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Gesundheitswesen 2014; 76(02): 96-102
DOI: 10.1055/s-0033-1337999
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Hepatitis A/B-Kombinationsimpfung: Evaluation eines Impfprogramms in Werkstätten für Menschen mit Behinderung

Combined Hepatitis A/B Vaccination: Evaluation of a Vaccination Schedule in Facilities for Handicapped People
B. Wolters   *
1   Institut für Virologie, Universität Duisburg-Essen
,
T. Müller   *
1   Institut für Virologie, Universität Duisburg-Essen
,
R. S. Ross
1   Institut für Virologie, Universität Duisburg-Essen
,
R. Kundt
2   Gesundheitsamt der Stadt Essen
,
M. Roggendorf
1   Institut für Virologie, Universität Duisburg-Essen
,
H. Roggendorf
1   Institut für Virologie, Universität Duisburg-Essen
2   Gesundheitsamt der Stadt Essen
› Author Affiliations
Further Information

Publication History

Publication Date:
16 April 2013 (online)

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Zusammenfassung

Ziel der Studie:

Menschen mit geistiger und körperlicher Behinderung haben ein erhöhtes Infek­tionsrisiko für eine virale Hepatitis. Bisherige ­Studien zeigen widersprüchliche Daten zum Hepatitis-Impferfolg in dieser Personengruppe, die häufig unter besonderen Bedingungen lebt und arbeitet ­sowie gelegentlich Immundefekte aufweist.

Methodik:

Wir untersuchten die Antikörperantwort nach kombinierter Hepatitis A und B Impfung in den Werkstätten für behinderte Menschen der Stadt Essen (Deutschland) sowohl bei den dort beschäftigten Menschen mit Behinderung (n=949) als auch bei deren Betreuern (n=115).

Ergebnisse:

Schützende Antikörper gegen das Hepatitis A Virus fanden wir in 98,9% der Menschen mit Behinderung und bei allen Betreuern. Die HBV-Seroprotektionsrate der Behinderten lag bei 90,2% und war vergleichbar mit der Seroprotektionsrate der Betreuer (91,3%). Auffrischimpfungen wurden bei allen Impflingen mit anti-HBs Werten unter 100 IU/l angeboten (28% der Menschen mit Behinderung, 23,5% der Betreuer). Die Low-Responder in der Gruppe der Menschen mit Behinderung entwickelten im Anschluss an die Nachimpfung in etwa 50% der Fälle eine anti-HBs Konzentration von über 100 IU/l. Die Non-Resonder dagegen zeigten in etwa 30–40% eine Seroprotektion nach der jeweiligen Impfstoffgabe.

Schlussfolgerung:

Aufgrund der Ergebnisse unserer Studie würden wir die serologische Untersuchung des HBV-Impferfolgs etwa 4–8 Wochen nach der Impfung empfehlen. Zum einen werden so die Personen erkannt, die eine Booster-Impfung benötigen und zum anderen sollten die Non-Responder auf das Vorliegen einer aktiven Hepatitis B untersucht werden. Bei einem Fünftel der in dieser Studie eingeschlossenen Non-Responder wurde eine HBsAg-positive Hepatitis B gefunden.

Abstract

Aim of the Study:

People with mental and physical disabilities have a higher risk of infection with hepatitis viruses. Studies conducted so far show contradictory results on the success of vaccination in this population. These people live and work under special conditions and sometimes have immune defects.

Methods:

We investigated the antibody response after combined vaccination against hepatitis A and B in facilities for handicapped people in the city of Essen/Germany. Antibodies were determined in people with disabilities (n=949) and also in social workers taking care of handicapped people (n=115).

Results:

Protective antibodies against hepatitis A were detected in 98.9% in people with disabilities and social workers. The seroconversion rate against hepatitis B in handicapped people was 90.2% and was comparable to the seroconversion rate in social workers (91.3%). Re-vaccinations were offered to all people with anti-HBs titres below 100 IU/L (28% of handicapped and 23.5% of social workers). In the group of low responders in handicapped people about 50% developed anti-HBs concentration above 100 IU/L. Non-responders showed 30–40% seroconversion rate after re-vaccination.

