year 14, Issue 4 (July - August 2020)                   Iran J Med Microbiol 2020, 14(4): 297-306 | Back to browse issues page


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Hashemi S M A, Hashemzadeh F, Bahrampour H, Nekoei F, Joharinia N, Sarvari J. The Evaluation Anti-HBsAb Titer Among University Students in Shiraz, 2019. Iran J Med Microbiol 2020; 14 (4) :297-306
URL: http://ijmm.ir/article-1-1106-en.html
1- Department of Bacteriology & Virology, Shiraz University of Medical Sciences, Shiraz, Iran
2- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran , sarvarij@sums.ac.ir
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Introduction

.

The hepatitis B virus (HBV)-related liver disease is a public health problem worldwide. HBV is classified in the Hepadnavirida family with an incomplete and circular DNA genome (1). The virus is transmitted through parenteral, sexual as well as vertically from mother to fetus (2). Due to the availability of an effective vaccine against the HBV as well as high cost of treatment for the health system, general vaccination is the best way to prevent the transmission of disease as an affordable and efficient strategy. However, some people may not respond to the vaccine or the titer of antibody decreases by time.
Following vaccination, antibodies are produced against a highly immunologic antigen, and the only serological index that appears after vaccination in the serum is anti-HBs Ab. In exposed subjected to the HBV, in addition to anti HBsAb, the anti- core antibody (anti-HBcAb) is also positive. The antibody titers created below the 10 IU/L indicate poor immunity, 10-100 IU/L as moderate immunity and the titer higher than 100 IU/L is considered as good immunity (11). Various studies conducted in different countries show that after a full period of vaccination against the HBV, 5-15% of individuals do not produce enough antibodies. Moreover, the titer of Ab may decrease after vaccination; thereby reduce the rate of immunity against the virus by time (12). Various studies have shown that peoples who produced high level of Abs after vaccination may have longer immunity (13). Moreover, after vaccination, it is essential to investigate the immunological level, especially in people with the possibility of occupational exposure. Therefore, the present study aimed to determine the frequency of anti-HBs Ab among university students in Fars province, southern Iran.


 

Materials and Methods

the assay of anti HBs Ab
The anti-HBs Ab titer was measured using an ELISA commercial kit according to the manu­facturer’s protocol (DiaPro, Italy). The results were reported as quantitative with mIU/mL.

0+Statistical ASubjects and Sampling
In this cross-sectional study, 825 students from Shiraz University of Medical Sciences (Shiraz, Iran) were enrolled consecutively. The study performed from September 2019 to January 2020. A questionnaire containing questions about demographic and history of vaccination were filled by participants.  Informed written consent was obtained from each participant, and the study was approved by Ethics Committee of Shiraz University of Medical Sciences (SUMS.MED.REC.1399.47). 5 mL blood sample were taken from each student, centrifuged and then the separated serum were stored at – 20°C until assay.

ELISA for nalysis
The results of this study were analyzed using SPSS version 26 (SPSS Inc., Chicago, IL., USA) and Chi-squared test, and P-value<0.05 was considered as a significant level.

 

Results

Out of 825 students 54% was male and 46% were female. The mean age of the students was 19.5±1.9. The titer of anti-HBsAb in 529 (64%) of subjects was lower than 10 mIU/mL. A significant relationship was observed between age and the titer of anti-HBsAb (P=0.001), although no significant relationship was observed between gender (P=0.19), history of the blood transfusion (P=0.58) and the titer of anti-HBsAb.

