Induction of peripheral blood T follicular helper cells expressing ICOS correlates with antibody response to hepatitis B vaccination.

T follicular helper (TFH) cells, a critical subset of CD4+ T cells, provide help to B cells during the procession of the humoral immune response in the germinal center (GC) and extrafollicular sites. CXCR5+ CD4+ T cells in human circulating blood, referred to herein as peripheral TFH (pTFH) cells, share phenotypes and functional properties with TFH cells in GC. Hepatitis B vaccine protects about 60% of the chronic hepatitis C patients from hepatitis B. The immunological bases that lead to the induction of protective antibody response is not well understood. In the present study, the pTFH cells subsets were determined in 18 healthy controls (anti-HBs ≥ 100 mIU/mL; HC), 21 nonresponders (anti-HBs < 10 mIU/mL; NR), and 23 weak responders (10 mIU/mL ≤ anti-HBs < 100 mIU/mL; WR) of chronic hepatitis patients upon routine hepatitis B vaccination. Though the frequency of the pTFH cell was equivalent in HC, WR, and NR, ICOS+ pTFH cells in HC underwent expansion with increased IL-21 secretion and production of serum anti-HBs response at 4 weeks after a full course of hepatitis B vaccination. These changes were not shown in both NR and WR. Analysis of ICOS+ pTFH cells represents a novel cellular determinant of the hepatitis B vaccine-induced humoral immune response, which may have relevance for design of hepatitis B vaccine.

Identifying Potential Norovirus Epidemics in China via Internet Surveillance.

BACKGROUND: Norovirus is a common virus that causes acute gastroenteritis worldwide, but a monitoring system for norovirus is unavailable in China. OBJECTIVE: We aimed to identify norovirus epidemics through Internet surveillance and construct an appropriate model to predict potential norovirus infections. METHODS: The norovirus-related data of a selected outbreak in Jiaxing Municipality, Zhejiang Province of China, in 2014 were collected from immediate epidemiological investigation, and the Internet search volume, as indicated by the Baidu Index, was acquired from the Baidu search engine. All correlated search keywords in relation to norovirus were captured, screened, and composited to establish the composite Baidu Index at different time lags by Spearman rank correlation. The optimal model was chosen and possibly predicted maps in Zhejiang Province were presented by ArcGIS software. RESULTS: The combination of two vital keywords at a time lag of 1 day was ultimately identified as optimal (ρ=.924, P<.001). The exponential curve model was constructed to fit the trend of this epidemic, suggesting that a one-unit increase in the mean composite Baidu Index contributed to an increase of norovirus infections by 2.15 times during the outbreak. In addition to Jiaxing Municipality, Hangzhou Municipality might have had some potential epidemics in the study time from the predicted model. CONCLUSIONS: Although there are limitations with early warning and unavoidable biases, Internet surveillance may be still useful for the monitoring of norovirus epidemics when a monitoring system is unavailable.

The effects of booster vaccination of hepatitis B vaccine on anti-HBV surface antigen negative children 11-15 years after primary vaccination.

The twin aims of this study were to investigate the changes in anti-HBs IgG levels after booster vaccinations and to compare the effects of different vaccine doses in children aged 11-15 years who were both negative for HBsAg and had an Anti-HBs < 10.0 mIU/mL after primary vaccination. Children who were born between 1993 and 1998 and who had completed their Hepatitis B vaccination program in infancy were randomly recruited to the study. The participants were divided into three groups according to their anti-HBs IgG levels: group I had a level < 0.1 mIU/mL; group II 0.1 - < 1.0 mIU/mL, and group III 1.0 - < 10.0 mIU/mL. The booster vaccination program comprised three (20µg) doses of HepB (CHO) vaccine administered at zero, one and six months after they are join this program: anti-HBs levels were measured one month after the first and third vaccinations. Among 448 HBsAg-negative infants, anti-HBs seroconversion rates (defined as an anti-HBs >= 10 mIU/mL) after the first and third vaccinations were 85.5% and 98.6% respectively - these observed differences were statistically significant (χ2 [1dof] = 50.11, p< 0.05). Seroconversion rates and GMTs after the first and third doses were significantly lower for group I children than the other two groups (p< 0.05). Compared, the OR of being negative (anti-HBs< 10mIU/ml) in group I after the first and the third dose were 7.66 (95%CI: 4.35-13.47, P< 0.05) and 20.48 (95% CI: 2.36-177.67, P< 0.05). So the anti-HBs titer levels decay to 10mIU/ml in 11-15 years of age children completed HepB Basic immunization, which need for booster immunization. The effect is better for those children with a relatively higher antibody titer before booster, and the effect of three doses booster is best.

