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- Title
Hepatitis B immunization in low birthweight infants: do they need an additional dose?
- Authors
Arora, N.K; Ganguly, S; Agadi, S.N; Irshad, M; Kohli, R; Deo, M; Paul, V.K; Deorari, A.K; Chellani, H; Prasad, M.S; Sharma, D
- Abstract
<bold>Aim: </bold>To determine the influence of gestation and weight on the development of protective anti-HB levels and geometric mean titres after three doses of HBV vaccine and to ascertain the need for a fourth dose in low birthweight infants.<bold>Methods: </bold>Hepatitis B vaccine (Enivac HB, Panacea Biotec Ltd., India) was given to 82 preterm (PT) and 60 term intrauterine growth-retarded (T-IUGR) infants at birth and at 6, 10 and 14wk of life.<bold>Results: </bold>Protective anti-HB levels (>10 mIU/ml) were reached in 86.6% (71/82) of PT infants and 96.7% (58/60) of T-IUGR infants after three doses of HBV vaccine (p = 0.044). The odds of having a protective response after the third dose of HBV vaccine was 1.25 (95% CI 1.02-1.53) with every one-week increase in gestation (p = 0.032). Birthweight was not associated with the development of a protective immune response. After the third dose, only 66.7% (8/12) of the PT infants whose mothers had anti-HB antibodies, developed protective anti-HB levels compared with 90% (63/70) of those with no maternal antibodies (p = 0.028). In PT infants after the fourth dose, there was a significant increase in the proportion of infants with protective antibody levels (8.6%, 95% CI 0.6-16.6%) among those with no maternal antibodies and 12.2% overall (95% CI 6.0-21.3) (p = 0.031 to 0.002) over that reached with the third dose. Administration of the fourth dose to T-IUGR infants did not confer such a benefit.<bold>Conclusion: </bold>In HBV-endemic areas, PT infants, irrespective of their birthweights, may benefit from an additional dose of hepatitis B vaccine in a schedule starting at birth. This approach will prevent vertical transmission and bring their immune response up to par with term infants. Term intrauterine growth-retarded infants should be vaccinated as per the schedule recommended for normal term infants. However, studies in other settings with different vaccine formulations and a longer follow-up period will be required before this strategy can be practised more widely.
- Subjects
HEPATITIS B; NEONATAL hepatitis; LOW birth weight; IMMUNIZATION
- Publication
Acta Paediatrica, 2002, Vol 91, Issue 9, p995
- ISSN
0803-5253
- Publication type
journal article
- DOI
10.1111/j.1651-2227.2002.tb02891.x