Table 1. Demographic and other features of subjects and relative seropositivity to anti-HBsAb among university students in Shiraz

Variables <10mIU/ml HBsAb titer
HBs Ab Titer<100mIU/ml 10mIU/ml<
>100mIU/ml P value
Sex       P =0.19
Male (n=446) 17(3.81%) 146(32.73%) 283(63.45%)
Female (n=379) 24(6.34%) 109(28.76%) 246(64.9%)
Age       P=0.001
≥20 (n=708) 29(4.1%) 233(32.9%) 446(63%)
<20  (n=117) 12(10.26%) 22(18.8%) 83(70.94%)
Majors       -
Medical Student (n=233) 11(4.72%) 74(31.76%) 148(63.52%)
Nursing (n=138) 10(7.25%) 30(21.74%) 98(71.01%)
Laboratory Science (n=84) 6(7.14%) 18(21.43%) 60(71.43%)
Anesthesia (n=53) 2(3.77%) 16(30.2%) 35(66.03%)
Dentistry (n=51) 4(7.85%) 14(27.45%) 33(64.7%)
Surgical Technologist (n=49) 3(6.12%) 11(22.45%) 35(71.43%)
EMT (n=44) 1(2.3%) 18(40.9%) 25(56.8%)
Physical Therapy (n=35) 0(0.0%) 11(31.4%) 24(68.6%)
Radiology Technologist (n=32) 3(9.37%) 10(31.25%) 19(59.3%)
Midwifery (n=22) 0(0.0%) 6(27.3%) 16(72.7%)
Occupational Therapy (n=22) 1(4.55%) 7(31.81%) 14(63.63%)
Others major (n=62) 1(1.61%) 23(37%) 38(61.3%)
Blood Transfusion (n=48) 2(4.17%) 16(33.33%) 30(62.5%) P=0.58


 

Discussion

Finding of this study showed that the titer of anti-HBsAb in 529 (64%) of subjects was lower than 10 mIU/mL. The significant relationship was observed between age and the titer of anti-HBsAb, although no significant relationship was observed between gender, history of the blood transfusion and the titer of anti-HBsAb. 
The understanding of effective and safe vaccination of hepatitis B is one of the most significant developments in medical science in the twentieth century. One of the most important ways to prevent morbidity and mortality related to HBV is a vaccination for all newly born babies, and the population is at risk.  Finding of this study showed that the titer of anti-HBsAb in more than half of students was lower than 10 mIU/mL and by time the anti-HBsAb titer was decreased, indicating the necessity of measurement of anti-HBsAb titer in medical students. Taiwan, which was an endemic area for chronic HBV infection and liver cancer, was the first place to start the child's general vaccination program in 1986 and recent studies have reported the efficacy of the long-term effect of this vaccination program in reducing liver cell carcinoma (14). The general vaccination program for infants in Iran started in 1993 (15). The routine program of neonatal and pediatric vaccination has significantly changed the epidemiology of HBV and has reduced the cancer of liver cells around the world (12,16). Rad et al. investigated the titer of anti-HBsAb in subjects with the ages of 1 to 18 years old in Ahvaz and found that the anti-HBsAb titer 10 mIU/mL among the children with the age one and teenagers 18 years were % 90 and % 48.9 respectively. They showed that, there was a significant relationship between the reductions of antibody titers with age (13). In a meta-analysis study Rezaei et al. showed that with age increase, the number of respondents in the vaccine was reduced significantly. (P = 0.001) There was no significant difference between the two groups in terms of gender, vaccines, ethnicity, and living place. Also, the meta-analysis was shown that based on Iranian research and other international research, there is no significant difference between the lacks of response to HBV vaccine (12).
According to studies, although the rate of response to the vaccine varies from country to country, the rate of response to the vaccine in childhood is higher than in adulthood. Several factors have been mentioned in connection with the lack of response to vaccines and reducing the antibody titers in various studies. However, due to the decrease in antibody titers over time, it is necessary to inject a booster dose in individuals who are likely to have an occupational exposure to the virus. The results of our study showed that there was a significant relationship between age and antibody titer and with increasing age, antibody titer was decreased. 
Moreover, a series of studies have shown that about 5% of individuals with a healthy immune system do not respond to vaccines after receiving regular vaccination periods and even after receiving booster doses (11). The factors that might be related to lower rate of responsively to the vaccine include male gender, diabetes, chronic liver disease, genetics background and smoking (23, 24). Other factors include vaccine storage, intervals time between injections and inappropriate concentration of injected vaccine (11, 24). Moreover, another factor that is important in the efficacy of vaccines and the production of neutralizing antibodies is the nature of the vaccine, and there are several different strategies that might improve the effectiveness of the vaccine. In the second generation that produced in yeast a part of HBs antigen that plays an essential role in virus attachment is used for the stimulation of neutralizing antibodies (21). The third generation of vaccines that produced in mammalian cells, increases the production of neutralizing antibodies in non-responder individuals (25). It is also reported that using appropriate adjuvants can improve the effect of HBV vaccine and its response in these individuals (26). Fabrizi et al. reported that using a higher dose of Timopentin as adjuvant can lead to an increase in the response rate to HBV vaccination (27).


