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Z Gastroenterol 2003; 41(10): 983-990
DOI: 10.1055/s-2003-42929
Originalarbeit
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Immunogenicity of an Accelerated Vaccination Regime with a Combined Hepatitis A/B Vaccine in Patients with Chronic Hepatitis C

Immunogenität eines Schnellimpfschemas mit dem kombinierten Hepatitis- A/B-Impfstoff bei Patienten mit einer chronischen Hepatitis-C-VirusinfektionB. Kallinowski1 , W. Jilg2 , L. Buchholz1 , W. Stremmel1 , S. Engler1
  • 1Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
  • 2Department of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
Further Information

Publication History

Manuscript received: 28. April 2003

Accepted after revision: 15. July 2003

Publication Date:
16 October 2003 (online)

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Zusammenfassung

Hintergrund: Bei Patienten mit chronischen Lebererkrankungen sind prophylaktische Impfungen gegen Hepatitis A und B empfohlen.

Methoden: Wir verglichen daher prospektiv die Immunogenität und Reaktogenität des kombinierten Hepatitis-A/B-Impfstoffes (Twinrix®) in einem akzelerierten Impfschema (0-7-21 Tage) mit dem Standardimpfschema (0-1-6 Monate) bei Patienten mit einer chronischen HCV-Infektion und gesunden Kontrollen.

Ergebnisse: Lokale und systemische Nebenwirkungen waren mild bei allen Impflingen. Einen Monat nach Komplettierung des akzelerierten und Standardimpfprotokolls waren 89 bzw. 88 % aller HCV-infizierten Patienten geschützt gegen Hepatitis A (anti-HAV > 33 IU/l), wobei diese Serokonversionsraten auf 94 bzw. 96 % gesteigert werden konnten durch erneute Boosterimmunisierung der initialen Nonresponder. Eine erfolgreiche Anti-HBs-Seroprotektion (Anti-HBs > 10 IU/l) konnte bei 77 und 82 % der HCV-Infizierten nach dem Schnellimpf- bzw. dem Standardimpfschema erzielt werden. Durch Boosterimpfung der initialen Nonresponder konnte die Anti-HBs-Serokonversionsrate sogar auf 84 bzw. 85 % bei Patienten mit einer chronischen HCV-Infektion angehoben werden. Protektive anti-HAV- und anti-HBs-Titer konnten in 89 bzw. 77 % der Fälle bereits zu Monat 2 mit dem Schnellimpfschema bei Hepatitis-C-Infizierten nachgewiesen werden. Gesunde Probanden entwickelten unabhängig vom Impfprotokoll protektive Anti-HAV- und Anti-HBs-Titer in 100 bzw. 98 % der Fälle.

Zusammenfassung: Diese Studie konnte zum ersten Mal zeigen, dass das akzelerierte Impfschema mit dem kombinierten Hepatitis-A/B-Impfstoff sicher und hoch immunogen ist auch in der Problemgruppe der Patienten mit einer chronischen Hepatitis-C-Virusinfektion.

Abstract

Objectives: Hepatitis A (HAV) and B (HBV) vaccinations are recommended in patients with chronic liver diseases.

Methods: We prospectively investigated immunogenicity and safety of an accelerated vaccination protocol (0-7-21 days) with the combined hepatitis A/B vaccine (Twinrix®) versus the standard vaccination scheme (0-1-6 months) in hepatitis C virus-infected patients versus healthy volunteers.

Results: Local and general symptoms were mostly mild in all groups. One month after completion of the accelerated vaccination or standard vaccination, with the combined hepatitis A/B vaccine anti-HAV seroconversion rates (>33 IU/l) were 89 % and 88 % in HCV-infected patients. Initial HCV-nonresponders developed protective anti-HAV antibodies in 94 % and 96 % after a booster dose. According to the anti-HBs seroprotection rate, HCV-infected patients developed protective anti-HBs titres (>10 IU/l) in 77 % and 82 % of cases one month after the accelerated and the standard vaccination scheme-at month 2 and 7, respectively. This anti-HBs seroprotection rate could even be increased to 84 % and 85 % when initial HCV-infected nonresponders where given a booster dose with the combined hepatitis A/B vaccine. Protective anti-HAV and anti-HBs titers were achieved as early as month 2 after the accelerated vaccination schedule in the majority of HCV-infected patients. Healthy subjects developed protective anti-HAV titers and anti-HBs titers in 100 % and 98 % after the accelerated and standard vaccination protocol.

Conclusions: This study is the first to have demonstrated that the accelerated combined hepatitis A/B vaccination is both safe and highly immunogenic against HAV and HBV in HCV-infected patients with well compensated liver disease.

Schlüsselwörter

Hepatitis-A/B-Impfstoff - Hepatitis-C-Virunsinfektion - Schnellimpfschema

Key words

Hepatitis A/B vaccine - hepatitis C virus infection - accelerated vaccination

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Birgit Kallinowski, MD, PhD

Dept. of Internal Medicine IV, University of Heidelberg

Bergheimer Straße 58

69115 Heidelberg

Germany

Email: birgit_kallinowski@med.uni-heidelberg.de

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