Minerva pediatrica | 2019
How diabetes type 1 affects immune response to hepatitis B virus vaccine in pediatric population? Evaluation of a booster dose in unresponsive subjects with type 1 diabetes.
Abstract
BACKGROUND\nHepatitis B virus (HBV) vaccine reduced the incidence of Hepatitis B worldwide. Genetic variability , by the presence of specific haplotypes of HLA system (HLA-DR3, HLA-DR4) , influences the response to the vaccination. Subjects affected by T1D, contrary to non-diabetics, have a high prevalence of Hepatitis B.\n\n\nMETHODS\nThe objective of the study was to evaluate anti-HBs antigen (anti-HBsAg) antibody (Ab) in a group of 201 children (age range: 2 - 18 years), regularly vaccinated against HBV according to the national vaccination schedule. Patients with anti-HBs Ab ≥10 mlU/mL have been defined Responders and those with anti-HBs Ab<10mlU/mL have been defined Non-Responders .The possible association between the Type 1 Diabetes (T1D) and a low immune response to the vaccine has been subsequently valued. Besides the presence of T1D, other possible influential variables have been studied: sex, age, presence of celiac disease and Hashimoto s thyroiditis, intervening years from the diagnosis of diabetes and presence/absence of diabetic ketoacidosis at time of diagnosis.\n\n\nRESULTS\nAmong the 201 subjects with type 1 diabetes, 90 (44.8%) were Responders, while 111 (55.2%) were non-Responders; among the 145 subjects without type 1 diabetes, 86 (59.3%) were Responders and 59 (40.7%) non-Responders. We invited Subjects with type 1 diabetes Non-Responders to undergo a booster dose of the same vaccine. Of these, 21 refused the booster, reducing the sample to 90 patients. After 4 weeks from the booster dose 81 patients showed seroconversion ( false Non-Responders ), and 9 did not( true Non-Responders ).\n\n\nCONCLUSIONS\nAfter the booster dose, immune response in our cross-section has been similar to general population. Given the high frequency of false Non-Responders anti-HBsAg Ab should be tested in T1D patients and a booster dose should be administrated in Non-Responders.