Factors Correlating to the Development of Hepatitis C Virus Infection in Hemodialysis Patients-Findings Mainly from Asiatic Populations: A Systematic Review and Meta-Analysis.

Hemodialysis is an effective replacement therapy for chronic renal failure patients. In recent decades, the number of hemodialysis patients has grown rapidly and some measures for preventing blood-borne diseases have been implemented, but hepatitis C virus (HCV) infection remains a significant problem. The meta-analysis published in 2009 on HCV infection-related factors was based on localized study objects, and some additional studies have been published since 2009; however, the contribution of these factors remains under dispute. Our study pooled the odds ratios (ORs) or mean standard deviations (MDs) with 95% confidence intervals (CIs) and analyzed sensitivity using Review Manager 5.1 software (5.1 version Copenhagen: The Nordic Cochrane Centre; 2011) by searching data in the PubMed, Elsevier, Springer, Wiley, and EBSCO databases. Spearman correlation analysis was performed using the SPSS package. In our meta-analysis, 1715 HCV-infected hemodialysis patients and 7093 non-HCV-infected hemodialysis patients from 44 studies were analyzed. The pooled ORs with 95% CIs were: histories of blood transfusion, 4.30 (3.11, 5.96); weekly hemodialysis times > 2, 6.00 (3.25, 11.06); kidney transplantation, 5.80 (3.95, 8.52); hemodialysis units > 2, 6.90 (2.42, 19.68); shared hemodialysis devices, 5.00 (2.35, 10.65); and drug addiction, 4.73 (1.54, 14.47). The pooled MDs with 95% CIs were duration of hemodialysis (months) 27.48 (21.67, 33.30). There was a positive correlation between duration of hemodialysis and the HCV infection rate (p < 0.01). Hemodialysis patients, especially from Asia, with shared hemodialysis devices, hemodialysis units > 2, blood transfusion, kidney transplantation, and drug addiction were at increased risk of HCV infection. The HCV infection rate increased with the duration of hemodialysis. High-risk hemodialysis patients should be monitored and receive timely screening.

Suitable hepatitis B vaccine for adult immunization in China: a systematic review and meta-analysis.

Hepatitis B virus (HBV) infection remains an important public health problem in China, and adults need to be vaccinated. This systematic review and meta-analysis assessed the appropriate immunization of adults in China. Only randomized controlled trials (RCTs) were eligible, and seroprotection was defined as anti-HBs≥ 10 mIU/ml; 18,308 participants in 27 studies were included. Relative risk (RR) and random effects models were used. Twenty micrograms of HBV vaccine resulted in a better response than 10 µg (RR: 1.05, 95% confidence interval (CI): 1.02 to 1.08), and the 0-, 1-, and 6-month schedule was more effective than the 0-, 1-, and 2 - or 3-month schedule (RR: 0.98, 95% CI: 0.96 to 1.00). No significant differences were observed between 10 µg and 5 µg (RR: 1.05, 95% CI: 0.88 to 1.01); (yeast-derived hepatitis B vaccines) YDV and recombinant Chinese hamster ovary cell (CHO) hepatitis B vaccine (RR: 1.01, 95% CI: 0.98 to 1.04); domestic and imported (RR: 1.02, 95% CI: 0.99 to 1.05); or 0-, 1-, and 6-month and 0-, 1-, and 12-month schedules (RR: 1.02, 95% CI: 0.89 to 1.08). In conclusion, 20 µg of vaccine is recommended for adults in China, and the 0-, 1-, and 12-month immunization program schedule is also worth choosing when it is not possible to complete the 0-, 1-, and 6-month schedule.

