Heshin-Bekenstein Merav, Turner Dan, Shamir Raanan, Bar-Meir Maskit, Dagan Ron, Zevit Noam, Silbermintz Ari
Pediatrics Department, Shaare Zedek Medical Center, Jerusalem.
J Pediatr Gastroenterol Nutr. 2015 Oct;61(4):400-3. doi: 10.1097/MPG.0000000000000856.
Previous studies have suggested that hepatitis B virus (HBV) vaccines may be less immunogenic in individuals with celiac disease (CD). A pre-S vaccine (Sci-B-Vac) has demonstrated superior immunogenicity compared with standard HBV vaccines in several diseases. We compared the short-term immunogenicity of a pre-S vaccine with a HBV vaccine (Engerix B) for repeat vaccination of seronegative, previously immunized patients with CD.
Participants were 1 to 18-year-old children with CD who despite standard HBV vaccines in infancy had nonprotective hepatitis B surface antibody (HBs-Ab) concentrations (≤10 mIU/mL). Patients were randomized to receive either Engerix B or pre-S vaccine. HBs-Ab concentrations were measured 1 month after the first dose. For those who had not responded after 1 dose, measurement was repeated after the third dose.
Children (n = 82) were analyzed (42 pre-S vaccine and 40 Engerix B). Baseline characteristics were similar for both groups, including gluten-free diet status. Both arms showed high response rates following the first injection: 41 (98%) versus 35 (87%) for pre-S vaccine and Engerix B recipients, respectively (P = 0.08). All other patients responded when measured after dose 3. HBs-Ab concentrations (mIU/mL) were higher in the pre-S vaccine group (median 925, interquartile range [IQR] 424-1000) than the Engerix B group (median 363, IQR 106-996, P = 0.005). Twenty (48%) of the pre-S vaccine recipients were "high responders" (>1000 mIU/mL) versus 10 (25%) in Engerix B recipients (P = 0.008).
Both vaccines elicited adequate booster responses in most previously vaccinated patients with CD with nonprotective HBs-Ab concentrations. Pre-S vaccine administration resulted in higher Hbs-Ab concentrations. Our data suggest that a single dose of either vaccine is sufficient to raise titers to protective levels in most patients with CD.
既往研究提示，乙肝疫苗在乳糜泻（CD）患者中的免疫原性可能较低。一种前S疫苗（Sci-B-Vac）在多种疾病中已显示出比标准乙肝疫苗更强的免疫原性。我们比较了前S疫苗与乙肝疫苗（安在时）对血清学阴性、既往已接种疫苗的CD患者进行重复接种时的短期免疫原性。
参与者为1至18岁的CD患儿，尽管在婴儿期接种了标准乙肝疫苗，但乙肝表面抗体（HBs-Ab）浓度仍无保护作用（≤10 mIU/mL）。患者被随机分为接受安在时或前S疫苗。在首剂接种后1个月测量HBs-Ab浓度。对于接种1剂后无反应者，在第3剂接种后重复测量。
对82名儿童（42名接受前S疫苗，40名接受安在时）进行了分析。两组的基线特征相似，包括无麸质饮食状况。两组在首次注射后均显示出高反应率：前S疫苗接种者为41名（98%），安在时接种者为35名（87%）（P = 0.08）。在第3剂接种后测量时，所有其他患者均有反应。前S疫苗组的HBs-Ab浓度（mIU/mL）高于安在时组（中位数925，四分位间距[IQR] 424 - 1000），而安在时组为（中位数363，IQR 106 - 996，P = 0.005）。前S疫苗接种者中有20名（48%）为“高反应者”（>1000 mIU/mL），而安在时接种者中为10名（25%）（P = 0.008）。
两种疫苗在大多数既往接种过疫苗、HBs-Ab浓度无保护作用的CD患者中均引发了足够的加强反应。接种前S疫苗导致更高的HBs-Ab浓度。我们的数据表明，单剂任何一种疫苗都足以使大多数CD患者的抗体滴度升高至保护水平。
