TİP 1 DİYABETES MELLİTUS TANILI ÇOCUKLARDA HEPATİT A VE B SEROPREVALANSI

AMAÇ: Tip1 diyabetes mellitus (T1DM) immün sistem üzerine etkileriyle aşılara karşı immünolojik yanıtı etkileyebilen otoimmun bir hastalıktır. Bu çalışmada T1DM’li hastalarda hepatit A (HA) ve hepatit B (HB) seroprevelansının araştırılması amaçlanmıştır.GEREÇ VE YÖNTEM: Ocak 2014-Ocak 2017 tarihleri arasında Konya Eğitim ve Araştırma Hastanesi Çocuk Endokrinoloji bölümünde izlenen 1-18 yaş aralığında 144 T1DM tanılı hasta ve 58 kontrol olgu alındı. Retrospektif olarak hasta kayıtlarından yaş, diyabet tanı zamanı, HBsAg, anti-HBs ve anti-HAV IgG, HbA1c sonuçları kaydedildi.BULGULAR: T1DM grubunda kontrol grubuna göre median anti-HBs düzeyi (14,8 mIU/ml [interquartile range (IQR): 4,2- 100] ve 37,7 mIU/ml [IQR: 7,16- 122,7], p=0,026), median anti-HAV IgG düzeyi (11 mIU/ml [IQR: 9,88- 21,7] ve 19,8 mIU/ml [IQR: 15,2- 80], p <0,001), hepatiti B virüs (HBV) seropozitif hasta oranı (%59 ve %73,7, p=0,048) ve hepatiti A virüs (HAV) seropozitif hasta oranı (%27,5 ve %44,2, p=0,027) düşük saptandı. Anti-HBs, anti-HAV IgG düzeyleri ile yaş, diyabet süresi ve HbA1c arasında korelasyon saptanmadı.SONUÇ: Çalışmamızda gösterilen düşük anti-HBs, anti-HAV IgG titreleri, HAV ve HBV seropozitif hasta oranları T1DM’li hastalarda HAV ve HBV aşılarına karşı immünolojik yanıtın yetersiz olduğunu düşündürmektedir.T1DM’li hastaların HBV maruziyeti için çeşitli risk faktörlerine sahip olması, HA enfeksiyonunda ilerleyen yaşla birlikte artan komplikasyon riski, enfeksiyona bağlı glisemik kontrolde bozulma ihtimalleri ve T1DM’li hastalarda düşük HAV ve HBV seropozitiflik oranları göz önüne alındığında ilk tanıda T1DM’li hastalarda HAV ve HBV serolojileri çalışılmalı, seronegatif hastalar aşılanmalı ve aşı yanıtları kontrol edilmelidir

Anahtar Kelimeler:

Tip 1 diabetes mellitus, anti-HBs, anti-HAV IgG, aşı

HEPATITIS A AND B SEROPREVALENCES IN CHILDREN WITH TYPE 1 DIABETES MELLITUS

OBJECTIVE: Type 1 diabetes mellitus (T1DM) is an autoimmune disease that can affect immunologic response to vaccines by its effects on the immune system. We aimed to investigate hepatitis A (HA) and hepatitis B (HB) seroprevalences in patients with T1DM.MATERIAL AND METHODS: We included 144 patients with T1DM and 58 patients in control group between the ages of 1 and 18 who have been followed up in the Pediatric Endocrinology Clinic of Konya Training and Research Hospital between January 2014 and January 2017. We have recorded the age of the patient, diabetes diagnosis time, HBsAg, anti-HBs, anti-HAV IgG and HbA1c results from records of the patients retrospectively.RESULTS: The median anti-HBs levels (14,8 mIU/ml [interquartile range (IQR): 4,2- 100] and 37,7 mIU/ml [IQR: 7,16- 122,7], p=0,026), median anti-HAV IgG levels (11 mIU/ml [IQR: 9,88- 21,7] and 19,8 mIU/ml [IQR: 15,2- 80], p <0,001), hepatitis B virus (HBV) seropositive patient rate (%59 and %73,7, p=0,048) and hepatitis A virus (HAV) seropositive patient rate (%27,5 and %44,2, p=0,027) were low in patients with T1DM comparing to patients in control group. We have found no correlation between anti-HBs, anti-HAV IgG levels and age, duration of diabetes and HbA1C levels.CONCLUSIONS: The findings of low anti-HBs, anti-HAV IgG levels, HAV and HBV seropositive patient rates in patients with T1DM demonstrated that immunologic responses to HAV and HBV vaccines were insufficient. Given the facts that patients with T1DM have various risk factors for HBV exposure, HA infection in advanced ages result in increased complication risk, poor glycemic control with infections and low HAV and HBV seropositivity rates in T1DM patients, we need to test T1DM patients for HAV and HBV serology, vaccinate the seronegative patients and monitor the vaccine response.