The effects of booster vaccination of hepatitis B vaccine on children 5-15 years after primary immunization: A 5-year follow-up study.

The aim of this study was to evaluate changes in hepatitis B surface antibody titers (anti-HBs) after booster vaccinations in children aged 5-15 y and to provide suitable immunization strategies. A total of 2208 children were initially enrolled in screening, and 559 children were finally included. The participants were divided into 2 groups according to their pre-booster anti-HBs levels: Group I, <10 mIU/ml and Group II, ≥10 mIU/ml. Group I was administered 3 doses of booster hepatitis B vaccine (0-1-6 months, 10 µg), and Group II was administered 1 dose of booster hepatitis B vaccine (10 µg). The antibody titer changes were examined at 4 time points: 1 month after dose 1 and dose 3, and 1 year and 5 years after dose 3. The protective seroconversion rates at those points were 95.65%, 99.67%, 97.59% and 91.05% (p < 0.001), respectively, in Group I, and 100.00%, 99.87%, 99.66% and 98.21% (χ2 = 6.04, p = 0.11), respectively, in Group II. The GMT in subjects aged 5-9 y were higher than that in subjects aged 10-15 y in both Group I and Group II at 1 month after dose 1, but no difference was observed at the other three time points. This study demonstrates that booster vaccination has a good medium-term effect. A booster dose for subjects with protective antibodies is not necessary but effective, and 3 doses of hepatitis B vaccination are recommended for those who have lost immunological memory. Receiving booster immunization at the age of 10-15 years may be more appropriate for individuals living in HBV high epidemic areas.

Effects of hepatitis B vaccine boosters on anti-HBs-negative children after primary immunization.

This study was aimed at evaluating the changes of hepatitis B surface antibody (anti-HBs) titer after booster vaccinations in 5-15-year-old children with negative antibodies (<10 mIU/mL). 225 subjects (mean age, 9.28 ± 2.95 years) included in the study consisted of 123 males and 102 females, with a complete hepatitis B vaccination during infancy. The participants were divided into 3 groups according to their pre-booster anti-HBs level: Group I, <0.1 mIU/mL; Group II, 0.1 to <1.0 mIU/mL; Group III, 1.0 to <10.0 mIU/mL. All the participants were administered 3 doses of booster hepatitis B vaccination (0-1-6 month, 20 µg), and changes in the levels of antibodies were examined at 4 time-points (one month after the first and the third dose, one year and 5 years after the third dose). The seroprotective rate (defined as anti-HBs ≥10.0 mIU/mL) among 225 subjects at the 4 time-points were 93.8%, 100%, 83.6% and 73.4%, respectively (χ2 = 90.29, p < 0.05). The seroprotective rate (≥10 mIU/mL) and anti-HBs geometric mean titer (GMT) in Group III were always higher than those in the other 2 groups (all p < 0.05). The immune effect of a 3 -dose booster revaccination is good, and the booster-induced immune response was correlated with the pre-booster titer level, and ≥1.0 mIU/mL ensuring a robust positive response, whereas titers below this value may indicate the need for a course of booster vaccination.

A Bibliometric Analysis of PubMed Literature on Middle East Respiratory Syndrome.

Middle East Respiratory Syndrome (MERS), a pandemic threat to human beings, has aroused huge concern worldwide, but no bibliometric studies have been conducted on MERS research. The aim of this study was to map research productivity on the disease based on the articles indexed in PubMed. The articles related to MERS dated from 2012 to 2015 were retrieved from PubMed. The articles were classified into three categories according to their focus. Publication outputs were assessed and frequently used terms were mapped using the VOS viewer software. A total of 443 articles were included for analysis. They were published in 162 journals, with Journal of Virology being the most productive (44 articles; 9.9%) and by six types of organizations, with universities being the most productive (276 articles; 62.4%).The largest proportion of the articles focused on basic medical sciences and clinical studies (47.2%) and those on prevention and control ranked third (26.2%), with those on other focuses coming in between (26.6%). The articles on prevention and control had the highest mean rank for impact factor (IF) (226.34), followed by those on basic medical sciences and clinical studies (180.23) and those on other focuses (168.03). The mean rank differences were statistically significant (p = 0.000). Besides, "conronavirus", "case", "transmission" and "detection" were found to be the most frequently used terms. The findings of this first bibliometric study on MERS suggest that the prevention and control of the disease has become a big concern and related research should be strengthened.

