RESUMO
Although recombinant hepatitis B vaccine is effective in a majority of population, a significant percent may do not respond [up to 10%]. Old age, obesity, heavy smoking and immunologic impairment have been associated with lower anti -HBs responses. In the present study, the efficacy of vaccine and effects of the abovementioned factors have been evaluated. Of 111 health care workers in Boo-Ali hospital, 72 participants completed primary vaccination series and antibody tittering. They received 20 micro g of recombinant HBV vaccine [Heberbiovac, Cuba] in standard schedule. Anti-HBs was determined by ELISA test [Diakey, South Korea] one month following the third dose. The lowest completion rate was reported among nursing staff and physicians [17%]. Seroprotection [anti-HBs >/= 10IU/L] was achieved in 86.1% of participants. Among seroprotected individuals, 52.8% were low-responders [anti -HBs titer of 10-99IU/L] and 33.3% were good responders [anti-HBs titer of >100IU/L]. The independent predictors of responsiveness were age less than 40 [OR=3.5, 95%CI=1.8-14.6, p<0.05], non-smoking status [OR=2.9, 95%CI=1.5- 17,2, p<0.05], and body mass index less than 25kg/m[2] [OR=4.3, 95%CI=l.9-18.0, p<0.05]. Of 10 non-responders, 7 received booster dose while anti-HBs titer was determined only in one. The primary factors associated with completion of immunization may not be amenable to job-education level. Non-compliance among non-responders was quite high [90%]. This situation seems to be grim for health care workers and warranted appropriate interventions
Assuntos
Humanos , Masculino , Feminino , Pessoal de Saúde , Prevenção Primária , ImunizaçãoRESUMO
Hepatitis B virus [HBV] infection is a worldwide health concern. Alpha-interferon and lamivudine have been approved for HBV patients; however, their efficacy remains a matter of controversy. The present study compares these two antiviral regimens in a group of Iranian patients with chronic hepatitis B. It was a randomized controlled clinical trial. Totally, 32 newly diagnosed hepatitis B patients were assigned in 2 groups of lamivudine [100mg per day orally] and alpha-interferon 2a [9 million units every other days subcutaneously]. Both groups were evaluated at weeks 0,1,2,4, and monthly after till the 6[th] month at Tehran Hepatitis Center. HBV DNA, HBeAg, anti-HBe, ALT activity, liver biopsy according to Knodell scoring system and drug side effects were determined, when appropriate. The mean age of the patients was 31.4 +/- 8.8 years. PCR studies revealed negative in 13 [81.3%] interferon- and 15 [93.8%] larnivudine-treated subjects after 6 months of therapy. Among 17 patients with ALT activity of less than 70IU/l prior to therapy, 9 [90%] interferon- and 7 [100%] lamivudine-treated patients were found to have negative PCR results following the therapy [p<0.001]. Primary response to therapy was detected in 3 interferon- and 6 lamivudine-treated subjects, while secondary response was reported in 8 [50%] interferon- and 12 [75%] lamivudine-treated patients. No lamivudine-associated side effect was demonstrated. Lamivudine is a well-tolerated cost-effective antiviral drug for hepatitis B patients. It could be prescribed as the initial drug for patients with chronic hepatitis B