If I Had the Hepatitis Shot Series in the Army Do I Need It Again
Am J Public Wellness. 2022 September; 108(Suppl iii): S204–S206.
Serosurveillance of First-Year Military Personnel for Hepatitis A and B
Michael Broderick, PhD, 
Saleem Kamili, PhD, Noele P. Nelson, PhD, Thao Le, BS, Dennis Faix, MD, MPH, and Sandra Romero-Steiner, PhD
The US armed forces utilizes a number of vaccines as strategic medical countermeasures, mandating immunizations in personnel confronting common infectious diseases, as well every bit special immunizations against rare and weaponized agents.1 Of import amidst the former are the vaccines against hepatitis A and B, which the military machine requires of all military accessions into service. While the Informational Committee on Immunization Practices (ACIP) does non explicitly recommend hepatitis A and B vaccination for military personnel, the war machine'southward rationale for preexposure prophylaxis is based on the likelihood that active duty armed forces personnel may run across populations for which ACIP does recommend vaccination, and piece of work in countries that have high or intermediate endemicity of hepatitis.2
In the United States, the hepatitis B vaccine is available as a single-antigen vaccine for adults, administered as a three-dose series over half-dozen months in various schedules, and hepatitis A vaccine is bachelor as a unmarried-antigen vaccine, administered every bit a two-dose series at least 6 months apart.two,3 A 3-dose vaccination regimen with combined hepatitis A and B vaccine (Twinrix; GlasxoSmithKline, Rixensart, Belgium) given at naught, one, and six months is indicated to confer protection against both hepatitis A virus (HAV) and hepatitis B virus (HBV) infections. ACIP recommends universal vaccination of adults at risk for HBV infection.3 HAV antibiotic equal to or above the antibiotic assay cut-off is considered a positive response to the vaccine. The level of protection for HBV infection has been recognized at antibody concentrations of 10 or more milli-international units per milliliter specific to hepatitis B surface antigen (anti-HBs).iv,v
In the nothing-, one-, and six-calendar month regimen, seroprotection to HBV in young adults increased with each dose from xxx% to 55% later on the outset dose of the hepatitis B vaccine given solitary, to 75% after the 2d dose, and greater than 90% subsequently the third dose.6 Twinrix appears to be an effective preventive mensurate in persons traveling to endemic areas, even when used nether an accelerated schedule; yet, express information are bachelor regarding its benefits to armed services personnel.
In a retrospective serosurvey of 428 military personnel who entered the armed services in 2006 to 2010 (284 were White, 54 were Hispanic, 37 were Black, and eleven were Asian; mean age = twenty years; 8% were female), we examined whether Twinrix as part of their vaccination regimen was associated with measurable HAV and HBV antibodies in a higher place baseline levels upon entry and throughout their kickoff year of service. Military personnel routinely receive several vaccines every bit medical countermeasures during their kickoff two weeks of training, of which Twinrix is one. For example, other vaccines coadministered in this cohort were measles, mumps, and rubella (n = 270); tetanus and diphtheria toxoids (adsorbed for adult utilize, north = 156); poliovirus vaccine (inactivated, n = 144); influenza virus vaccine (purified surface antigen, northward = 40); influenza (whole, northward = 100); flu virus vaccine (live, adulterate, intranasal employ [FluMist], northward = 27); meningococcal polysaccharide vaccine (n = 296); and pneumococcal vaccine (northward = 140). This comprehensive vaccination regimen ensures that war machine personnel are protected against infectious agents that they may encounter during their tour of duty. For hepatitis A and B, the second dose of Twinrix is routinely scheduled for administration at approximately ii to five weeks from the first dose, and the third dose is scheduled for administration six months from the original dose. In our study, nosotros did not have records verifying receipt of the second and third doses.
Nosotros found at least 55% and 85% of participants evaluated 331 to 360 days later on baseline were seroprotected against HAV and HBV, respectively (Table one). Geometric mean concentrations started to peak 2 months later on entry to service for anti-HBs and three months for anti-HAV. The percentage of personnel protected against HBV was significantly higher across time than the percentage protected against HAV (ii-mode ANOVA for month and antigen establish P < .001 for both principal effects, with the interaction P = .239). Antibiotic concentrations of HAV and HBV antigens remained at high levels for seven to 8 months later entry to service. Although a decline in antibody concentrations was observed over time, the geometric mean concentrations remained above baseline levels at 360 days (Table ane).
