Hepatitis B vaccine in children

Duca P, Del Pont JM, D Agostino D. Successful immune response to a recombinant hepatitis B vaccine in children after livertransplantation.JP6 c zd rGa5 ro6 A7fero/A wfr (2001) 32,168-70. 

Barton M, Finkelstein Y, Opavsky MA, Ito S, Ho T, Ford-Jones LE, Taylor G, Benson L, Gold R. Eosinophilic myocarditis temporally associated with conjugate meningococcal C and hepatitis B vaccines in children. Pediatr Infect Dis J 2008 27 831-5. 

Hepatitis B vaccine Pediarix (GlaxoSK) Hepatitis B immunization in children... 

Whittle, H.C. Lamb, W.H. Ryder, R.W. Trial of intra-dermal hepatitis B vaccines in Gambian children. Ann. Trop. Paediatr. 1987, 7, 6-9. 

In a paper dealing mainly with indications for the use of hepatitis vaccine, the data on the hepatitis A vaccines most widely used, HAVRIX (manufactured by Glaxo SmithKline) and VAQTA (manufactured by Merck), have been summarized (1). The data are based on prelicensure clinical trials and worldwide follow-up reports. No serious adverse effects have been attributed to hepatitis A vaccines. In children who received HAVRIX, soreness (15%) and induration (4%) at the injection site, feeding problems (8%), and headaches (4%) have been the most frequently observed adverse effects. In children who received VAQTA, the most common adverse effects were pain (19%), tenderness (17%), and warmth (9%) at the injection site. The reported frequencies were similar to the frequencies reported with hepatitis B vaccines. 

Chang M, Chen C, Lai M, Hsu H, Wu T, Kong M, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med 1997 336 1855-9. 

Hepatitis B virus is a blood-borne or sexually transmitted virus. Most acute infections occur in adults, while chronic infections usually occur in individuals infected as infants or children. However, about 10% of adults who contract hepatitis B virus will fail to clear their infection and develop chronic hepatitis B infection. Individuals with chronic hepatitis B infection are at risk for cirrhosis or hepatocellular carcinoma. Vaccination with hepatitis B vaccine is the most effective way to prevent hepatitis B infection.6... 

Hepatitis B vaccine is recommended for routine use in children. The first dose should be given within 12 hours of birth. The second and third doses are given at 2 months and 6 months after the first dose if using the single component vaccine, or at 2, 4, and 6 months if using combination vaccines. If the infant weighs less than 2000 g at birth, the birth dose is not counted in the three-dose series. Infants less than 2000 g do not produce an adequate immune response to the birth dose of hepatitis B vaccine. Adolescents should receive the three-dose series if not previously vaccinated.6... 

Adults with HIV infection should be vaccinated with the 23-valent pneumococcal polysaccharide and hepatitis B vaccines as early in the course of the disease as possible. Inactivated influenza vaccine should be given yearly. Children should continue to receive vaccinations on the standard childhood immunization schedule. The individual may experience a transient elevation in HIV viral load following vaccination.17... 

Thymosin is an immunomodulatory peptide produced by the thymus gland and other cells. Thymosin alfa 1, a 28-amino acid peptide, is one member of the family of thymosins that collectively appear to influence a variety of regulatory and counter-regulatory functions in terms of T-cell maturation and antigen recognition, stimulation of native interferons and cytokines such as interleukin-2, and activity of natural killer cell-mediated cytotoxicity. In some countries it is approved as an adjuvant for influenza vaccine or as a treatment for chronic hepatitis B and, in combination with interferon for hepatitis C. Thymosin alfa 1 has been used with some success to treat children with the severe form of Di-George Syndrome. 

The official French position on hepatitis B immunization, expressed in January 1999, was that children should be vaccinated against hepatitis B, that adolescents should receive a dose of hepatitis B vaccine if they have not been vaccinated earlier, that adults at risk should be similarly vaccinated, and that the obligation is maintained for health professionals to be vaccinated against hepatitis B. The steps taken in 1998 had sought only to ensure that informed consent could be attained before children were vaccinated. 

In the children of 10 women who had received hepatitis B vaccine during the first trimester of pregnancy there were no congenital abnormalities at 2-12 months the infants were physically and developmentally normal for their ages (74). 

In 40 children born to HBsAg-positive mothers who had received second and third doses of hepatitis B vaccine simultaneously with DTP vaccine and inactivated poliomyelitis vaccine, immunogenicity and reactogenicity were comparable with non-simultaneous administration of the different vaccines (87). 

