Hepatitis B vaccine immunogenicity among adults vaccinated during an outbreak response in an assisted living facility--Virginia, 2010

Abstract

Background: Failure to adhere to infection control guidelines, especially during assisted monitoring of blood glucose, has caused multiple hepatitis B outbreaks in assisted living facilities (ALFs). In conjunction with the response to such an outbreak at an ALF ("Facility X") where most residents had neuropsychiatric disorders, we evaluated seroprotection rates conferred by hepatitis B vaccine and assessed the influence of demographic factors on vaccine response.

Methods: Residents were screened for hepatitis B and C infection, and those susceptible were vaccinated against hepatitis A and hepatitis B with one dose of TWINRIX™ (GSK) given at 0, 1, and 7 months. Blood samples were collected 1-2 months after receipt of the third vaccine dose to test for antibody to hepatitis B surface antigen (anti-HBs).

Results: Of the 27 residents who had post-vaccination blood specimens collected, 22 (81%) achieved anti-HBs concentrations ≥10 mIU/mL. Neither age nor neuropsychiatric comorbidity was a significant determinant of seroprotection. Geometric mean concentration was lower among residents aged 60-74 years (74.3 mIU/mL) than among residents aged 46-59 years (105.3 mIU/mL) but highest among residents aged ≥75 years (122.5 mIU/mL). The effect of diabetes on vaccination response could not be examined because 16/17 (94%) diabetic residents had HBV infection by the time of investigation.

Conclusions: Adult vaccine recipients of all ages, even those over 60 years of age, demonstrated a robust capacity for achieving hepatitis B seroprotection in response to the combined hepatitis A/hepatitis B vaccine. The role for vaccination in interrupting HBV transmission during an outbreak remains unclear, but concerns about age-related response to hepatitis B vaccine may be insufficient to justify foregoing vaccination of susceptible residents of ALFs.

Keywords: Age; HBV; Hepatitis B; Neuropsychiatric; Vaccination.

Fig. 1

Participant flow chart for hepatitis B screening and vaccination—Virginia, 2010. ALF, assisted living facility; HBV, hepatitis B virus; anti-HBs, antibody to hepatitis B surface antigen; anti-HBc, antibody to hepatitis B core antigen; HBsAg, hepatitis B surface antigen; immune, anti-HBs ≥10 mIU/mL. ¹ Serologic markers indicating chronic infection: positive hepatitis B surface antigen (HBsAg) and total hepatitis B core antibody (anti-HBc), negative hepatitis B IgM core antibody (IgM anti-HBc). ² Serologic markers indicating acute infection: positive HBsAg and IgM anti-HBc. One resident was determined to have acute infection based on a well-documented HBsAg seroconversion even though IgM-anti-HBc remained negative. ³ Serologic markers indicating immunity to hepatitis B due to past infection: positive hepatitis B antibody to surface antigen (anti-HBs) and total hepatitis B core antibody (anti-HBc). ⁴ Serologic markers indicating immunity to hepatitis B due to past vaccination: positive anti-HBs (level ≥10 mIU/mL) and anti-HBc negative. ⁵ Seroprotective response defined as anti-HBs ≥10 mIU/mL.