Epidemiologic Features of Enterovirus 71-Associated Hand-Foot-and-Mouth Disease from 2009 to 2013 in Zhejiang, China.

Enterovirus 71 (EV71) usually causes hand-foot-and-mouth disease (HFMD) with severe clinical symptoms and even deaths in China. There is no efficient antiviral drug to protect against severe EV71-associated HFMD, making the development of EV71 vaccines therefore a priority. However, the potential target subject population(s) to be immunized with EV71 vaccine are not well understood. In this study, we characterized the epidemiology regarding EV71-associated HFMD on the basis of provincial-level surveillance. We extracted data on EV71-associated HFMD from the National Notifiable Disease Reporting System in Zhejiang Province, China between 1 January 2009 and 31 December 2013 (n = 7650). The higher incidence rate of EV71 cases occurred in those children aged 12-23 months, with boys being predominant. Interestingly, different peaks activities of EV71 infection was observed in different calendar year, with one peak in 2009 and 2013 and two peaks in 2010-2012. However, EV71 infection seemed to predominately occur in warm season and a distinguished cyclic peak that seemed to be of about 12 months. Children aged 12-23 months are thus identified as an important target population for public health intervention, for example, it is recommended that these key subjects immunized with EV71 vaccine. In addition, an enhanced surveillance system for EV71-associated with HFMD needs to focus on generic and phylogenetic analysis.

Analysis of Risk Factors Associated with the Development of Hepatocellular Carcinoma in Chronic HBV-Infected Chinese: A Meta-Analysis.

Hepatitis B virus (HBV) infection is a major risk factor for the development of hepatocellular carcinoma (HCC) in China. At present, there still are 9.3 million chronic HBV-infected Chinese. Numerous studies have explored the association between possible factors and hepatocellular carcinoma risk, however, the results remains inconsistent. Therefore, we did this pooled analysis so as to get a precise result. Here, we took the chronic HBV-infected Chinese as the object. We systematically searched for studies evaluating whether the proposed factors changed HCC risk in PubMed, Chinese National Knowledge Infrastructure, VIP database and Wanfang data. Odds ratios (OR) with 95% confidence intervals (CI) were calculated by Review Manager 5.0 and publication bias was determined by Begg's test and Egger's test. In total, 3165 cases and 10,896 controls from 27 studies were included in this meta-analysis. Our results showed that pooled OR with 95% CI for each of the factors investigated were: non-antiviral treatment 2.70 (2.01, 3.62), high HBV DNA levels 2.61 (1.73, 3.94), alcohol consumption 2.19 (1.53, 3.13), a family history of HCC 3.58 (2.53, 5.06) and male gender 2.14 (1.68, 2.73), respectively. Our meta-analysis supports that high HBV DNA levels, non-antiviral treatment, alcohol consumption, a family history of HCC and male gender contributed to the risk of hepatocellular carcinoma in chronic HBV-infected Chinese from currently available evidence. Given the high prevalence of the non-antiviral treatment and alcohol drinking, behavior interventions for the two factors should be tackled first.

Responses to hepatitis B vaccine in isolated anti-HBc positive adults.