Tabular array i—
Geometric Mean Concentrations (GMCs) of Antibodies Specific to Hepatitis A Virus (Anti-HAV) and Hepatitis B Surface Antigen (Anti-HBs,) and Percentage of Personnel Protected Over Fourth dimension Subsequently Entry Into Military Service: Usa, 2006–2010
| Anti-HAV | Anti-HBs | |||||
| Daysa | Total No.b | GMCc | % Protected | Total No.b | GMCc | % Protected |
| Baseline | 426 | 2.one | 14 | 407 | 21.0 | 57 |
| 31–60 | 91 | six.9 | 37 | 90 | 139.4 | 67 |
| 61–xc | 53 | 17.8 | 57 | 52 | 1471.6 | 87 |
| 91–120 | 71 | 35.0 | 69 | 71 | 1197.7 | 89 |
| 121–150 | 63 | 25.8 | 68 | 62 | 1477.4 | 92 |
| 151–180 | 31 | 38.0 | 74 | 29 | 1157.0 | xc |
| 181–210 | 24 | 31.0 | 79 | 23 | 642.5 | 83 |
| 211–240 | 22 | 23.one | 64 | 22 | 1055.0 | 100 |
| 241–270 | 17 | xx.half dozen | 71 | 17 | 293.iii | 82 |
| 271–300 | 13 | 14.5 | 54 | fourteen | 417.2 | 79 |
| 301–330 | 15 | 4.seven | 47 | 14 | 489.two | 93 |
| 331–360 | 20 | xiv.two | 55 | xx | 453.3 | 85 |
This is highly important considering military personnel may engage in a variety of activities, from assisting civilian government with disaster preparation to profitable first responders, rescuing victims, providing medical care, delivering supplies, and cleaning up the backwash. The experience with Hurricane Katrina in the Gulf Coast in 2005 demonstrated the extent of the need for armed services involvement during an emergency, in which tens of thousands of reserve and active duty personnel were called upon.
PUBLIC Health IMPLICATIONS
The military requires vaccination of all armed forces accessions into service. Vaccines are a medical countermeasure dispensed to armed forces personnel during their first two weeks of training camp to ensure protection of personnel upon deployment to areas of conflict or during response to public wellness emergencies similar Hurricanes Harvey, Irma, and Maria where exposure may happen (e.g., sewage, medical waste, or via direct contact with populations in which hepatitis A and B are endemic). In this report, a large proportion of personnel remained seroprotected against HAV (55%) and HBV (85%) at 360 days subsequently entry to the military. There were relatively more personnel with antibodies below protective levels for HAV than to HBV antigens at all fourth dimension points measured (Tabular array ane), likely a reflection of the earlier universal infant hepatitis B vaccination recommendation in 1991 compared with the hepatitis A universal babyhood vaccination recommendation in 2006.2,three Although the tertiary dose of Twinrix would have been scheduled, it is possible some personnel instead received a dose of the hepatitis B vaccine only. Participants' records in this serosurvey did not include whether they had been screened for existing anti-HAV or anti-HBs antibodies. Screening is currently done at most basic training camps only not all. Only military personnel who have antibodies below the protective level of hepatitis A and hepatitis B are immunized with Twinrix. Based on this serosurvey, persons seronegative for hepatitis A but should receive hepatitis A vaccine in two doses separated past approximately six months rather than Twinrix. However, it may be reasonable to administer Twinrix to hepatitis B seronegative personnel because virtually are seronegative to hepatitis A, and therefore will do good from dual vaccination. Hepatitis A and B vaccines both afford long-term protection even amid those who are seronegative but retain immunological retentiveness. Therefore, review of immunization records instead of antibody screening may be cost-effective because the cost of serologic screening and immunization of seronegative individuals could be avoided. Equally new formulations emerge, vaccine practices and recommendations may change to run across the demands of populations at chance, similar the military. Boosted studies may be required to determine if, in the military setting, antibody-level monitoring and revaccination of nonresponders to HAV and HBV should exist considered to ensure 100% protection among active duty armed forces personnel, a group at risk for infection considering of travel to endemic areas and close personal contacts while on active duty.
ACKNOWLEDGMENTS
This piece of work was funded by the Military Vaccine Agency (MILVAX, at present the Immunization Healthcare Branch, Public Health Division, Defence Health Agency). Michael Broderick is a military service member (or employee of the US Authorities). This piece of work was prepared as part of his official duties. Title 17, U.South.C. §105 provides the "Copyright protection under this title is not available for any work of the United States Government." Title 17, U.s.C. §101 defines a US Government piece of work as work prepared by a military service member or employee of the US Authorities as part of that person's official duties. The written report is supported by the Defense Health Agency under work unit no. 60501.
The authors thank Natasha Khudyakov (CDC) for serologic testing of samples. Jennifer Radin (Henry Thou. Jackson Foundation) and Christian J. Hansen (Scripps Translational Scientific discipline Institute) contributed statistical analyses performed and edited the report.
Note. The conclusions, findings and opinions expressed in this report are those of the authors and do not necessarily reflect the official position of the Department of the Navy, Department of the Ground forces, Department of the Air Strength, Department of Veterans Affairs, Section of Defence force, or the US Government. Canonical for public release; distribution unlimited.
Human being PARTICIPANT PROTECTION
The Naval Health Research Center institutional review lath approved the initial report (Protocol NHRC.2011.0015). This report was determined to be as non-engaged in human participant research at CDC.
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Articles from American Journal of Public Health are provided hither courtesy of American Public Health Association
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129650/
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