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HIGH RISK OF HBV INFECTION IN VACCINATED POLYTRANSFUSED CHILDREN
Author(s):
Manal El-Sayed
,
Manal El-Sayed
Affiliations:
Pediatric Department,Ain Shams University, Faculty of Medicine,Cairo,Egypt
Zeinab Said
,
Zeinab Said
Affiliations:
Microbiology Department,Faculty of Medicine (for girls), Al-Azhar University, Cairo,Egypt
Enas Abou elmagd Abou elmagd
,
Enas Abou elmagd Abou elmagd
Affiliations:
Microbiology Department,Faculty of Medicine (for girls), Al-Azhar University,Cairo,Egypt
Eman Salama
,
Eman Salama
Affiliations:
Community Medicine Department,National Research Center,Cairo,Egypt
Fatma Ebeid
Fatma Ebeid
Affiliations:
Pediatric Department,Ain Shams University, Faculty of Medicine,Cairo,Egypt
(Abstract release date: 05/18/17) EHA Library. Soliman Ebeid F. 05/18/17; 182949; PB2236
Fatma Soliman Ebeid
Fatma Soliman Ebeid
Contributions
PDF Abstract
Abstract

Abstract: PB2236

Type: Publication Only

Background
Children receiving chemotherapy for neoplastic diseases are still susceptible to Hepatitis B virus (HBV) infection despite the national HBV vaccination program coverage for all infants since 1992.

Aims
This study aimed to analyze immunity against HBV and occurrence of HBV breakthrough infections in polytransfused children who had been vaccinated during infancy.

Methods
The study included 89 children with hematological disorders and malignancies, who were categorized into group (A): 37 receiving chemotherapy (M:F 20:17; mean age:7.7±4.0) and group (B): 52 polytransfused children (M:F 31:21; mean age:7.6±3.2). A matched healthy control group (n=162) was also included. All patients and controls had received their primary vaccination against HBV in infancy. Quantitative anti-HBs were tested for patients and controls. Patients’ sera were tested for HBsAg, anti-HBc, and HBV-DNA (nested PCR for surface, core & x-regions).

Results

Levels of anti-HBs between 10-100 IU/L and ≥100 IU/L were found among 13.5% and 21.6% [group (A)], 44.2% and 11.5% [group (B)] and 32.1% and 10.5% of controls respectively. There was a significant difference in HBsAb between patients receiving chemotherapy (group A) and both groups B patients (p=0.008) and controls (p=0.032). However, no difference was found between polytransfused children [group (B)] and controls.
HBsAg was positive in 21(67.7%) children under chemotherapy [group (A)] compared to 10 (32.2%) polytransfused children [group (B)] (p<0.0005). Overall, 49 patients (55%) were HBV-DNA positive; 44 c-region positive, 7 s-region positive, 2 positive for both c and s-regions and one positive for c and x-regions. Of those, only 21 patients (42.8%) were also positive for HBsAg; while 28 (47.2%) had occult HBV infection (HBsAg-negative). There was no significant difference between patients receiving chemotherapy [group (A)] and polytransfused children [group (B)] (p 0.157), regarding the rate of HBV DNA. Anti-HBs ≥10 IU/L co-existed in 38.7% (12/31) of HBsAg positive patients and 49% (24/49) of HBV-DNA positive patients.

Conclusion
Children with neoplastic diseases vaccinated during infancy were at a high risk for HBV infection. The effect of immunosuppression on the HBV protective level favored overt HBV infection in children receiving chemotherapy. The co-existence of anti-HBs with HBsAg and/or HBV-DNA demonstrated a possible residual transfusion-transmission risk with mutant HBV strains.

Session topic: 30. Transfusion medicine

Keyword(s): Liver disease, Blood transfusion, Acute lymphoblastic leukemia

Abstract: PB2236

Type: Publication Only

Background
Children receiving chemotherapy for neoplastic diseases are still susceptible to Hepatitis B virus (HBV) infection despite the national HBV vaccination program coverage for all infants since 1992.

Aims
This study aimed to analyze immunity against HBV and occurrence of HBV breakthrough infections in polytransfused children who had been vaccinated during infancy.

Methods
The study included 89 children with hematological disorders and malignancies, who were categorized into group (A): 37 receiving chemotherapy (M:F 20:17; mean age:7.7±4.0) and group (B): 52 polytransfused children (M:F 31:21; mean age:7.6±3.2). A matched healthy control group (n=162) was also included. All patients and controls had received their primary vaccination against HBV in infancy. Quantitative anti-HBs were tested for patients and controls. Patients’ sera were tested for HBsAg, anti-HBc, and HBV-DNA (nested PCR for surface, core & x-regions).

Results

Levels of anti-HBs between 10-100 IU/L and ≥100 IU/L were found among 13.5% and 21.6% [group (A)], 44.2% and 11.5% [group (B)] and 32.1% and 10.5% of controls respectively. There was a significant difference in HBsAb between patients receiving chemotherapy (group A) and both groups B patients (p=0.008) and controls (p=0.032). However, no difference was found between polytransfused children [group (B)] and controls.
HBsAg was positive in 21(67.7%) children under chemotherapy [group (A)] compared to 10 (32.2%) polytransfused children [group (B)] (p<0.0005). Overall, 49 patients (55%) were HBV-DNA positive; 44 c-region positive, 7 s-region positive, 2 positive for both c and s-regions and one positive for c and x-regions. Of those, only 21 patients (42.8%) were also positive for HBsAg; while 28 (47.2%) had occult HBV infection (HBsAg-negative). There was no significant difference between patients receiving chemotherapy [group (A)] and polytransfused children [group (B)] (p 0.157), regarding the rate of HBV DNA. Anti-HBs ≥10 IU/L co-existed in 38.7% (12/31) of HBsAg positive patients and 49% (24/49) of HBV-DNA positive patients.

Conclusion
Children with neoplastic diseases vaccinated during infancy were at a high risk for HBV infection. The effect of immunosuppression on the HBV protective level favored overt HBV infection in children receiving chemotherapy. The co-existence of anti-HBs with HBsAg and/or HBV-DNA demonstrated a possible residual transfusion-transmission risk with mutant HBV strains.

Session topic: 30. Transfusion medicine

Keyword(s): Liver disease, Blood transfusion, Acute lymphoblastic leukemia

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