Hepatitis A Vaccine Safe in Childhood-Onset SLE

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The inactivated hepatitis A vaccine is safe and well tolerated in patients with childhood-onset systemic lupus erythematosus, with no adverse events or increase in activity.
The inactivated hepatitis A vaccine is safe and well tolerated in patients with childhood-onset systemic lupus erythematosus, with no adverse events or increase in activity.

Inactivated hepatitis A vaccine may be safe and well tolerated in patients with childhood-onset systemic lupus erythematosus (SLE), according to a study recently published in Pediatric Lupus.

SLE is a multisystemic chronic or remitting/relapse disease in which autoimmune dysfunction leads to inflammation, and eventually permanent organ damage. SLE is a fatal disease when left untreated, and has a 5-year mortality rate of 95%. The leading cause of death as a result of SLE-related infections are end-stage renal disease and cardiovascular diseases. The hepatitis A virus (HAV) has a high endemicity in countries that are developing and have poor sanitary conditions. Symptomatic HAV infection in the form of acute liver failure and death is more prominent in adolescents and adults; therefore, patients with childhood-onset SLE (average disease onset age, 12 years) are at high risk for HAV infection and complications thereof. 

Better management of this disease may be provided through immunization via vaccination against this infectious agent. However, there is a lack of knowledge on the effects of using non-live vaccines in children with rheumatic diseases. Therefore, this study aimed to compare the immunogenicity and safety of inactivated hepatitis A vaccination in childhood-onset systemic lupus erythematosus with those in healthy individuals.

Between 2016 and 2017, 30 participants with childhood-onset SLE and 39 healthy participants who were seronegative for HAV received 2 doses of the hepatitis A vaccine on a 0- and 6-month schedule. Before vaccination and 7 months after vaccination, HAV IgG antibodies were measured.

Results showed that the inactivated hepatitis A vaccine was safe and well tolerated in patients with childhood-onset SLE. The anti-HAV IgG antibody titers after vaccination were somewhat lower in children with SLE when compared with healthy subjects, but the difference in seroconversion rate was insignificant (80% vs 84.6% respectively; P <.06). Further, the seroconversion rates in patients with childhood-onset SLE were not affected by medication (corticosteroid, azathioprine, and hydroxychloroquine), high disease activity (defined as Systemic Lupus Erythematosus Disease Activity Index-2K scores > 6), and anti-dsDNA positivity. No flares or adverse reactions were experienced by any patients throughout the study.

Overall, the study authors concluded that, "Although anti-HAV IgG antibody titers after vaccination have been found to be somewhat lower in [patients with childhood SLE] than those of healthy subjects, an adequate seroconversion was achieved at the end of the study in [patients with childhood SLE]."

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Reference

Mertoglu S, Sahin S, Adrovic A, et al. Hepatitis A virus vaccination in childhood-onset systemic lupus erythematosus [published online December 14, 2018]. Lupus. doi: 10.1177/0961203318819827

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