Immune responses of isolated anti-HBc subjects are not well characterized in populations in China. This study aimed to evaluate immune responses to hepatitis B vaccination in isolated anti-HBc positive subjects. A cohort of 608 subjects were selected and separated into isolated anti-HBc (negative for HBsAg and anti-HBs, positive for anti-HBc) and control (negative for HBsAg, anti-HBs, and anti-HBc) groups, who were matched by age and sex. All subjects received 3 doses of hepatitis B vaccine (20µg) at months 0, 1, and 3, followed by testing for serological responses 1 month after the third vaccination. The positive seroprotection rate and geometric mean titer (GMT) for hepatitis B surface antibody (anti-HBs) of isolated anti-HBc subjects were significantly lower than those in the control group(86.2% vs.92.1%, P = 0.02; 47.26 vs.97.81 mIU/mL, P < 0.001). When stratified by age, positive seroprotection rate in the isolated anti-HBc group were 92%, 88.5% and 79.4% in the 20-34, 35-49, and 50-60 y old subgroups, respectively (χ2 = 5.919, P = 0.04). Additionally, the GMT level for anti-HBs in the isolated anti-HBc group for different age subgroups were 104.43, 47.87 and 31.79 mIU/mL respectively (χ2 = 19.44, P < 0.001). The GMT level for anti-HBc before vaccination were negatively correlated with GMT for anti-HBs after 3 doses of hepatitis B vaccine (r = -0.165, P < 0.001). In conclusion, isolated anti-HBc positive subjects can achieve good immune responses after hepatitis B vaccination, and the positive seroprotection rate and GMT level for anti-HBs were lower than the control group. Better responses could be observed in young adults, and significant negative correlations were found between GMT of anti-HBc before vaccination and GMT of anti-HBs after vaccination.

Chinese Public Attention to the Outbreak of Ebola in West Africa: Evidence from the Online Big Data Platform.

OBJECTIVE: The outbreak of the Ebola epidemic in West Africa in 2014 exerted enormous global public reaction via the Internet and social media. This study aimed to investigate and evaluate the public reaction to Ebola in China and identify the primitive correlation between possible influence factors caused by the outbreak of Ebola in West Africa and Chinese public attention via Internet surveillance. METHODS: Baidu Index (BDI) and Sina Micro Index (SMI) were collected from their official websites, and the disease-related data were recorded from the websites of the World Health Organization (WHO), U.S. Centers for Disease Control and Prevention (CDC), and U.S. National Ministries of Health. The average BDI of Internet users in different regions were calculated to identify the public reaction to the Ebola outbreak. Spearman's rank correlation was used to check the relationship of epidemic trends with BDI and SMI. Additionally, spatio-temporal analysis and autocorrelation analysis were performed to detect the clustered areas with the high attention to the topic of "Ebola". The related news reports were collected from authoritative websites to identify potential patterns. RESULTS: The BDI and the SMI for "Ebola" showed a similar fluctuating trend with a correlation coefficient = 0.9 (p < 0.05). The average BDI in Beijing, Tibet, and Shanghai was higher than other cities. However, the disease-related indicators did not identify potential correlation with both indices above. A hotspot area was detected in Tibet by local autocorrelation analysis. The most likely cluster identified by spatiotemporal cluster analysis was in the northeast regions of China with the relative risk (RR) of 2.26 (p ≤ 0.01) from 30 July to 14 August in 2014. Qualitative analysis indicated that negative news could lead to a continuous increase of the public's attention until the appearance of a positive news report. CONCLUSIONS: Confronted with the risk of cross-border transmission of the infectious disease, online surveillance might be used as an innovative approach to perform public communication and health education through examining the public's reaction and attitude.

Suitable hepatitis B vaccine for adult immunization in China.

The aim of this study was to evaluate, in adults, the immunogenicity of six hepatitis B vaccines with different doses or different manufacturers in the Chinese market and to provide evidence to support adult hepatitis B vaccination. Participants were randomly divided into six groups (I-VI). Six vaccines (4 at 10 µg/dose and 2 at 20 µg/dose) were administered intramuscularly to healthy adults at 0, 1 and 6 month intervals. All participants (16-50 years) who were negative for any hepatitis B virus serological markers were vaccinated. Anti-HBs levels were assessed 1 month and 1 year after the third vaccination. The anti-HBs seroconversion rate (anti-HBs >10 mIU/ml) was 99.4 % (99.9 % for 10 µg dose groups and 97.9 % for 20 µg dose groups) 1 month after the third vaccination, and the anti-HBs seroreversion rate was 77.0 % (75.3 and 82.6 %) 1 year after the third vaccination (n = 1036). One month after completing the vaccinations, the seroconversion rates were not significantly different (100.0, 100.0, 99.6, 100.0 %) for the four 10 µg dose and two 20 µg dose groups (99.1, 96.9 %). One year after the third vaccination, the group II positive rate was significantly higher than the other three 10 µg dose groups, and the group VI positive rate was significantly higher than the other 20 µg dose group. Groups II and VI showed a significantly higher positive rate and anti-HBs geometric mean titer (GMT) than the other groups. The anti-HBs level declined with increasing age, and the seroreversion rate and GMT decreased over time. All six vaccines had high anti-HBs seroconversion rates and good immunization effects. The 10 µg dose vaccine (Dalian High-Tech) and the 20 µg dose vaccine (GlaxoSmithKline) are recommended for adults.

