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 start again from zero b you offer a third dose of hepatitis b vaccine

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 start again from zero b you offer a third dose of hepatitis b vaccine

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 doses of hepatitis b vaccine

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 start again from zero b you offer a third dose of hepatitis b vaccine

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 start again from zero b you offer a third dose of hepatitis b vaccine

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 start again from zero b you offer a third dose of hepatitis b vaccine

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.


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

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

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 start again from zero b you offer a third dose of hepatitis b vaccine

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 start again from zero b you offer a third dose of hepatitis b vaccine

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 with hepatitis b vaccine

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 protection with hepatitis b vaccine

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 of hepatitis b vaccine

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

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

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 implications1

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

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 start again from zero b you offer a third dose of hepatitis b vaccine

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 start again from zero b you offer a third dose of hepatitis b vaccine

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

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 vaccination1

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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