Clinical

HBV vaccine nonresponders may respond to combined Hep A/B vaccine

Last Updated: 2008-09-02 9:37:41 -0400 (Reuters Health)

NEW YORK (Reuters Health) - For the 5% to 10% of adults who fail to mount an adequate response to the standard hepatitis B virus (HBV) vaccine regimen, a double dose of the combined hepatitis A and B vaccine may turn these nonresponders into responders, results of a study from Sweden suggest.

Most guidelines recommend a repeated course of the standard HBV vaccine in people who fail to develop protective levels of antibodies to hepatitis B surface antigen (anti-HBs).

Instead of repeating the standard HBV vaccine regimen in nonresponders, Dr. Kristina Cardell from University Hospital, Linkoping and colleagues opted to administer the combined hepatitis A and B vaccine. Their study involved 48 healthcare workers who failed to respond to the HBV vaccine and 20 control subjects na�ve to the HBV vaccine.

After the first dose of the combined vaccine, protective levels of anti-HBs were achieved in 59% of HBV vaccine nonresponders and 10% of control subjects, the investigators report in the August 1 issue of the Journal of Infectious Diseases. After 3 doses, 95% of prior nonresponders and 100% of controls had developed a response.

"This is most likely explained by the increased dose, a positive bystander effect conferred by the hepatitis A vaccine, or both," Dr. Cardell and colleagues say.

In a commentary, Dr. Helmut M. Diepolder from University of Munich, Germany, writes, "These results are among the best achieved in comparable studies using revaccination with the standard hepatitis B vaccine and are comparable to results from revaccination studies using the pre-S1/S2 vaccine or vaccines with new adjuvants."

"Importantly, the combined vaccine was well tolerated and is, thus, an interesting option to use in hepatitis B nonresponders who are negative for antibodies to hepatitis A virus," Dr. Diepolder adds.

J Infect Dis 2008;198:297-304.