Influence of anti-tumor necrosis factor-alpha therapy to pregnant inflammatory bowel disease women and their children's immunity

BACKGROUND/AIMS: The onset of inflammatory bowel disease (IBD) usually occurs at young age, and therefore, women IBD patients experience pregnancy during their disease progression. Recently, the use of anti-tumor necrosis factor-α (anti-TNF-α) has been rapidly increasing. The aim of this study was to evaluate pregnancy related outcomes in women with IBD who were treated with anti-TNF-α during pregnancy and immunity of their children. METHODS: Korean women with IBD who had been treated with anti-TNF-α during pregnancy had been enrolled. Medical records were reviewed and a survey was performed for each patient. For the patients who agreed on additional examination for their children, children's growth, medical history and antibody to hepatitis B surface antigen (anti-HBs) titer were checked. RESULTS: All 18 patients had been diagnosed with Crohn's disease. There was not any case of preterm delivery, low birth-weight infant, congenital anomaly, nor stillbirth. All 12 children had followed the regular vaccination schedule for hepatitis B and 4 of them showed negative results for anti-HBs. After the 1 booster vaccination, all children demonstrated seroconversion. Regarding live vaccines, 4 children had bacillus Calmette-Guerin and 4 had rotavirus vaccine before 6 months, without any specific side effects. CONCLUSIONS: This was the first study of immunity of the children born from IBD women who had been treated with anti-TNF-α medication during their pregnancy. IBD women had comparable pregnancy outcomes with the general women population, suggesting that the disease activity rather than the administered medication would be more important in healthy pregnancy. Considering the history of vaccination and anti-HBs titers, immunity seems to be intact in the children.

Prevalence of anti-HBV antibody among immunized population and evaluation of different detection methods of anti-HBc antibody / 中国人兽共患病学报

In this study ,we detected the positive rate of anti‐HBs and anti‐HBc antibody among the subject population in Fujian Medical University Union Hospital ,and to evaluate different detection methods of anti‐HBc antibody .The positive rate of anti‐HBs and anti‐HBc antibody were detected by chemiluminescent microparticle immunoassay (CMIA) and one‐step com‐petitive enzyme‐linked immunosorbent assay (ELISA) from the year 2012 to 2013 .The subject population was divided into three groups :group 1 with the age of less than 2 years old ,group 2 with the age of 2‐20 years old ,and group 3 with the age of more than 20 years old .The positive rates of anti‐HBV antibody in the different groups were analyzed .Furthermore ,anti‐HBc antibody of 92 samples selected from the immunized population was detected by CMIA and three kinds of ELISA reagents . Meanwhile ,the detection of anti‐HBc antibody by the same ELISA reagent but different operating modes were performed in these samples .The highest positive rate of anti‐HBs antibody was detected in group 1 ,and there was no significance difference of positive rate between two detection methods of anti‐HBs antibody among three groups .The positive rate of anti‐HBc anti‐body using CMIA was significantly lower than those with ELISA among group 1 and 2 .Among the 92 samples ,the positive rate of anti‐HBc antibody was 2 .2% using CMIA .With three kinds of method of ELISA reagent ,the positive rate of anti‐HBc antibody were 79 .3% ,82 .6% and 94 .6% ,respectively ,and there was no statistical significance among the results of three ELISA reagents .Anti‐HBc was not detected from 19 samples using ELISA methods with different operating modes .It's con‐cluded that the anti‐HBs antibody declined with the increase of age ,and it is necessary to discriminate the specific population to strengthen immune system .The obviously higher positive rate of anti‐HBc antibody was found by ELISA in immunized popula‐tion than that by CM IA . Concerning on the false positive of ELISA , specimen sampling with one specific test item or the CMIA method was recommended to detect the anti‐HBc antibody .

Factors Associated with Anti-HBs Antibody Titers in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: The incidence and prevalence of Hepatitis B virus (HBV) infection had decreased significantly in longterm hemodialysis (HD) patients. However, Seroconversion rates in response to HBV vaccine are poor in the HD population compared with the general population (35-80% vs above 95%) and the duration of immunity is shorter. The purpose of this study was to determine the association between hepatitis B immunity with HBsAb titer and variable dialysis-related factors as well as inflammation in HD patients. METHODS: The clinically stable 65 patients maintained on thrice weekly HD were divided into two groups according to their previous vaccination (V+group) or others (V-group). In V+group (n=25), patients with HBsAb titer less than 50 IU/L were administered a single dose of 40 microgram of IM HBV vaccine as a booster dose. Patients who lost immunity (defined as Ab titer decreasing to or =10 IU/L, N=31) were followed over 12 months in our center. V-group without natural immunity (n=9) received three doses of IM HBV vaccination (40 microgram). RESULTS: Most (90%) of vaccinated patients at pre-dialysis period had persistent immunity. Booster at HBs Ab titer below 10 IU/L had significantly shorter duration of immunity. Increase of (delta)hsCRP between pre & post-booster was significantly related to the loss of immunity. Based on multivariate logistic analysis, the subset of variables best explaining seroconversion after booster was lower (delta)hsCRP and younger age. Seroconversion rate to ID vaccination was 66.7%. Non-diabetes, higher hematocrit & low rHuEpo dose were implicated as having a role in maintaining strong naturally acquired immunity (Ab titer> or =100 IU/L) (p<0.05). Patients with weak naturally acquired immunity had increased median hsCRP than patients with strong. Seroconversion rate to conventional IM vaccination was 66.7%. CONCLUSION: We suggest that tailored modification of strategies about hepatitis B is required to persist protective immunity in hemodialysis patients before too late until loss of immunity, HBsAb titers below 10 IU/L. Also, our study implicated patients with prolonged and strong immunity against HBV may be related to higher hematocrit, better adequacy of dialysis and low inflammatory state, which all associated with better cardiovascular outcome and survival in hemodialysis patients.