 

Conclusion

In conclusion, the results of this study indicated that by time, the level of immunity against hepatitis B virus is decreased. So it is necessary for high-risk groups including students of medical sciences, that the anti-HBsAb titer were examined, and if the titer was lower than 10 mIU/mL, the booster dose was recommended.


 

Acknowledgements

The study was financially supported by the office of vice-chancellor for research of Shiraz University of Medical Sciences (Grant No 98-01-01-21063). The study was the subject of the MD dissertation of Fatemeh Hashemzadeh. The authors thank the staff of the Department of Bacteriology and Virology as well as all the students who attended in this research.
 

Conflicts of Interest

Noun
 

Type of Study: Original Research Article | Subject: Medical Virology
Received: 2020/04/12 | Accepted: 2020/07/18 | ePublished: 2020/08/20

References
1. Aspinall E, Hawkins G, Fraser A, Hutchinson S, Goldberg D. Hepatitis B prevention, diagnosis, treatment and care: a review. Occupational medicine. 2011;61(8):531-40. [DOI:10.1093/occmed/kqr136] [PMID]
2. Salisbury D, Ramsay M, Noakes K. Immunisation against infectious diseases: The Stationery Office; 2006.
3. Kao J-H. Diagnosis of hepatitis B virus infection through serological and virological markers. Expert review of gastroenterology & hepatology. 2008;2(4):553-62. [DOI:10.1586/17474124.2.4.553] [PMID]
4. Raimondo G, Pollicino T, Squadrito G. Clinical virology of hepatitis B virus infection. Journal of hepatology. 2003;39:26-30. [DOI:10.1016/S0168-8278(03)00135-1]
5. Alter MJ. Epidemiology of hepatitis B in Europe and worldwide. Journal of hepatology. 2003;39:64-9. [DOI:10.1016/S0168-8278(03)00141-7]
6. Fattovich G. Natural history of hepatitis B. Journal of hepatology. 2003;39:50-8. [DOI:10.1016/S0168-8278(03)00139-9]
7. Hajarizadeh B, Mesgarpour B, Nasiri MJ, Alavian SM, Merat S, Poustchi H, et al. Estimating the prevalence of hepatitis B virus infection and exposure among general population in Iran. Hepatitis Monthly. 2017;17(8). [DOI:10.5812/hepatmon.11715]
8. Poustchi H, MOHAMMADNEZHAD M, Malekzadeh R. Hepatitis B virus infection in Iran. 2007.
9. Alavian SM. Hepatitis B virus infection in Iran; Changing the epidemiology. 2010. [DOI:10.5005/jp/books/11250_10]
10. Poorolajal J, Majdzadeh R. Prevalence of chronic hepatitis B infection in Iran: a review article. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2009;14(4):249.
11. Hajikazemi E. Hepatitis B vaccination. Iran Journal of Nursing. 2001;13(25):58-63.
12. Rezaee R, Aghcheli B, Poortahmasebi V, Qorbani M, Alavian SM, Jazayeri SM. Prevalence of national responsiveness to HBV vaccine after 22 years of Iranian expanded program on immunization (EPI): a systematic review and meta-analysis study. Hepatitis monthly. 2015;15(5). [DOI:10.5812/hepatmon.15(4)2015.23618]
13. Norouzirad R, Shakurnia AH, Assarehzadegan M-A, Serajian A, Khabazkhoob M. Serum levels of anti-hepatitis B surface antibody among vaccinated population aged 1 to 18 years in ahvaz city southwest of iran. Hepatitis monthly. 2014;14(1). [DOI:10.5812/hepatmon.13625] [PMID] [PMCID]
