Schnyder Jenny L, Garcia Garrido Hannah M, Tanck Michael W, Maurer Irma, Harskamp Agnes M, Kootstra Neeltje, Grobusch Martin P, Goorhuis Abraham
Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Department of Epidemiology and Data Science, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
J Travel Med. 2025 Mar 11;32(2). doi: 10.1093/jtm/taae125.
Hepatitis A (hepA) vaccination is highly immunogenic in healthy individuals; however, there is uncertainty about the immunogenicity in immunocompromised populations (ICPs).
In this prospective cohort study, people living with HIV (PLWH), patients on immunosuppressive mono- and combination therapy, and controls received two hepA vaccine doses at months 0 and 6-12, or three combined hepA/B vaccine doses at months 0, 1 and 6-12. Antibody levels were measured before and at different time-points post-vaccination (T2, 6, 8, 12 months). The primary endpoint was the seroconversion rate (SCR) at T8, defined as hepA antibodies ≥20 mIU/ml. To assess boostability, an additional vaccine dose was administered 1-5 years after T12 in those with antibodies < 50 mIU/ml, with antibody measurements before and seven days after the booster dose.
We included 150 participants. At T2 SCRs ranged between 35-58% in ICPs versus 94% in controls. Among PLWH, patients on monotherapy, combination therapy and controls SCRs at T8 were 33/34 (97%), 32/34 (94%), 25/30 (83%) and 28/28 (100%), respectively. The booster dose resulted in 71% additional seroconversion (17/24), with only patients using combination therapy not responding.
HepA vaccination is highly immunogenic in virologically suppressed PLWH and patients on immunosuppressive monotherapy, with SCRs after the complete hepA vaccination schedule similar to controls and adequate booster responses in case of waning immunity. However, patients using immunosuppressive combination therapy as well as all ICPs who did not receive the complete hepA vaccination schedule, are at risk of non-response to vaccination and post-vaccination antibody measurements are recommended.
甲型肝炎（hepA）疫苗在健康个体中具有高度免疫原性；然而，免疫功能低下人群（ICPs）的免疫原性尚不确定。
在这项前瞻性队列研究中，HIV感染者（PLWH）、接受免疫抑制单药和联合治疗的患者以及对照组在第0个月和第6 - 12个月接受两剂甲型肝炎疫苗，或在第0、1和6 - 12个月接受三剂甲型肝炎/乙型肝炎联合疫苗。在接种疫苗前和接种后不同时间点（第2、6、8、12个月）测量抗体水平。主要终点是第8个月时的血清转化率（SCR），定义为甲型肝炎抗体≥20 mIU/ml。为评估增强免疫能力，在第12个月后1 - 5年，对抗体<50 mIU/ml的人群额外接种一剂疫苗，并在接种加强剂量前和接种后7天测量抗体。
我们纳入了150名参与者。在第2个月时，免疫功能低下人群的血清转化率在35% - 58%之间，而对照组为94%。在HIV感染者、接受单药治疗的患者、接受联合治疗的患者和对照组中，第8个月时的血清转化率分别为33/34（97%）、32/34（94%）、25/30（83%）和28/28（100%）。加强剂量导致额外71%的血清转化（17/24），只有接受联合治疗的患者无反应。
甲型肝炎疫苗在病毒学抑制的HIV感染者和接受免疫抑制单药治疗的患者中具有高度免疫原性，完整的甲型肝炎疫苗接种方案后的血清转化率与对照组相似，免疫力下降时加强免疫反应良好。然而，接受免疫抑制联合治疗的患者以及所有未完成完整甲型肝炎疫苗接种方案的免疫功能低下人群有接种无反应的风险，建议进行接种后抗体测量。