Identification of Distribution Characteristics and Epidemic Trends of Hepatitis E in Zhejiang Province, China from 2007 to 2012.

Hepatitis E virus is a common hepatotropic virus that causes serious gastrointestinal symptoms. Data of reported HEV cases in Zhejiang Province was collected between 2007 and 2012. Descriptive epidemiological methods and spatial-temporal epidemiological methods were used to investigate the epidemiological trends and identify high-risk regions of hepatitis E infection. In this study, the average morbidity of hepatitis E infection was 4.03 per 100,000 in Zhejiang Province, peaking in winter and spring. The ratio between the male and the female was 2.39:1, and the high-risk population was found to be aged between 40 and 60. Trend surface analysis and IDW maps revealed higher incidences in the northwestern counties. The spatial-temporal analysis showed comparable incidences in the counties at the basins of three rivers, mostly under administration of Hangzhou Municipality. Besides, the seasonal exponential smoothing method was determined as the better model for the retrieved data. The epidemiological characteristics of HEV suggested the need of strengthened supervision and surveillance of sanitary water, sewage treatment and food in high-risk areas especially around the Spring Festival. Additionally, time series model could be useful for forecasting the epidemics of HEV in future. All these findings may contribute to the prevention and control of HEV epidemics.

Knowledge, Attitudes, and Practices Regarding Avian Influenza A (H7N9) Among Mobile Phone Users: A Survey in Zhejiang Province, China.

BACKGROUND: Understanding people's knowledge, attitudes, and practices (KAP) regarding a new infectious disease is crucial to the prevention and control of it. Human infection with avian influenza A (H7N9) was first identified on March 31, 2013 in China. Out of the total number of 134 cases confirmed from March to September 2013 in China, Zhejiang Province saw the greatest number (46 cases). OBJECTIVE: This study employed a mobile Internet survey to assess KAP regarding H7N9 among mobile phone users in Zhejiang Province. This study intended to examine KAP by region and the association between sociodemographic variables and KAP. METHODS: An anonymous questionnaire was designed by Zhejiang Provincial Center for Disease Control and Prevention (CDC). A cross-sectional survey was executed through a mobile Internet application platform of China Unicom in 5 regions in Zhejiang Province. Stratified and clustered sampling methods were applied and mobile phone users were invited to participate in the study voluntarily. RESULTS: A total of 9582 eligible mobile phone users participated in the survey with a response rate of 1.92% (9582/5,000,000). A total of 9105 valid responses (95.02%) were included for statistical analysis. Generally, more than three-quarters of the participants had some basic knowledge of H7N9 and held the attitude recommended by the Zhejiang CDC toward eating cooked poultry (77.55%, 7061/9105) and visiting a hospital at the occurrence of symptoms (78.51%, 7148/9105). Approximately half of the participants worried about contracting H7N9, and took preventive practices recommended by the Zhejiang CDC. But only 14.29% (1301/9105) of participants kept eating cooked poultry as usual. Although worry about H7N9 infection did not differ by region, Hangzhou saw the largest proportion of participants with knowledge of H7N9, which was probably because Hangzhou had the greatest number of H7N9 cases. KAP varied by some sociodemographic variables. Female participants were more likely to know about symptoms of H7N9 (OR 1.32, 95% CI 1.08-1.61), to worry about contracting it (OR 1.15, 95% CI 1.04-1.27), and to report their lives being influenced by it (OR 1.27, 95% CI 1.15-1.41). They were also more likely to take the recommended precautions. Male participants and younger participants were less likely to comply with advocated protective practices. CONCLUSIONS: The results suggest that health education should be customized depending on sociodemographic variables to achieve more effective behavioral outcomes.

