Hepatitis B vaccination: The key towards elimination and eradication of hepatitis B.

Engerix-B® (Hep-B[Eng]) is a noninfectious recombinant DNA vaccine containing hepatitis B surface antigen (HBsAg). It is produced from genetically engineered yeast (Saccharomyces cerevisiae).

Intramuscular Hep-B(Eng) [0-, 1-, 6-month schedule] has excellent immunogenicity in healthy neonates and infants, children, adolescents and adults, with seroprotection rates of 85–100% seen ≈1 month after the final dose of vaccine; seroprotection was defined as an antibody against HBsAg (anti-HBs) titre of ≥10 IU/L. The use of alternative Hep-B(Eng) immunisation schedules (e.g. a 0-, 1-, 2-, 12-month schedule in neonates and infants, 0-, 12-, 24-month or two-dose schedules in children and adolescents, and accelerated schedules in adults) have also been associated with high rates of seroprotection.

Seroprotection rates were generally similar with Hep-B(Eng) and the recombinant vaccine Recombivax HB® (Hep-B[Rax]) or plasma-derived vaccines (PDVs)≈=1 month after the final dose (although anti-HBs geometric mean titres were significantly higher with Hep-B[Eng] than with Hep-B[Rax]). One month after the final dose, adults had significantly higher seroprotection rates with the recombinant triple-antigen vaccine Bio-Hep-B® (Hep-B[Bio]) than with Hep-B(Eng), although seroprotection rates in healthy infants were similar with Hep-B(Eng) and Hep-B(Bio).

Hep-B(Eng) had excellent immunogenicity in several groups considered at high risk of acquiring hepatitis B (e.g. neonates born to hepatitis B carrier mothers and healthcare workers). The immunogenicity of Hep-B(Eng) was reduced in patients with conditions associated with impaired immune function (e.g. patients undergoing haemodialysis or being treated for malignancy), although it had good immunogenicity in patients with diabetes mellitus.

Hep-B(Eng) had excellent protective efficacy against HBsAg carriage in healthy infants and children, and in neonates born to hepatitis B carrier mothers (protective efficacy of 95–99%). Hep-B(Eng) also demonstrated good protective efficacy in a number of other high-risk groups.

Hep-B(Eng) is generally well tolerated with a tolerability profile similar to that of Hep-B(Rax), Hep-B(Bio) and PDVs.

In conclusion, Hep-B(Eng) is a well established, highly immunogenic hepatitis B vaccine with good tolerability and excellent protective efficacy; it offers flexibility through a variety of immunisation schedules. In addition, it appears that Hep-B(Eng) confers immunity for at least 10 years. Hep-B(Eng) has an important role in mass vaccination campaigns against hepatitis B, as well as in groups considered at high risk of acquiring hepatitis B.

Recombinant hepatitis B vaccine (Engerix-B): a review of its immunogenicity and protective efficacy against hepatitis B.

https://www.gastro.theclinics.com/article/S0889-8553(02)00064-X/pdf

Abdominal pain during pregnancy

Aptamers are short single-stranded DNA or RNA oligonucleotides and can be selected from synthetic combinatorial libraries in vitro. They have a high binding affinity and specificity for their targets. Agarose gels, nitrocellulose membranes, and adsorptive microplates are often used as carriers to immobilize targets in the SELEX (systematic evolution of ligands by exponential enrichment) process, but the subsequent separation step is tedious and time-consuming. Therefore, we used magnetic nanoparticles (MNPs) as carriers to immobilize the target, hepatitis B surface antigen (HBsAg), which is convenient for fast magnetic separation. In this study, we first selected DNA aptamers against HBsAg by immobilizing HBsAg on the surface of carboxylated MNPs. The ssDNA library of each selection round was prepared by asymmetric PCR amplification for the next selection round. To obtain aptamer sequences, the final selected products were purified by gel electrophoresis, then cloned, and sequenced. DNA aptamers that spec...

Selection of HBsAg-Specific DNA Aptamers Based on Carboxylated Magnetic Nanoparticles and Their Application in the Rapid and Simple Detection of Hepatitis B Virus Infection

We have assessed the protective efficacy of a recombinant DNA hepatitis B vaccine alone in infants of women who were positive for the surface antigen and the e antigen. The infants received a 10-μg dose of the vaccine within 12 hours of birth and additional doses 1, 2, and 12 months later. No significant adverse reactions to vaccination were observed and the vaccine was highly immunogenic. Only 2 (3.6%) of the 55 infants followed up to 13 months became chronically infected with the hepatitis B virus, as evidenced by the persistent presence of hepatitis B surface antigen in serum samples. Without immunoprophylaxis, 65% to 90% of such infants would become chronic carriers. Immunization with a recombinant vaccine without concomitant administration of hepatitis B immunoglobulin, therefore, considerably decreased the incidence of the carrier state. (JAMA. 1989;261:3278-3281)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=377612&pdfFileName=jama_261_22_033.pdf

