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Abstract Number: 384

Protection Against Hepatitis B in Immunocompromised Pediatric Rheumatology and Gastroenterology Patients

Najla Aljaberi1, Emily A. Smitherman2, Enas Ghulam3, Allen Watts2, Dana MH Dykes4 and Jennifer L. Huggins5, 1Pediatric rheumatology, Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 2Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 3Environmental health and biostatistics, Department of Environmental Health, University of Cincinnati, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 4Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 5Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Hepatitis, immunity, Pediatric rheumatology, serologic tests and vaccines

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Session Information

Date: Sunday, November 5, 2017

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects Poster I: Autoinflammatory Disorders and Miscellaneous

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Hepatitis B infection remains a significant public health challenge, particularly for patients on chronic immunosuppressive therapy, due to a considerable mortality risk associated with hepatitis B reactivation. Serologic screening for immunocompromised patients should include hepatitis B surface antibodies (anti-HBsAb) to assess for immunity, hepatitis B core antibodies (anti-HBcAb) and hepatitis B surface antigen (HBsAg) to evaluate for acute or chronic infection. Our primary aim was to determine the burden of non-immunity against hepatitis B, provide insight into factors leading to lack of immunity against hepatitis B and establish the basis for the need for universal screening of these patients. Secondarily, we determined serologic response to a single hepatitis B vaccination booster.

  Methods:

Subjects are patients seen at the rheumatology and inflammatory bowel disease (IBD) clinics who are immunocompromised. We use a clinical algorithm as part of standard practice to check hepatitis B serology in immunocompromised patients, offer a booster vaccination if needed, and then repeat serology to determine the response. The results of anti-HBsAb are reported as positive, negative or indeterminate.  Immunity is defined as a positive result for anti-HBsAb. An indeterminate or negative result for anti-HBsAb is non-immune. A retrospective chart review was performed to collect demographic and clinical factors as well as serology results. Descriptive statistics were calculated for all variables. R software was used to perform all analyses. For continuous variables, mean and standard deviation are reported, and comparisons were calculated using two-sample t-tests. For categorical variables, frequency and percentage are reported, and comparisons were calculated using chi-square tests.

  Results:

A total of 502 patient charts of immunocompromised patients were reviewed, 280 rheumatology and 222 IBD. Out of the 502 patients, 70% were non-immune (anti-HBsAb negative/indeterminate) (see Table). The highest portion of non-immune patients were those between the ages of 16-20 years (p=0.005) There was no clinically significant difference between immune and non-immune patients with regards to diagnosis (p=0.69), age at the start of treatment (p=0.72) or type of medications. A total of 196 non-immune patients received a booster dose of hepatitis B vaccine and 61 (72%) of those re-screened developed a positive anti-HBsAB. Of note, one patient was identified with a previously unknown chronic hepatitis B infection (anti-HBcAb positive).

  Conclusion:

A majority of patients had non-immune hepatitis B serology. Lack of serologic immunity is highest at 16-20 years. A majority of patients developed positive anti-HBsAb following booster vaccination. Results support serologic screening for hepatitis B in immunocompromised patients.


Disclosure: N. Aljaberi, None; E. A. Smitherman, None; E. Ghulam, None; A. Watts, None; D. M. Dykes, None; J. L. Huggins, None.

To cite this abstract in AMA style:

Aljaberi N, Smitherman EA, Ghulam E, Watts A, Dykes DM, Huggins JL. Protection Against Hepatitis B in Immunocompromised Pediatric Rheumatology and Gastroenterology Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/protection-against-hepatitis-b-in-immunocompromised-pediatric-rheumatology-and-gastroenterology-patients/. Accessed .
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