A 23 year old business woman got two shots of hepatitis B 1 month apart 2 years ago. Today she is at...
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A. start again from zero. B. you offer a third dose of hepatitis B vaccine PowerPoint PPT Presentation


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A 23 year old business woman got two shots of hepatitis B 1 month apart 2 years ago. Today she is at your practice for ending the schedule. What should be done?. A. start again from zero. B. you offer a third dose of hepatitis B vaccine C. you first control the anti-HBs and if > 10 IU/L,

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A. start again from zero. B. you offer a third dose of hepatitis B vaccine

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A 23 year old business woman got two shots of hepatitis B 1 month apart 2 years ago. Today she is at your practice for ending the schedule. What should be done?

  • A. start again from zero.

  • B. you offer a third dose of hepatitis B vaccine

  • C. you first control the anti-HBs and if > 10 IU/L,

  • D. you tell her she is protected


A 23 year old business woman got two shots of hepatitis B 1 month apart 2 years ago. Today she is at your practice for ending the schedule. What should be done?

  • A. start again from zero.

  • B.you offer a third dose of hepatitis B vaccine

  • C. you first check the anti-HBs and if > 10 IU/L,

  • D. you tell her she is protected


Delayed and Incorrect Dosesof Hepatitis B Vaccine

  • If vaccination series is interrupted

    • no need to restart series

    • second dose missed: give missing dose and continue series

    • third dose missed: complete series

  • If an incorrect (i.e., low) dose of vaccine is given, dose should be repeated


A 45 year old nurse is going to work in an orphanage in an Eastern European country. She received 3 doses of hepatitis B vaccine in 1986. She can remember she was tested and her anti-HBs was 1124 mIU/ml. What do you recommend?

  • A. tell her she is protected for life.

  • B. tell her she should start vaccination from zero again

  • C. offer her one additional dose and measure the anti-HBs one month later again.

  • D. test for anti-HBs before any further intervention.


A 45 year old nurse is going to work in an orphanage in an Eastern European country. She received 3 doses of hepatitis B vaccine in 1986. She can remember she was tested and her anti-HBs was 1124 mIU/ml. What do you recommend?

  • A. tell her she is protected for life.

  • B. tell her she should start vaccination from zero again

  • C. offer her one additional dose and measure the anti-HBs one month later again.

  • D. test for anti-HBs before any further intervention.


As part of your adolescent immunization programme you are considering post-vaccination serologic testing. Is this indicated?

  • A. yes, for all ados

  • B. no, for no one.

  • C. yes, for some adolescents.


As part of your adolescent immunization programme you are considering post-vaccination serologic testing. Is this indicated?

  • A. yes, for all ados

  • B. no, for no one.

  • C. yes, for some adolescents.


Post-Vaccination Testing

Vaccine highly immunogenic

>95% seroconversion after 3-dose series

Almost all vaccinated persons protected

Post-vaccination testing NOT indicated

after routine immunization


A 33 year old HCW comes in your practice for anti-HBs control 8 years after he got a complete vaccination schedule. And he wants to be tested. What shall you do?

  • A. he is protected for life

  • B. he should start vaccination from zero again

  • C. offer him one additional dose and measure the anti-HBs one month later again.

  • D. try to check whether anti-HBs data are available from the past

  • E. tell him he is not protected

  • F. check his anti-HBS as requested


A 33 year old HCW comes in your practice for anti-HBs control 8 years after he got a complete vaccination schedule. And he wants to be tested. What shall you do?

  • A. he is protected for life

  • B. he should start vaccination from zero again

  • C. offer him one additional dose and measure the anti-HBs one month later again.

  • D. try to check whether anti-HBs data are available from the past

  • E. tell him he is not protected

  • F. check his anti-HBS as requested


Long-Term Protection withHepatitis B Vaccine

  • Vaccine provides long-term protection

  • Immunity persists despite loss of anti-HBs

    • documented protection up to 15 years

    • lifelong protection likely

    • continued follow-up needed to determine duration of protection

      Booster doses of hepatitis B vaccine NOT currently recommended


Mechanism of Long-Term Protectionwith Hepatitis B Vaccine

Primary vaccination series

Immune memory

Anamnestic antibody response

Rapid rise in anti-HBs

Protection from infection

Exposure

to HBV


Serologic Response to Booster Dose ofHepatitis B Vaccine

4 weeks post-booster

2 weeks post-booster

1 year

post-booster

Booster dose (simulating

natural infection)

Primary

series

Source: Williams, CDC


Long-Term Protection with Hepatitis B Vaccine Among Vaccinated Infants and Children

Country

Years

f/u

n

Anti-HBs

>10 mIU/ml

Anti-HBc

Positive

HBsAg

Positive

2%

0

0.4%

0

0

1%

0

15

12

10

10

10

9

10

52

148

805

118

53

675

474

50%

74%

85%

67%

68%

--

68%

6%

1%

14%

12%

0

13%

1%

China

Hong Kong

Taiwan

Taiwan

Italy

Gambia

Italy


Long-lasting protection:implications

  • scientific data do not support the need for routine booster vaccinations (ACIP, ACIP Canada, VHPB)

  • therefore, no booster recommendation :

    • for universal HB vaccination programmes (infants, children and adolescents)

    • for adults who are immunocompetent


Long-lasting protection:implications

  • European consensus group on hepatitis B immunity (October 1998, Florence):

  • no need for booster doses in immunocompetent individuals

  • HB booster vaccination to be considered for mmunocompromised individuals:

    • haemodialysis

    • chronic renal failure/liver disease

    • HIV positive

    • ...

Kane M et al. Lancet 2000; 355: 561-565


Long-lasting protection: benefits

  • Maintains immunity in the population

  • Reduces morbidity and mortality

  • Reduces transmission in the population

  • Protects against disease for longer

  • Reduces direct and indirect costs of booster vaccination programs


A mother brings her child for a second hepatitis B shot, and the child has a cold and fever of 38.0C. What should you do?

  • A. give the shot as scheduled

  • B. send the child home, and tell the mother to bring the child back over one week.

  • C. give to shot and keep the child in your clinic for 24h. Observation.


A mother brings her child for a second hepatitis B shot, and the child has a cold and fever of 38.0C. What should you do?

  • A. give the shot as scheduled

  • B. send the child home, and tell the mother to bring the child back over one week.

  • C. give to shot and keep the child in your clinic for 24h. Observation.


The Following are NOT Contraindications to Vaccination

1. Minor illness with temp <38.5

2. Allergy or asthma

3. History of seizures

4. Family history of seizures

5. Treatment with antibiotics

6. Infection with HIV


The Following are NOT Contraindications to Vaccination

7. Chronic diseases - such as chronic heart, lung, liver, kidney diseases

8. Stable neurologic conditions - such as cerebral palsey, Downs syndrome

9. Premature infants

10. Jaundice at birth

11. Breast feeding

12. Pregnancy


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