Pratt PK Jr¹, Nunes D², Long MT², Farraye FA³. Dig Dis Sci. 2019 Apr 3. doi: 10.1007/s10620-019-05595-6. [Epub ahead of print]

Author information

1 Division of Gastroenterology and Hepatology, University of Connecticut Health, Farmington, CT, USA.

2 Section of Gastroenterology, Boston University Medical Center, 85 East Concord Street, Boston, MA, 02118, USA.

3 Section of Gastroenterology, Boston University Medical Center, 85 East Concord Street, Boston, MA, 02118, USA. francis.farraye@bmc.org.

Abstract

BACKGROUND: Studies have shown the efficacy of hepatitis B (HBV) vaccination in patients with inflammatorybowel 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.