Keywords:

Tip 1 diabetes mellitus, anti-HBs, , anti-HAV,

PDF

___

Sağlam H. Diyabet ve Enfeksiyonlar. Güncel Pediatri 2004; 2: 44–52.
Pozzilli P, Arduini P, Visalli N, et al. Reduced protection against hepatitis B virus following vaccination in patients with type 1 (insulin-dependent) diabetes. Diabetologia 1987; 30: 817–9.
Mormile R. Hepatitis B vaccine non response: A predictor of latent autoimmunity? Med Hypotheses 2017; 104: 45–7.
Leonardi S, Vitaliti G, Garozzo MT, Miraglia del Giudice M, Marseglia G, La Rosa M. Hepatitis B vaccination failure in children with diabetes mellitus? The debate continues. Hum Vaccin Immunother 2012; 8: 448–52.
Vitaliti G, Praticò AD, Cimino C, et al. Hepatitis B vaccine in celiac disease: yesterday, today and tomorrow. World J Gastroenterol 2013; 19: 838–845.
Arslanoğlu I, Çetin B, Işgüven P, Karavuş M. Anti-HB Response to Standard Hepatitis Β Vaccination in Children and Adolescents with Diabetes Mellitus. Journal of Pediatric Endocrinology and Metabolism 2002; 15: 389–96.
Yoldaş Ö, Bulut A, Altındiş M. Hepatit A Enfeksiyonlarına Güncel Yaklaşım. Viral Hepatit Dergisi 2012; 18: 81–6.
Çetinkol Y, Yıldırım AA. The Seroprevalence of Viral Hepatitis A in Patiens Who Had Been Consulted at Ünye State Hospital. Kocatepe Tıp Dergisi 2011; 12: 18–22.
Tekay F. Hakkari Devlet Hastanesine Başvuran 0-14 Yaş Grubu Çocuklarda Hepatit A Sıklığı. Dicle Tıp Dergisi 2006; 33: 245–7.
Arabacı F, Oldacay M. The seroprevalance of Hepatitis A in Different Age Groups and Hepatitis A Incidence in Acute Hepatitis Cases in The Çanakkale Province. J Pediatr İnf 2009; 3: 58–61.
Ceyhan M, Yildirim I, Kurt N, et al. Differences in hepatitis A seroprevalence among geographical regions in Turkey: a need for regional vaccination recommendations. J Viral Hepat 2008; 15: 69–72.
Tosun S. Viral hepatitlerin ülkemizdeki değişen epidemiyolojisi. Ankem Dergisi 2013; 27: 128–134.
Elrashidy H, Elbahrawy A, El-Didamony G, et al. Antibody levels against hepatitis B virus after hepatitis B vaccination in Egyptian diabetic children and adolescents. Hum Vaccin Immunother 2013; 9: 2002–6.
Zhang X, An J, Tu A, et al. Comparison of immune persistence among inactivated and live attenuated hepatitis a vaccines 2 years after a single dose. Hum Vaccin Immunother 2016; 12: 2322–6.
Noyan N, Aycan S. Ülkemizde rutin aşılama programları ve uygulamada karşılaşılan sorunlar. Klinik Çocuk Forumu Pediatrik Aşılar Özel Sayısı 2002; 2: 1–8.
De Silvestri A, Pasi A, Martinetti M, at al. Family study of non-responsiveness to hepatitis B vaccine confirms the importance of HLA class III C4A locus. Genes Immun 2001; 2: 367–72.
Schuenke KW, Cook RG, Rich RR. Binding specificity of a class II-restricted hepatitis B epitope by DR molecules from responder and nonresponder vaccine recipients. Hum Immunol 1998; 59: 783–93.
Mormile R. Hepatitis B virus vaccination failure in celiac disease and type 1 diabetes: what is the truth? Int J Colorectal Dis 2016; 31: 1049.
Geerlings SE, Hoepelman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 1999; 26: 259–65.
Martinetti M, De Silvestri A, Belloni C, et al. Humoral response to recombinant hepatitis B virus vaccine at birth: role of HLA and beyond. Clin Immunol 2000; 97: 234–40.
Wang C, Tang J, Song W, Lobashevsky E, Wilson CM, Kaslow RA. HLA and cytokine gene polymorphisms are independently associated with responses to hepatitis B vaccination. Hepatology 2004; 39: 978–88.
Godkin A, Davenport M, Hill AVS. Molecular analysis of HLA class II associations with hepatitis B virus clearance and vaccine nonresponsiveness. Hepatology 2005; 4: 1383–90.
Hermann R, Knip M, Veijola R, et al. Temporalchanges in the frequencies of HLA genotypes in patients with Type 1 Diabetes, indication of an increased environmental pressure? Diabetologia 2003; 46: 420–5.
Marseglia G, Alibrandi A, d’Annunzio G, et al. Long term persistence of anti-HBs protective levels in young patients with type 1 diabetes after recombinant hepatitis B vaccine. Vaccine 2000; 19: 680–3.
Halota W, Muszyńska M, Pawłowska M. Hepatitis B virus serologic markers and anti-hepatitis B vaccination in patients with diabetes. Med Sci Monit 2002; 8: CR516–9.
Çetin BD, Arslanoğlu İ, İşgüven P, et al. Tip 1 Diyabetli Çocuk ve Adolesanlarda Standart Hepatit B Aşılamasının Etkinliği. Viral Hepat J 2001; 7 (1).
Onal Z, Ersen A, Bayramoglu E, Yaroglu Kazancı S, Onal H, Adal E. Seroprotection status of hepatitis B and measles vaccines in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2016; 29: 1013–7.
Ficicioğlu C, Mikla S, Midilli K, Aydin A, Cam H, Erğin S. Reduced immune response to hepatitis B vaccine in children with insülin dependent diabetes. Acta Paediatr Jpn 1995; 37: 687–90.
Schillie SF, Spradling PR, Murphy TV. Immune response of hepatitis B vaccine among persons with diabetes: a systematic review of the literature. Diabetes Care 2012; 35: 2690–7.
Atabek ME, Kart H, Erkul I. Prevalence of hepatitis A, B, C and E virus in adolescents with type-1 diabetes mellitus. Int J Adolesc Med Health 2003; 15: 133–7.
Eibl N, Spatz M, Fischer GF, et al. Impaired primary immune response in type-1 diabetes: results from acontrolled vaccination study. Clin Immunol 2002; 103: 249–59.