Improved Antibody Response to Three Additional Hepatitis B Vaccine Doses Following Primary Vaccination Failure in Patients with Inflammatory Bowel Disease
Studies have shown the efficacy of hepatitis B (HBV) vaccination in patients with inflammatory bowel disease (IBD) is impaired, but few data exist regarding the effectiveness of revaccination strategies following primary vaccination failure. Our aim was to analyze the association between administration of additional vaccine doses and hepatitis B surface antibody (HBsAb) seroconversion.
This is a retrospective cohort study. Inclusion criteria are as follows: age ≥ 18, diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC), inadequate HBsAb < 10 IU/L following initial HBV vaccination series, subsequent administration of 1–3 additional doses of HBV vaccine with follow-up serum HBsAb measurements. Patients were stratified into groups of ≤ 2 or 3 doses received. Primary outcome was achieving HBsAb > 10 IU/L. Outcomes were stratified by age ≥ or < 40 years. We performed logistic and linear multivariable regression analyses for categorical and continuous data.
The study cohort consists of (n = 149) 54.4% women; 77.9% white; 72.6% with CD, with mean age: 46.2. Patients of all ages and age ≥ 40 years, who received 3 additional doses of vaccine, were more likely to achieve seroprotective HBsAb levels than patients who received 1 or 2 doses (OR 1.77, P = 0.01; OR 1.9, P = 0.03, respectively, after adjusting for age, sex, race, immunosuppressive medication exposure, time between vaccine/titer).
Following initial HBV vaccination failure, patients with IBD of all ages are more likely to develop seroprotective levels of HBsAb following 3 additional vaccine doses, rather than 1 or 2 alone. In patients who fail primary HBV vaccination, providers should consider a more aggressive revaccination strategy with an additional 3-dose series.
KeywordsInflammatory bowel disease Crohn’s disease Ulcerative colitis Hepatitis B virus immunity Hepatitis B virus vaccination failure Booster Revaccination
This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K23 DK113252). This work was also supported by Robin & Andrew Davis, Susan Nicol, and Aimee & Kleanthis Dendrinos, MD, for support of this work.
PKP were involved in the study conception and design, literature search and review, data collection, analysis and interpretation of data, drafting and revision of manuscript, final approval of version to be published, and agreement to be accountable. DN was involved in the analysis and interpretation of data, critical revision of manuscript, final approval of version to be published, and agreement to be accountable. MTL was involved in the analysis and interpretation of data, critical revision of manuscript, final approval of version to be published, and agreement to be accountable. FAF was involved in the study conception and design, literature search and review, analysis and interpretation of data, critical revision of manuscript, final approval of version to be published, and agreement to be accountable.
Compliance with ethical standards
Conflict of interest
The other authors have no relevant conflicts to report.
- 1.Chudy-Onwugaje KO, Christian KE, Farraye FA, Cross RK. A state-of-the-art review of new and emerging therapies for the treatment of IBD. Inflamm Bowel Dis. 2018;Nov:15.Google Scholar