High Risk of HBV Infection Among Vaccinated Polytransfused Children With Malignancy.

AIM OF THE STUDY: The national Egyptian hepatitis B virus (HBV) vaccination program coverage of all infants started in 1992. The study aimed to assess immunity against HBV and occurrence of HBV breakthrough infections in vaccinated polytransfused children with malignancies. PATIENTS AND METHODS: Eighty-nine polytransfused children with malignancies were recruited; 37 were on chemotherapy (male:female 20:17; mean age 7.7±4.0 y), and there were 52 naive patients (male:female 31:21; mean age 7.6±3.2 y). In addition, 162 age-matched and sex-matched healthy controls were recruited. Patients' sera were tested for quantitative anti-hepatitis B surface (HBs) (enzyme-linked immunoassays technique), hepatitis B surface antigen (HBsAg), total anti-hepatitis B core, and HBV-DNA (nested polymerase chain reaction for surface, core, and x-regions). RESULTS: There was a significant lower percentage of having protective anti-HBs (10 to 100 IU/L) level among those receiving chemotherapy (13.5%) than those without (44.2%) and controls (32.1%). Twenty-one (67.7%) of those on chemotherapy were HBsAg positive compared with 10 (32.2%) of those without. Overall, 46 patients were HBV-DNA positive; 38 were c-region positive, 5 were s-region positive, 2 positive for the c-region and the s-region, and 1 tested positive for the c-region and the x-region. Of 46 patients, 20 were also positive for HBsAg (overt infection), while 26 had occult HBV infection (HBsAg-negative). Anti-HBs ≥10 IU/L co-existed among 45% of patients with overt infection and in 50% of those with occult infection. There was nonsignificant impact of receiving chemotherapy on the level of HBV-DNA. CONCLUSIONS: Vaccinated children with malignancies, especially those under chemotherapy, are at a significant risk of HBV infection. The co-existence of anti-HBs with HBsAg and/or HBV-DNA may represent a possible residual transfusion-transmission risk with mutant HBV strains.

Soluble intercellular adhesion molecule-1 (slCAM-1) for early diagnosis of neonatal infections.

We investigated the validity of circulating soluble intercellular adhesion molecule-1 (slCAM-1) as an early immunological marker of neonatal sepsis as compared to C-reactive protein (CRP), immature to total neutrophils ratio (IlT) and blood culture assays. The study included 28 full term neonates with clinical manifestations of sepsis, 10 of them had suspected sepsis "Group I" with negative blood culture, positive CRP during 1st week of life and one or more risk factors for infections. The other 18 neonates had proven sepsis "Group II"; with positive blood culture and positive CRP. 14 normal age and sex matched controls "Group III" were also included. Serum slCAM-1 concentrations (ng/ml) were measured using enzyme linked immunosorbent assay (ELISA) in two successive blood samples; before (S1) and one week after (S2) the start of antibiotics respectively. The mean value of I/T ratio was significantly higher in both SI and S2 (P<0.05; P<0.001 respectively) in septic neonates compared with controls. In addition, a significant difference (P<0.05) was detected in S2 between mean CRP levels in group I (9.6+/-15.7 mg/dl) and group II (17.3+/-30.0 mg/dl). The mean values of slCAM-1 in (Sl) of septic groups I and II (445.7+/-138.5 and 512.8+240.9 ng/ml respectively) were significantly higher (P<0.05) than those of control group (364.0+/-67.4). In contrast, in (S2) insignificant differences were detected between both groups (392.6+/-149.8 and 420.0+/-184.7 respectively) and controls. A positive correlation was revealed between CRP and slCAM-1 values in (Sl) (r=0.3, P<0.05). Positive correlations were also detected between slCAM-1 levels and leukocytic counts (r=0.3, P<0.05) and CRP (r=0.5, P<0.001) in (S2) while, negative correlation was detected between slCAM-1 levels and platelet counts (r= -0.5, P<0.001). In conclusion, serum concentration of ICAM-1 is a potential marker for diagnosis of neonatal sepsis at its early stages.