Department of Pediatrics, Ministry of Health, Goztepe Training and Research Hospital, Istanbul, Turkey.
J Chin Med Assoc. 2011 May;74(5):205-8. doi: 10.1016/j.jcma.2011.03.004. Epub 2011 Apr 8.
Autoimmune mechanisms and drugs used in treatment increase the risk of liver disease in patients with juvenile idiopathic arthritis (JIA) and hepatitis A virus (HAV) vaccination is important, especially in intermediate-endemicity areas like Turkey. In our study, we aimed to evaluate the immune response to hepatitis A vaccine and vaccine safety in children with JIA.
This study was carried out in our hospital's Pediatric Rheumatology outpatient clinic and Healthy Child clinic between the years 2003 and 2008. The study group consisted of 47 children with JIA (23 male and 24 female) diagnosed according to International League of Associations for Rheumatology diagnostic criteria. The control group consisted of 67 healthy children (31 female, 36 male) who did not have a history of hepatitis A infection or vaccination. Both groups were vaccinated with two doses of hepatitis A vaccine at 6-month intervals. Anti-HAV IgG >80 MIU was accepted as positive response.
There was no significant difference between the groups in terms of age and sex. None of the patients with JIA had fever, clinical worsening, or disease activation after vaccination. Anti-HAV IgG positivity rate was significantly higher in the control group (p < 0.05). Anti-HAV IgG was negative in only four cases, and they were all male patients with systemic JIA who had active disease under anti-tumor necrosis factor treatment.
Hepatitis A vaccine was safe in patients with JIA, and response to vaccine did not differ between healthy children and patients with JIA except for children with active systemic JIA receiving anti-tumor necrosis factor alpha drugs.
自身免疫机制和治疗中使用的药物会增加幼年特发性关节炎（JIA）患者发生肝病的风险，因此接种甲型肝炎病毒（HAV）疫苗非常重要，尤其是在像土耳其这样的中度流行地区。在我们的研究中，我们旨在评估甲型肝炎疫苗在 JIA 患儿中的免疫反应和疫苗安全性。
本研究于 2003 年至 2008 年在我院儿科风湿病门诊和健康儿童诊所进行。研究组包括 47 例 JIA 患儿（男 23 例，女 24 例），根据国际风湿病协会联合会的诊断标准进行诊断。对照组包括 67 例健康儿童（女 31 例，男 36 例），他们没有甲型肝炎感染或接种史。两组均在 6 个月的间隔内接种两剂甲型肝炎疫苗。抗-HAV IgG >80 MIU 被认为是阳性反应。
两组在年龄和性别方面无显著差异。接种后，JIA 患儿均无发热、临床恶化或疾病活动。对照组抗-HAV IgG 阳性率显著较高（p < 0.05）。仅 4 例抗-HAV IgG 阴性，均为接受抗肿瘤坏死因子治疗的全身型 JIA 男性患儿，且疾病活动。
甲型肝炎疫苗在 JIA 患儿中是安全的，除了接受抗肿瘤坏死因子 α 药物治疗的活动期全身型 JIA 患儿外，健康儿童和 JIA 患儿对疫苗的反应无差异。
