If I Had the Hepatitis Shot Series in the Army Do I Need It Again
Am J Public Health. 2018 September; 108(Suppl 3): S204–S206.
Serosurveillance of Starting time-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 United states of america military utilizes a number of vaccines as strategic medical countermeasures, mandating immunizations in personnel against mutual infectious diseases, as well as special immunizations against rare and weaponized agents.one Important amidst the erstwhile are the vaccines against hepatitis A and B, which the military 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 war machine personnel, the military's rationale for preexposure prophylaxis is based on the likelihood that active duty military personnel may run across populations for which ACIP does recommend vaccination, and work in countries that have loftier or intermediate endemicity of hepatitis.2
In the Usa, the hepatitis B vaccine is available as a single-antigen vaccine for adults, administered as a three-dose series over 6 months in various schedules, and hepatitis A vaccine is available as a single-antigen vaccine, administered as a two-dose series at to the lowest degree six months apart.2,three A three-dose vaccination regimen with combined hepatitis A and B vaccine (Twinrix; GlasxoSmithKline, Rixensart, Kingdom of belgium) given at nix, 1, and half-dozen months is indicated to confer protection confronting both hepatitis A virus (HAV) and hepatitis B virus (HBV) infections. ACIP recommends universal vaccination of adults at risk for HBV infection.3 HAV antibody 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,5
In the zero-, one-, and six-month regimen, seroprotection to HBV in young adults increased with each dose from 30% to 55% after the first dose of the hepatitis B vaccine given alone, to 75% later the 2nd dose, and greater than xc% later on the third dose.half dozen Twinrix appears to be an constructive preventive measure in persons traveling to owned areas, even when used nether an accelerated schedule; however, limited data are available regarding its benefits to armed forces personnel.
In a retrospective serosurvey of 428 military personnel who entered the military in 2006 to 2010 (284 were White, 54 were Hispanic, 37 were Black, and 11 were Asian; mean age = 20 years; 8% were female person), we examined whether Twinrix as part of their vaccination regimen was associated with measurable HAV and HBV antibodies above baseline levels upon entry and throughout their starting time yr of service. Military personnel routinely receive several vaccines every bit medical countermeasures during their first 2 weeks of training, of which Twinrix is i. For example, other vaccines coadministered in this cohort were measles, mumps, and rubella (n = 270); tetanus and diphtheria toxoids (adsorbed for adult use, north = 156); poliovirus vaccine (inactivated, northward = 144); influenza virus vaccine (purified surface antigen, n = 40); influenza (whole, n = 100); influenza virus vaccine (live, attenuated, intranasal apply [FluMist], n = 27); meningococcal polysaccharide vaccine (n = 296); and pneumococcal vaccine (north = 140). This comprehensive vaccination regimen ensures that military personnel are protected against infectious agents that they may run across during their bout of duty. For hepatitis A and B, the second dose of Twinrix is routinely scheduled for administration at approximately two to v weeks from the first dose, and the 3rd dose is scheduled for administration six months from the original dose. In our study, we 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 confronting HAV and HBV, respectively (Table 1). Geometric mean concentrations started to top two months after entry to service for anti-HBs and 3 months for anti-HAV. The percentage of personnel protected against HBV was significantly higher across fourth dimension than the percentage protected against HAV (two-mode ANOVA for month and antigen found P < .001 for both principal effects, with the interaction P = .239). Antibody concentrations of HAV and HBV antigens remained at high levels for seven to viii months afterwards entry to service. Although a decline in antibiotic concentrations was observed over time, the geometric hateful concentrations remained above baseline levels at 360 days (Table i).