Optimal vaccination program for healthy adults in China.

There is still no suitable routine hepatitis B immunization strategy for adults in China. To establish an optimal vaccination schedule for healthy adults, we investigated various schedules in healthy adults. In this randomized 5143 healthy adults received 10 µg hepatitis B vaccine at 0, 1 and 3 months(group A), 0, 1 and 6 months(group B), or 0, 1 and 12 months(group C). Blood samples were collected after 1 month and 12 months after the third dose. The geometric mean titer (GMT), seroconversion rate (levels of anti-HBs ≥ 10 mIU/mL) and high response rate (levels of anti-HBs ≥ 100 mIU/mL) were assayed. In our study, 2438 healthy adults finished the full vaccination program and follow-up. The seroconversion/sero-protective rate of groups A-C at one and 12 month after administration of the third vaccine dose was 100%, 99.9% and 97.9% verse 64.9%, 75.7% and 79.0%, respectively. GMT for anti-HBs tested in group A to C within 1 or 12 month after the third vaccination was 213.16, 432.58 and 451.47 mIU/ml verse 22.07, 46.70 and 56.18 mIU/ml, respectively. There were significant differences of seroconversion/sero-protective rate and GMT among the 3 groups (p < 0.01). Given the high anti-HBs seroconversion rate and GMT in all 3 groups, a flexible schedule for Hepatitis B vaccine should be recommended to adults, but 0-1-12 schedule is a better choice.

The one year effects of three doses of hepatitis B vaccine as a booster in anti-HBs-negative children 11-15 years after primary immunization; China, 2009-2011.

The aim of this study was to evaluate hepatitis B surface antibody (anti-HBs) levels one year after hepatitis B booster vaccination in anti-HBs-negative (<10 mIU/mL) children 11-15 y after primary vaccination. Anti-HBs titers were examined in 235 children who were negative for hepatitis B surface antigen (HBsAg), anti-HBs, and hepatitis B core antibody (anti-HBc). The children were then divided into 3 groups based on their anti-HBs levels pre-booster: Group I, <0 .1 mIU/mL; Group II, 0.1 to <1 .0 mIU/mL; and Group III, 1.0 to <10 .0 mIU/mL. They were vaccinated with 3 doses of hepatitis B vaccine (0-1-6 month, 20 ug), and anti-HBs levels were measured. One month after the first dose, the anti-HBs positive rates (≥ 10 mIU/mL) in Groups I-III were 56.14%, 83.61% and 100%. One month after the third dose, the anti-HBs-positive rates in Groups I-III were 96.49%, 98.36% and 100%. One year after the third dose, the anti-HBs-positive rates in Groups I-III were 73.68%, 75.41% and 98.29%, respectively. Protective levels declined more rapidly for those with lower titers. Children with pre-booster anti-HBs titers of 1-9.9 mIU/mL might not need any booster dose, and the children with pre-booster titers of 0.1-0.9 and <0 .1 mIU/mL might need more than one dose booster vaccination.

Comparison of the effect of two different doses of recombinant hepatitis B vaccine on immunogenicity in healthy adults.