Conclusion:

Based on this study we would recommend serological tests about 4–8 weeks after vaccination to confirm seroconversion. By this procedure people who need a booster vaccina­tion will be recognized and non-responders should be offered another HBV vaccination. In about 20% of the non-responders included in this study HBs antigen was detected.

Schlüsselwörter

Impfung - Hepatitis - HAV - HBV - Werkstatt für behinderte Menschen - Twinrix

Key words

vaccination - hepatitis - HAV - HBV - centers for handicapped people - twinrix

* B. Wolters und T. Müller gemeinsame Erstautorenschaft.


 

  • Literatur

  • 1 World Health Organization. WHO Fact sheets: Hepatitis A and Hepatitis B. http://www.who.int/mediacentre/factsheets/en/ (accessed 22.07.2010)
    PubMedGoogle Scholar
  • 2 Robert Koch Institut . Epidemiologisches Bulletin. 2006; 46: 399-403
    PubMedGoogle Scholar
  • 3 Robert Koch Institut . Infektionsepidemiologisches Jahrbuch für 2009. Berlin: 2010
    Google Scholar
  • 4 Tormans G, van Damme P, van Doorslaer E. Cost-effectiveness analysis of hepatitis A prevention in travellers. Vaccine 1992; 10 (Suppl. 01) S88-S92
    CrossrefPubMedGoogle Scholar
  • 5 Berge JJ, Drennan DP, Jacobs RJ et al. The cost of hepatitis A infections in American adolescents and adults in 1997. Hepatology (Baltimore, Md.) 2000; 31: 469-473
    CrossrefPubMedGoogle Scholar
  • 6 Lehmann NI, Sharma DL, Gust ID. Prevalence of antibody to the hepatitis A virus in a large institution for the mentally retarded. Journal of Medical Virology 1978; 2: 335-339
    CrossrefPubMedGoogle Scholar
  • 7 Lunding S, Hansen KS, Krogsgaard K et al. Occurrence of hepatitis B and C among mentally retarded. Ugeskrift for laeger 1999; 161: 4393-4396
    PubMedGoogle Scholar
  • 8 Asensio F, Bayas JM, Bertran MJ et al. Prevalence of hepatitis B infection in long-stay mentally handicapped adults. European Journal of Epidemiology 2000; 16: 725-729
    CrossrefPubMedGoogle Scholar
  • 9 Robert Koch Institut . Epidemiologisches Bulletin. 2011; 30: 240
    PubMedGoogle Scholar
  • 10 Cooper BW, Klimek JJ, Upadhyaya A et al. Poor seroconversion rate after hepatitis B vaccination in high-risk institutionalized mentally retarded patients. American Journal of Infection control 1986; 14: 204-208
    CrossrefPubMedGoogle Scholar
  • 11 Avanzini MA, Monafo V, de Amici M et al. Humoral immunodeficiencies in Down syndrome: serum IgG subclass and antibody response to hepatitis B vaccine. American Journal of Medical Genetics Supplement 1990; 7: 231-233
    PubMedGoogle Scholar
  • 12 van Damme P, Vranckx R, Meheus A. Immunogenicity of a recombinant DNA hepatitis B vaccine in institutionalized patients with Down’s syndrome. Vaccine 1990; 8 Suppl S53-S55 discussion S60-S62
    CrossrefPubMedGoogle Scholar
  • 13 Renard D, Bruckers L, Molenberghs G et al. Repeated-measures models to evaluate a hepatitis B vaccination programme. Statistics in Medicine 2001; 20: 951-963
    CrossrefPubMedGoogle Scholar
  • 14 World Health Organization. WHO Global Database on Body Mass Index. http://apps.who.int/bmi [27.08.2010] Thierfelder et al. Europ J Epiodemiol 2001; 17: 429-435
    PubMedGoogle Scholar
  • 15 Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 1934; 26: 404-413
    CrossrefPubMedGoogle Scholar
  • 16 van Ditzhuijsen TJ, de Witte-van der Schoot E, van Loon AM et al. Hepatitis B virus infection in an institution for the mentally retarded. American Journal of Epidemiology 1988; 128: 629-638
    PubMedGoogle Scholar
  • 17 Findor JA, Sordá JA, Rey J et al. Hepatitis B (HBV) and C (HBC) virus infections in Down’s syndrome and in neuropsychiatric patients without Down’s syndrome. GEN 1992; 46: 208-212
