A majority of immunocompromised pediatric patients with rheumatologic conditions and inflammatory bowel disease (IBD) lack serologic immunity against hepatitis B virus (HBV), according to study results published in The Journal of Rheumatology.
Although universal vaccination against HBV is common, data suggest that 10% of vaccine recipients fail to demonstrate a serologic response to the vaccine. Because acute hepatitis B infection and reactivation is associated with increased morbidity and mortality risk in immunocompromised patients, several professional societies have recommended that all patients receiving immunosuppressive therapy for rheumatologic or gastroenterologic disorders be screened for HBV infection and/or immunity and receive repeat vaccinations as needed.
Limited data are available on the rate of prior or chronic hepatitis B infection in immunocompromised children; therefore, the objective of the current study was to assess the prevalence of serologic immunity against hepatitis B infection in immunocompromised pediatric rheumatology and IBD, to identify potential risk factors for lack of immunity, and evaluate the response to a vaccine booster.
The retrospective study included 354 patients (mean age at screening, 16 years) from the rheumatology clinic and 226 (mean age at screening, 15 years) from the IBD clinic at Cincinnati Children’s Hospital Medical Center, Ohio. All participants enrolled in the study were immunocompromised.
After screening, 409 (71%) of the 580 patients reviewed for the study were nonimmune to hepatitis B, with a similar rate in rheumatology (73%) and IBD (67%) clinics. The highest portion of nonimmune to immune patients (75%) were among those aged between 11 and 18 years (P =.004). Among the 409 serologically nonimmune patients, 291 (71%) received a booster dose of HBV vaccine and seroconversion was documented in 68% of patients. The highest portion of nonimmunity after the HBV booster dose was evident among patients aged >18 years (47%, P =.010).
There was no significant difference between immune and nonimmune patients with regard to the different disease categories (P =.342), age at diagnosis (P =.639), duration of treatment (P =.069), and between the different classes of immunosuppressant medications (P =.080).
One of the limitations of the study was the lack of data on prior medication use.
“[F]or those immunocompromised rheumatology and IBD patients who do not have recent HBV serologic data, one might consider obtaining this serologic screening at age 11 years. Because only half of patients who were 18 years and older seroconverted following  booster vaccine, this age group may benefit from receiving the complete HBV vaccine series,” the researchers concluded.
Aljaberi N, Ghulam E, Smitherman EA, et al. Maintaining hepatitis B protection in immunocompromised pediatric rheumatology and inflammatory bowel disease patients. Published online August 1, 2020. J Rheumatol. doi:10.3899/jrheum.200283