis B and A. However, the immune response to both hepatitis vaccines seems to be reduced in HIV-infected subjects. The aim of this review was to analyze the immunogenicity, safety, long-term protection and current recommendations of hepatitis B and A vaccination among HIV-infected adults. The factors most frequently associated with a deficient level of anti-HBs or IgG anti-HAV after vaccination are those related to immunosuppression (CD4 level and HIV RNA viral load) and to the frequency of administration and/or the amount of antigenic load per dose. The duration of the response to both HBV and HAV vaccines is associated with suppression of the viral load at vaccination and, in the case of HBV vaccination, with a higher level of antibodies after vaccination. In terms of safety, there is no evidence of more, or different, adverse effects compared with HIV-free individuals. Despite literature-based advice on the administration of alternative schedules, revaccination after the failure of primary vaccination, and the need for periodic re-evaluation of antibody levels, few firm recommendations are found in the leading guidelines