Options for HBV Vaccine Non-Responders

StephenW

Options for HBV Vaccine Non-RespondersBy Maureen Kamischke, Hepatitis B Foundation HepBblog
http://wp.hepb.org/2011/09/29/hbv-vaccine-non-responder-alternatives/

                                                                                        Posted on September 29, 2011 by hepbtalk|                                                                                        
                                       
Are you a hepatitis B vaccine non-responder? Approximately 5-15% of people who receive the vaccine are considered non-responders. This is especially important for health care workers, families living in households with people that have HBV, and others who may be at increased risk of exposure to HBV.  A vaccine non-responder is someone that does not build up an adequate immune response after receiving two, 3-shot series of the HBV vaccine.  In other words, they complete one series of the HBV vaccine, and follow it with a surface antibody test (HBsAb or Anti-HBs) 4-6 weeks following the last injection of the series.  If the anti-HBs titre is not greater than 10IU/l, than the series is repeated, preferably with an HBV vaccine from a different manufacturer, and the person is once again tested for immunity by testing for adequate anti-HBs. (See previous blog, “Got Hepatitis B? Keeping loved ones safe though HBV vaccination” for details)
Fortunately there are other options for those concerned with being an HBV vaccine non-responder. There is a higher concentration of the HBV vaccine recommended by the CDC that is used for patients undergoing dialysis, and for those that are immune suppressed.  It is a 40µg/ml concentration. If it has been one year or less since you completed the three-shot series of the regular concentration of the vaccine, you can try one intramuscular dose of 1.0 ml of the 40µg HBV vaccine.  If it has been more than one year since your last three shot series of the vaccine, you can repeat the entire three-shot series with the 40µg concentration of the vaccine.  Follow up with an anti-HBs titre test 4 to 6 weeks following the last injection to ensure it is greater than 10 IU/l, and that you have adequate immunity.
If you continue to remain a non-responder, you can try a series of as many as five intra-dermal injections, given every two weeks, using the 40µg concentration of the HBV vaccine.  Dose one consists of 0.10 ml of the 40µg/ml vaccine, followed by the same dose two 2-weeks later.  At that time an anti-HBs titre test would be drawn to check for immunity.  If there was not adequate immunity, a third-intra-dermal dose of the vaccine would be given two weeks later.  Anti-HBs titres would be checked every two weeks and the patient would be given another intra-dermal injection up to a total of 5 intradermal injections of the 40µg concentration of the HBV vaccine. Don’t forget to ensure that your anti-HBs titre is greater than 10IU/l.
Please note that the schedule for the series might vary depending on the study your doctor chooses to follow.  However, it is recommended that the higher concentration (40µg) of the hepatitis B vaccine be used for best results.
                                                                                       

StephenW

对乙肝疫苗无应答的选项
2011年9月29日，来自hepbtalk | 4评论
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你是B型肝炎疫苗无反应？约5-15％的人接种疫苗被认为是无反应。医护人员，家庭中有乙肝病毒与人的家庭生活，和其他人可能接触乙型肝炎病毒的风险增加，这一点尤为重要。疫苗无反应是有人不建立足够的免疫反应后收到两个，3次乙肝疫苗系列。换句话说，他们完成一个系列的乙肝疫苗，表面抗体测试（HBsAb或抗-HBs），该系列的最后一次注射后4-6周。如果抗-HBs滴度不大于10IU / L，比重复系列，从不同制造商的乙肝疫苗，人最好是再次测试测试足够的抗-HBs的免疫力。 （见以前的博客，“得了乙肝？保持安全的亲人，虽然乙肝疫苗接种”）

幸运的是，有关乙肝疫苗无应答者的其他选项。有一个高浓度乙肝疫苗用于透析患者的疾病预防控制中心建议，并为那些有免疫抑制。这是一个40μg/ml浓度。如果它已经一年或一年以下的，因为你完成了疫苗的常规浓度的三杆系列，你可以尝试肌肉注射1.0毫升40μg乙肝疫苗的剂量。如果它已经超过一年，因为你过去三年shot系列疫苗，可以重复使用的疫苗40μg浓度整个三杆系列。抗-HBs滴度测试4至6周的最后一次注射后，以确保它是大于10 IU / L，你有足够的免疫力。

如果你继续保持一个非应答，您可以尝试多达五个系列真皮内注射，由于每两个星期，使用浓度40μg乙肝疫苗。剂量40μg/ml疫苗0.10毫升，同样剂量2周后。当时，抗-HBs滴度测试将提请检查免疫力。当然，如果没有足够的免疫力，第三真皮内剂量的疫苗将给予两个星期后。抗-HBs滴度会检查每两个星期，病人将得到另一个真皮内注射共5皮内注射乙肝疫苗40μg浓度。不要忘记，以确保您的抗-HBs滴度大于10IU / L。

请注意的是一系列的时间表可能会有所不同取决于医生选择遵循的研究。然而，建议使用较高浓度的B型肝炎疫苗（40μg），以取得最佳效果。

把握当下

CDC对进行透析、免疫抑制人群的高剂量乙肝疫苗推荐使用方法：

采用40µg/ml剂量。

1） 3针流程
完成3针常规疫苗注射之后1年或不足1年（但s抗体不足），可以尝试肌肉注射1.0 ml的40µg乙肝疫苗。
3针常规疫苗注射之后超过1年，可以使用40µg剂量重复3针流程。
最后一针后4-6周检查s抗体浓度，确定s抗体是否超过10 IU/l，即有充分免疫力。

2）5针流程
如果仍然无应答，可以尝试进行5次皮内注射，每隔两周一次，40µg剂量。
第一次注射0.10 ml的40µg剂量乙肝疫苗。2周后注射相同剂量，同时检查s抗体浓度；如果浓度不足，2周后进行第3次皮内注射。为确保s抗体超过10IU/l，s抗体每隔两周检查一次，直到第5针皮内注射完毕。

疫苗注射流程可根据医生意见不同，但一般推荐使用40µg/ml剂量保证效果。