The aim of this study was to evaluate the one-month immune response to 2 different doses (10 and 20 µg) of recombinant hepatitis B vaccine in adults aged 20-46 y. Subjects who were negative for hepatitis B surface antigen (HBsAg), hepatitis B antibody (anti-HBs), and hepatitis B core antibody (anti-HBc) were recruited. The participants were divided into 2 groups: group I received 3 doses of 10 µg hepatitis B vaccine at 0, 1 and 3 months, and group II received 3 doses of 20 µg at the same time points. The anti-HBs levels were measured one month after the third vaccination. Among 739 subjects, 62 (9.70%) were positive for HBsAg, and 317 subjects were eligible. The anti-HBs seroprotection rates (anti-HBs ≥ 10 mIU/mL was considered to indicate seroprotection) after the third vaccination were 88.05% and 94.06% in group I and group II respectively, and the geometric mean titers were 91.69 and 290.23 mIU/mL respectively. The difference in the seroprotection rate was not significant (χ(2) = 2.566, P > 0.05), but the GMT after the third dose was significantly lower for group I than for group II (F = 20.587, P < 0.05). Better responses were observed in young adults, especially in group I. In group I, the seroprotection rate and GMT were significantly higher in the 20-35 y group than in the 36-46 y group (P < 0.05); there was no significant difference compared to group II (P > 0.05). The hepatitis B vaccine has good immunological effect; the 20 µg dose can be used in adults aged 20-46 y and the 10 µg dose can be used in subjects aged 20-35 years, and it should be tested on a larger number of subjects before recommending it for adult routine vaccination.

The response of hepatitis B vaccination on seronegative adults with different vaccination schedules.

The purpose of this study was to compare the response of hepatitis B vaccination with different vaccination schedules among seronegative adults, and to provide suitable vaccination schedules for floating and fixed population. The study included adults aged 20 to 39 y without prior history of vaccination with hepatitis B vaccine. The serum samples were collected and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core antibody (anti-HBc) levels. Out of all, 686 adults who were negative for anti-HBs, anti-HBc and HBsAg were vaccinated with 10 ug hepatitis B vaccine at 0, 1 and 3, 6 or 12 month schedules, and their antibody titers were monitored. The rates of completion of the vaccination in floating and fixed population were 90.4% and 94.1% respectively (p = 0.061). The anti-HBs positive rates in adults vaccinated at 0, 1 and 3 ,6 or 12 month were 83.9%, 88.2% and 94.2% respectively (P = 0.0003). The corresponding geometric mean titers (GMTs) were 61.19 (95%CI:47.10-81.23) mIU/mL, 214.04(95%CI:157.14-291.61) mIU/mL and 345.78(95%CI:251.25-475.77) mIU/mL, respectively ( P < 0.0001). Vaccination of hepatitis B with both 0-1-6 and 0-1-12 month schedules in adults result in better level of immune responses. Also, a longer vaccination schedule (0-1-12 month) may be more suitable for floating population and 0-1-6 month schedule is recommended for the fixed population.

The effects of different dosage levels of hepatitis B vaccine as booster on anti-HBs-negative children 5-15 y after primary immunization; China, 2009-2010.

The changes in lgG antibody levels to hepatitis B surface antigen (HBsAg) and in antibody to HBsAg (anti-HBs) seroconversion rates due to different dosages of hepatitis B vaccine (HepB) were compared in 2106 children. Children who had been previously vaccinated as infants with HepB were revaccinated at 5-15 y of age, after which the antibody titers were determined. After the first booster dose, the anti-HBs seroconversion rate (defined as an anti-HBs ≥10 mIU/ml) with 10 µg of HepB (93.6%) was significantly greater than the rate with 5 µg of HepB (90.3%) (P<0.05); the anti-HBs seroconversion rate in 10-15-y-old boys vaccinated with 10 µg of HepB (90.9%) was significantly greater than the rate with 5 µg of HepB (84.3%) (P<0.05). The anti-HBs seroconversion rates after the third booster dose with 5 or 10 µg of HepB were greater than those after the first booster dose (99.6% and 99.7%, vs. 90.3% and 93.6%, P<0.05); as was the corresponding GMTs (658 ± 4 mIU/ml and 2599 ± 3 mIU/ml, vs. 255 ± 11 mIU/ml and 877 ± 11 mIU/ml [P<0.05]). The immunization effects of booster vaccination with 3 doses of HepB with 5 or 10 µg are effective; a single booster dose with 10 µg of HepB for 10-15-y-old boys and with 5 or 10 µg of HepB for 5-9 y old boys and for 5-15-y-old girls are effective in generating protective antibody against HBV; however, for anti-HBs-negative children after a single dose of booster, 3 doses are needed.