Protective Efficacy of a Recombinant DNA Hepatitis B Vaccine in Neonates of HBe Antigen—Positive Mothers

The high prevalence of hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) in pregnant women is considered to be the most important factor contributing to the high carrier rate of HBsAg in some populations. Several factors, including the age at which infection occurs, predispose to the acquisition and frequency of the carrier state. The proportion of infected people who become chronic carriers ranges from about 80 to 95% for babies born to HBsAg/HBeAg-positive mothers. In this study of Indonesian infants receiving only active immunization against HBV, we measured the HBV markers passively acquired from their HBsAg-positive mothers. The relationship of these markers with vaccination response and with HBV infection status was studied longitudinally in the infants. In the exposed neonates from the HBsAg-positive mothers (n=61), the seroconversion rate to hepatitis B surface antibody (HBsAb) positivity was 95% after the first booster vaccination, with a geometric mean titre (GMT) of 2017IUl–1. After 60months, the GMT in this group decreased to 50IUl–1. Four newborns in this group became HBsAg carriers. Of the four vaccination failures, three newborns were HBsAg/HBeAg positive at birth, suggesting that they had been infected in utero. No vaccination strategy (active alone, or passive/active) can prevent this transmission from occurring. One carrier was HBsAg negative at birth and up to month 4 but was HBsAg positive at month 12 and subsequently, suggesting a postnatal infection. Vaccination early in life can, to a large extent, prevent perinatal transmission and hepatitis B virus (HBV) infection later in infancy and childhood. In this study, the protective efficacy of the vaccination was 85% in the subcohort of neonates from HBeAg-positive mothers and 100% in the subcohort of neonates from HBeAg-negative mothers. Lack of maternal antibodies to hepatitis B core antigen (HBcAb) correlated strongly with transmission of HBV infection.

Hepatitis B virus vaccination and antenatal transmission of HBV markers to neonates.

Infants of HBsAg-positive mothers (Group I) as well as those born to women without HBV markers (Group II) were vaccinated with a 10 micrograms dose of a recombinant DNA hepatitis B vaccine within 24 hours after birth according to a 0, 1, and 2 month schedule, with a booster dose planned 12 months later. Vaccination results in 14 (Group I) and 47 (Group II) neonates showed that at two months after the third dose of vaccine, 86% (6/7) and 100% (37/37), respectively, seroconverted, with anti-HBs geometric mean titres of 80 IU/l and 266 IU/l in the respective groups. No adverse reactions to the vaccine were observed. These preliminary results indicate that the recombinant DNA hepatitis B vaccine is safe and highly immunogenic in newborns.

Immunogenicity of a recombinant DNA hepatitis B vaccine in neonates.

In Bandung, West Java, 300 consecutive pregnant women were screened for hepatitis B virus (HBV) markers at a prenatal consultation. The prevalence of HBsAg and of anti-HBs/anti-HBc was 4.7% (14/300) and 35.6% (107/300) respectively, while 59.7% (179/300) was sero-negative. Prevalence of HBV markers increased significantly with both age and parity. Women with less schooling and a low socioeconomic class seemed to be at higher risk for HBV infection (HBV-markers prevalence of 49.3% (35/71) and 58.3% (21/36) respectively). Among employed women, the subgroup of school-teachers had a significantly higher HBV-markers prevalence of 54.8% (23/42), with a HBsAg carrier rate of 11.9% (5/42). This could indicate an important nonparenteral transmission of HBV in schools. The prevalence of HBeAg in HBsAg positive women was 64.3% (9/14). Based on historical data on perinatal HBV transmission, this would lead to a HBV carriership in 2.4 to 3.5% of all newborns. Possible strategies of prevention of HBV infection in newborns are briefly discussed.

Prevalence and determinants of hepatitis B virus markers in pregnant women in West Java, Indonesia.

Knowledge of the epidemiology of hepatitis D virus (HDV)-infection is very scarce in many parts of the world. The endemicity of delta-infection is believed to be maintained and spread through the network of hepatitis B surface antigen (HBsAg) carriers in the community. In the Far East and the Pacific area, the prevalence of chronic HBsAg carriers is mostly high. Markers of HDV infection are very frequent in some regions (e.g. parts of China, Fiji Isles, Samoa), in other regions they are almost absent (e.g. Taiwan, Thailand, parts of China). In the Bandung region (West Java, Indonesia) we found 26 (2.8%) HBsAg carriers among 926 pregnant women. Most of them are chronic carriers (anti hepatitis B core (HBc) IgM negative). Although HBsAg is frequent in this Indonesian population, we could not find any anti-HD positive. This data warrants the conclusion that HDV infection has not yet been introduced in that densely populated area of Indonesia.

Prevalence of anti-delta antibodies in pregnant women in Bandung, Indonesia.

AIDS in Indonesia.

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