Hepatitis A virus (HAV) accounts for about one fourth to one third the cases of clinical acute hepatitis in the United States and 20% to 25% worldwide. Although most commonly an infection of children and adolescents, the disease tends to be more virulent in middle-aged and older people. Most sporadic cases occur from person-to-person contact, such as occurs in children in day care centers. Epidemics have been associated with waterborne and food-borne contamination. Ingestion of raw shellfish from contaminated waters has caused both sporadic and epidemic cases. Although not as common a cause of liver infection as hepatitis B, it is more frequently associated with jaundice when occurring in adults than either hepatitis B or C an estimated 50% to 70% of infected adults develop jaundice. In contrast, hepatitis A infection in children is rarely associated with jaundice, and thus is usually not detected clinically. The incidence of the disease is declining in the developed world with introduction of hepatitis A vaccine complete immunization of less than half the at-risk population has been shown to reduce incidence of acute hepatitis A infection by more than 90% in areas of high endemicity. Universal vaccination of... 

The two recombinant hepatitis B vaccine products available in the United States (Recombivax HB, Merck Engerix-B, SmithKline Beecham) have comparable immune responses and safety profiles. The vaccines contain 5 to 40 meg HBsAg protein per milliliter adsorbed onto aluminum. Neither brand of hepatitis B vaccine contains thimerosal. The recent availability of a combined HAV and HBV vaccine allows for a more accelerated schedule for immunization. For a more detailed comparison of the potential vaccination schedules refer to the cited reference. These vaccines are some of the safest available. Side effects of the vaccine are soreness at the injection site, headache, fatigue, irritability, and fever. The number of patients experiencing adverse reactions decreases with each vaccine dose, and adverse reactions are less common in infants and children than in adults. There is no association between Guillain-Barre syndrome and the recombinant vaccine, and the vaccine does not transmit HIV. The hepatitis B vaccine is contraindicated for patients with anaphylaxis to... 

Werzberger A, Mensch B, Kuter B, et al. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children. N Engl J Med 1992 327 453 57. 

Murray JM, Wieland SE, Purcell RH, Chisari EV (2005) Dynamics of hepatitis B virus clearance in chimpanzees. Proc Natl Acad Sd USA 102 17780-17785 Ni Y-H, Chang M-H, Huang L-M, Chen HL, Hsu HY, Chiu TY et al (2001) Hepatitis B virus infection in children and adolescents in a hyperendemic area 15 years after mass hepatitis B vaccination. Ann Intern Med 135 796-800... 

Active Immunization of Children Recommended schedules for active immunization of children are shown in Table 62-3. They include hepatitis B vaccine, DTP (toxoids of diphtheria... 

The protective efficacy of Engerix B has been demonstrated in a number of trials, in the context of infants, children and adults. Seroprotection rates (measured as serum anti-hepatitis B antibody titres above a value of 10 mlU ml-1) of over 95 per cent were usually recorded. The product was found to be generally well tolerated. The most frequently reported adverse effects were local reactions at the injection sites, fever, headache and dizziness. Special consideration to risk benefit ratio should be given to MS patients, as exacerbations of this condition have been (rarely) reported following administration of hepatitis B and other vaccines. Engerix B is manufactured and marketed by GlaxoSmithKline. 

Chronic transfusion is indicated to prevent stroke and stroke recurrence in children. Transfusion frequency is usually every 3 to 4 weeks and should be adjusted to maintain HbS of less than 30% of total hemoglobin. The optimal duration is unknown. Risks include alloimmunization, hyperviscosity, viral transmission (requiring hepatitis A and B vaccination), volume and iron overload, and transfusion reactions. 

In children, primary immunization against tetanus is usually done in conjunction with diphtheria and pertussis vaccination using DTaP or a combination vaccine that includes hepatitis B and polio vaccines. A 0.5-mL dose is recommended at 2, 4, 6, and 15 to 18 months of age. 

Vaccines made with recombinant proteins marshal an immune response to specific viruses to treat or prevent disease. Vaccines to prevent infection with the liver-damaging hepatitis viruses (Twinrix , Recombivax HB , and Engerix-B ) include a recombinant version of a hepatitis virus B protein. Recombinant hepatitis B protein is also included in some combination vaccines given to children. Comvax also includes a recombinant flu virus protein. 

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