Cardell Kristina, Akerlind Britt, Sällberg Matti, Frydén Aril
Department of Infectious Diseases, University Hospital, Linköping, Sweden.
J Infect Dis. 2008 Aug 1;198(3):299-304. doi: 10.1086/589722.
Hepatitis B vaccine has been shown to be highly efficient in preventing hepatitis B. However, 5%-10% of individuals fail to develop protective levels (>or=10 mIU/mL) of antibodies to hepatitis B surface antigen (anti-HBs) and are considered to be nonresponders.
A total of 48 nonresponders and 20 subjects naive to the HBV vaccine received a double dose of combined hepatitis A and B vaccine (Twinrix) at 0, 1, and 6 months. The levels of anti-HBs and antibodies to hepatitis A virus (anti-HAV) were determined before vaccination and 1 month after each dose.
Among 44 nonresponders, protective anti-HBs levels were found in 26 (59%) after the first dose and in 42 (95%) after the third dose. Among the control subjects, the corresponding figures were 10% and 100%, respectively. All subjects seroconverted to anti-HAV. The titers of both anti-HBs and anti-HAV were lower in the previously nonresponsive subjects (P< .01).
Revaccination of nonresponders to the standard hepatitis B vaccine regimen with a double dose of the combined hepatitis A and B vaccine was highly effective. This is most likely explained by the increased dose, a positive bystander effect conferred by the hepatitis A vaccine, or both.
乙肝疫苗已被证明在预防乙肝方面非常有效。然而，5% - 10%的个体未能产生乙肝表面抗原抗体（抗-HBs）的保护水平（≥10 mIU/mL），被认为是无应答者。
共有48名无应答者和20名未接种过乙肝疫苗的受试者在0、1和6个月时接受了双倍剂量的甲型和乙型肝炎联合疫苗（安在时）。在接种疫苗前以及每次接种后1个月测定抗-HBs和甲型肝炎病毒抗体（抗-HAV）水平。
在44名无应答者中，首次接种后26名（59%）出现了保护性抗-HBs水平，第三次接种后42名（95%）出现了保护性抗-HBs水平。在对照受试者中，相应数字分别为10%和100%。所有受试者均血清转化为抗-HAV。先前无应答的受试者中抗-HBs和抗-HAV的滴度均较低（P < 0.01）。
对标准乙肝疫苗接种方案无应答者用双倍剂量的甲型和乙型肝炎联合疫苗进行再接种非常有效。这很可能是由于剂量增加、甲型肝炎疫苗产生的正向旁观者效应或两者共同作用所致。
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