Aysun KARA UZUN

Birincil Hepatit B Aşı Yanıtsız Çocuklarda Hatırlatma Doz Aşı Yanıtları ve Aşı Yanıtında Hassas Gruplar

Amaç: Çalışmada birincil hepatit B aşı yanıtsız 2-16 yaş aralığındaki 83 çocukta, 0, 1 ve 6. ay aşı şeması uygulanarak elde edilen hatırlatma doz aşı yanıtları değerlendirilmiş ve aşı yanıtında hassas gruplar belirlenmeye çalışılmıştır. Gereç ve Yöntemler: Küçük cerrahi girişimler öncesi yapılan tetkikler sonrasında birincil hepatit B aşı yanıtsızlığı saptanan 2-16 yaş aralığındaki sağlıklı 83 çocuğa, 2. kez 0, 1 ve 6. aylarda 3 doz 10 μg HBsAg içeren Euvax B aşısı deltoid kasa 0.5ml kas içine uygulanmıştır. Çocuklardan birinci aşıdan 1, 6 ve 7. ay sonra olmak üzere, 3 kez kan alınarak anti- HBs titresi enzyme-linked immunosorbent assay tekniği ile değerlendirilmiştir. Bulgular: Çocukların yaş ortalaması 9.3±3.6 yıl (2-15.9) bulunmuştur. Birinci aşı sonrası anti-HBs ortalama geometrik konsantrasyonu 537.97±377.51 mIU/mL (0.6-1000), 2. aşı sonrası 309.33± 337.45 mIU/mL (8-1000), 3. aşı sonrası 609.78±347.43 mIU/mL (11.1-1000) bulunmuştur. Birinci aşı sonrası tetkik yapılabilen 81 çocuk arasında T1’de anti- HBs-positive serokonversiyon oranı, aşı öncesi anti-HBs titresi 1 mIU/mL’nin altında olan çocuklarda diğer gruba göreistatistiksel anlamlı biçimde daha düşük bulunmuştur (p=0.01, Z -3.29, U 469). Bu 2 grup arasında T6 ve T7’de istatistiksel fark saptanmamıştır.Malnütrisyonlu hastalarda T6 ve T7’de anti-HBs positive serokonversiyon oranı diğer gruba göre istatistiksel anlamlı olarak dahayüksek bulunmuştur (p=0.008, Z -2.56, U 60.5, p=0.03, Z -2.11, U 26.5).Sonuç: İki doz aşıya rağmen T6’daki hızlı düşüşe bakıldığında, anti-HBs serokonversiyon oranı ve anti-HBs ortalama geometrik konsantrasyondeğerleri hatırlatma doz sayısından ziyade, hatırlatma yapılmasına, aşı öncesi anti-HBs titresine ve anti-HBs titresi bakma zamanıylailgili gözükmektedir. Ancak, aşı öncesi anti-HBs titresi <1 mIU/mL olanlar ve malnütrisyonlu çocuklarda 3 doz aşılamanın daha doğru olacağı kanaatindeyiz.

Anahtar Kelimeler:

Hatırlatma aşılaması, Çocuk, Hepatit B virüs

Booster Dose Vaccine Response among Children Who were Primary Hepatitis B Vaccine Non-Responders and Sensitive Groups Concerning Vaccine Response

Objective: In this study, booster dose vaccine response was evaluated after performing a vaccine schedule at 0,1st and 6th months among 83 children aged between 2 and 16 years who were primary hepatitis B vaccine nonrespondersand we tried to determine which groups were sensitive concerning vaccine response.Material and Methods: Euvax B vaccine which included 10 μg HBsAg was administered in 3 doses for the secondtime at 0, 1 and 6 months as 0.5 ml intramuscularly in the deltoid muscle to 83 healthy children aged between 2 and 16years who were primary hepatitis B vaccine non-responders and their vaccine status was determined with tests beforeminor surgery. Blood tests were taken three times from children at 1, 6 and 7 months after the first vaccination and anti-HBs titer was evaluated by using enzyme-linked immunosorbent assay technique.Results: The mean age of the children was 9.3±3.6 years (2-15,9 years). The anti-HBs geometric mean concentrationwas found to be 537.97±377.51 mIU/mL (0.6-1000) after the first vaccination, as 309.33± 337.45 mIU/mL (8-1000)after the second vaccination and as 609.78±347.43 mIU/mL (11.1-1000) following the third vaccination. Anti-HBspositive conversion rates in T1 were compared in 81 children who had been checked after the first vaccination and anti-HBs positive conversion rates were found to be significantly lower in children whose anti-HBs titer was under 1 mlU/mlbefore vaccination (p=0,01, Z -3.29, U 469). There was no difference concerning T6 and T7 between these two groups.Anti-HBs positive conversion rates in T6 and T7 were found to be significantly higher in children with malnutrition(p=0.008, Z -2.56, U 60.5, p=0.03, Z -2.11, U 26.5).Conclusion: When observing the rapid decrease in T6 in contrast with the two dose vaccination, it is thought that anti-HBs seroconversion rates and anti-HBs geometric mean concentration are related with reminding, anti-HBs titer beforevaccination and checking time of anti-HBs rather than the number of reminding doses. In fact, we believe that 3 dose vaccination is better among those children whose anti-HBs titer is under <1 mIU/mL and who have malnutrition.

Keywords:

Booster vaccination, Child, Hepatitis B virus,

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