    PubMedGoogle Scholar
  • 18 Bell JC, Crewe EB, Capon AG. Seroprevalence of hepatitis A antibodies among residents of a centre for people with developmental disabilities. Australian and New Zealand Journal of Medicine 1994; 24: 365-367
    CrossrefPubMedGoogle Scholar
  • 19 van Damme P, van Herck K. A review of the efficacy, immunogenicity and tolerability of a combined hepatitis A and B vaccine. Expert Review of Vaccines 2004; 3: 249-267
    CrossrefPubMedGoogle Scholar
  • 20 Czeschinski PA, Binding N, Witting U. Hepatitis A and hepatitis B vaccinations: immunogenicity of combined vaccine and of simultaneously or separately applied single vaccines. Vaccine 2000; 18: 1074-1080
    CrossrefPubMedGoogle Scholar
  • 21 Greub G, Genton B, Safary A et al. Comparison of the reactogenicity and immunogenicity of a two injection combined high-dose hepatitis A and hepatitis B vaccine to those of Twinrix. Vaccine 2000; 19: 1113-1117
    CrossrefPubMedGoogle Scholar
  • 22 Kallinowski B, Knöll A, Lindner E et al. Can monovalent hepatitis A and B vaccines be replaced by a combined hepatitis A/B vaccine during the primary immunization course?. Vaccine 2000; 19: 16-22
    CrossrefPubMedGoogle Scholar
  • 23 Joines RW, Blatter M, Abraham B et al. A prospective, randomized, comparative US trial of a combination hepatitis A and B vaccine (Twinrix) with corresponding monovalent vaccines (Havrix and Engerix-B) in adults. Vaccine 2001; 19: 4710-4719
    CrossrefPubMedGoogle Scholar
  • 24 Nothdurft HD, Dietrich M, Zuckerman JN et al. A new accelerated vaccination schedule for rapid protection against hepatitis A and B. Vaccine 2002; 20: 1157-1162
    CrossrefPubMedGoogle Scholar
  • 25 van der Wielen M, van Damme P, Chlibek R et al. Hepatitis A/B vaccination of adults over 40 years old: comparison of three vaccine regimens and effect of influencing factors. Vaccine 2006; 24: 5509-5515
    CrossrefPubMedGoogle Scholar
  • 26 Wolters B, Müller T, Ross RS et al. Comparative evaluation of the immunogenicity of combined hepatitis A and B vaccine by a prospective and retrospective trial. Human Vaccines 2009; 5: 248-253
    CrossrefPubMedGoogle Scholar
  • 27 Fisman DN, Agrawal D, Leder K. The effect of age on immunologic response to recombinant hepatitis B vaccine: a meta-analysis. Clinical Infectious Diseases 2002; 35: 1368-1375
    CrossrefPubMedGoogle Scholar
  • 28 Hagedorn HJ, Rettmann NA, Dieperink EW et al. Antibody response to hepatitis B vaccine in substance use disorder patients. Drug Alcohol Depend 2010; 107: 39-43
    CrossrefPubMedGoogle Scholar
  • 29 Leonardi S, Spina M, Spicuzza L et al. Hepatitis B vaccination failure in celiac disease: is there a need to reassess current immunization strategies?. Vaccine 2009; 27: 6030-6033
    CrossrefPubMedGoogle Scholar
  • 30 Reniers J, Vranckx R, Heremans G et al. Age and immune response to hepatitis B vaccine in mentally handicapped. Archives belges=Belgisch archief 1986; 44: 489-493
    PubMedGoogle Scholar
  • 31 García Bengoechea M, Cortés A, Cabriada J et al. Respuesta a la vacuna DNA recombinada antihepatitis B en los deficientes mentales con síndrome de Down: estudio controlado. Medicina clínica 1990; 94: 528-530
    PubMedGoogle Scholar
  • 32 Höhler T, Groeger-Bicanic G, Hoet B et al. Antibody persistence and immune memory elicited by combined hepatitis A and B vaccination in older adults. Vaccine 2007; 25: 1503-1508
    CrossrefPubMedGoogle Scholar
  • 33 Robert Koch Institut . Epidemiologisches Bulletin. 2010; 30: 279-298
    PubMedGoogle Scholar