14. Chang M-H, You S-L, Chen C-J, Liu C-J, Lai M-W, Wu T-C, et al. Long-term effects of hepatitis B immunization of infants in preventing liver cancer. Gastroenterology. 2016;151(3):472-80. e1. [DOI:10.1053/j.gastro.2016.05.048] [PMID]
15. Nilforushan M. EXPANDED PROGRAMME ON IMMUNIZATION AND HEPATITIS B VACCINE. Razi Journal of Medical Sciences. 1994;1:44-9.
16. Bonanni P, Pesavento G, Bechini A, Tiscione E, Mannelli F, Benucci C, et al. Impact of universal vaccination programmes on the epidemiology of hepatitis B: 10 years of experience in Italy. Vaccine. 2003;21(7-8):685-91. [DOI:10.1016/S0264-410X(02)00580-7]
17. Amin S, Andalibi S, Mahmoudi M. Anti-HBs response and its protective effect in children and adults receiving hepatitis B recombinant vaccine in Tehran. 2002.
18. Zad Fattah F, Blourian M, Sadegh A . The evaluation of Hepatitis B Antibody titer among vaccinated students in Ardebil College of Dentistry. Iranian Journal of Medical Microbiology2016;10(3): 68-72.
19. Tashakkori F, Yahyapour Y, Abdollahpour SM, Dargahi S, Bagheri M, Haji-Ahmadi M. Serological markers of hepatitis B in Students at Babol University of Medical Sciences. Iranian Journal of Medical Microbiology. 2016;9(4):79-86.
20. Lee KH, Shim KS, Lim IS, Chae SA, Yun SW, Lee NM, et al. Changes in hepatitis B virus antibody titers over time among children: a single center study from 2012 to 2015 in an urban of South Korea. BMC pediatrics. 2017;17(1):164. [DOI:10.1186/s12887-017-0924-7] [PMID] [PMCID]
21. Namdari S, Arabsolghar R, Sharifzadeh S, Farhadi A, Toopchi S, Seyyedi N, et al. Anti-HBs Antibody Levels and Anti-HBc Detection Among HBV-Vaccinated Freshmen Enrolled in the Department of Laboratory Sciences, Shiraz University of Medical Sciences, Iran. Shiraz E-Medical Journal. 2018;19(7). [DOI:10.5812/semj.64831]
22. Arefkhah N, Vafazadeh S, Shahriarirad S, Ghorbani F, Zoghi S, Emami M, et al. Serum levels of anti-hepatitis B surface antibodies among vaccinated children aged 1 to 12 years in a rural community in Fars Province, southern Iran. Journal of Immunoassay and Immunochemistry. 2019:1-8. [DOI:10.1080/15321819.2019.1675696] [PMID]
23. Walayat S, Ahmed Z, Martin D, Puli S, Cashman M, Dhillon S. Recent advances in vaccination of non-responders to standard dose hepatitis B virus vaccine. World journal of hepatology. 2015;7(24):2503. [DOI:10.4254/wjh.v7.i24.2503] [PMID] [PMCID]
24. Nejad HN, Ghorbani G, Razaghi R, Akbari H. Comparison of Two Recombinant Hepatitis B Vaccines. Hepatitis Monthly. 2009;9(3).
25. Roberts S. DNA tumour viruses: virology, pathogenesis and vaccines: Caister Academic Press; 2018.
26. Cooper C, Mackie D. Hepatitis B surface antigen-1018 ISS adjuvant-containing vaccine: a review of HEPLISAV™ safety and efficacy. Expert review of vaccines. 2011;10(4):417-27. [DOI:10.1586/erv.10.162] [PMID]
27. Fabrizi F, Dixit V, Martin P. Meta‐analysis: the adjuvant role of thymopentin on immunological response to hepatitis B virus vaccine in end‐stage renal disease. Alimentary pharmacology & therapeutics. 2006;23(11):1559-66. [DOI:10.1111/j.1365-2036.2006.02923.x] [PMID]

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