Table 1—
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 Later Entry Into Military Service: United states of america, 2006–2010
| Anti-HAV | Anti-HBs | |||||
| Daysa | Total No.b | GMCc | % Protected | Total No.b | GMCc | % Protected |
| Baseline | 426 | 2.1 | 14 | 407 | 21.0 | 57 |
| 31–threescore | 91 | 6.ix | 37 | 90 | 139.4 | 67 |
| 61–90 | 53 | 17.viii | 57 | 52 | 1471.6 | 87 |
| 91–120 | 71 | 35.0 | 69 | 71 | 1197.7 | 89 |
| 121–150 | 63 | 25.viii | 68 | 62 | 1477.4 | 92 |
| 151–180 | 31 | 38.0 | 74 | 29 | 1157.0 | 90 |
| 181–210 | 24 | 31.0 | 79 | 23 | 642.5 | 83 |
| 211–240 | 22 | 23.i | 64 | 22 | 1055.0 | 100 |
| 241–270 | 17 | 20.6 | 71 | 17 | 293.3 | 82 |
| 271–300 | 13 | 14.five | 54 | xiv | 417.ii | 79 |
| 301–330 | 15 | 4.7 | 47 | xiv | 489.2 | 93 |
| 331–360 | xx | xiv.2 | 55 | 20 | 453.three | 85 |
This is highly important because military personnel may engage in a variety of activities, from assisting civilian regime with disaster training to assisting first responders, rescuing victims, providing medical intendance, delivering supplies, and cleaning up the aftermath. The feel with Hurricane Katrina in the Gulf Coast in 2005 demonstrated the extent of the need for armed forces 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 services accessions into service. Vaccines are a medical countermeasure dispensed to armed services 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 health emergencies like Hurricanes Harvey, Irma, and Maria where exposure may happen (e.thou., sewage, medical waste, or via direct contact with populations in which hepatitis A and B are owned). In this report, a big proportion of personnel remained seroprotected against HAV (55%) and HBV (85%) at 360 days afterward entry to the military. There were relatively more personnel with antibodies beneath protective levels for HAV than to HBV antigens at all time points measured (Table 1), likely a reflection of the before universal babe hepatitis B vaccination recommendation in 1991 compared with the hepatitis A universal childhood vaccination recommendation in 2006.2,3 Although the 3rd dose of Twinrix would have been scheduled, information technology is possible some personnel instead received a dose of the hepatitis B vaccine simply. 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 almost basic training camps but non all. Just military personnel who take antibodies beneath the protective level of hepatitis A and hepatitis B are immunized with Twinrix. Based on this serosurvey, persons seronegative for hepatitis A only should receive hepatitis A vaccine in two doses separated past approximately six months rather than Twinrix. Notwithstanding, it may be reasonable to administer Twinrix to hepatitis B seronegative personnel because most are seronegative to hepatitis A, and therefore volition benefit from dual vaccination. Hepatitis A and B vaccines both afford long-term protection even amid those who are seronegative but retain immunological retention. 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. Every bit new formulations emerge, vaccine practices and recommendations may alter to meet the demands of populations at hazard, like the armed forces. Additional studies may be required to decide if, in the armed services setting, antibody-level monitoring and revaccination of nonresponders to HAV and HBV should be considered to ensure 100% protection among agile duty military personnel, a group at risk for infection because of travel to endemic areas and close personal contacts while on active duty.
ACKNOWLEDGMENTS
This piece of work was funded past the Military Vaccine Agency (MILVAX, now the Immunization Healthcare Branch, Public Wellness Division, Defense force Health Agency). Michael Broderick is a war machine service member (or employee of the United states Government). This work was prepared as role of his official duties. Title 17, United states of americaC. §105 provides the "Copyright protection nether this title is not available for any work of the U.s. Government." Championship 17, United states of americaC. §101 defines a US Government work as work prepared past a military service member or employee of the U.s.a. Government as function of that person'south official duties. The report is supported past the Defence force Health Bureau nether work unit no. 60501.
The authors give thanks 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.
Notation. The conclusions, findings and opinions expressed in this report are those of the authors and do non necessarily reverberate the official position of the Department of the Navy, Department of the Army, Department of the Air Forcefulness, Department of Veterans Affairs, Section of Defence force, or the Usa Government. Canonical for public release; distribution unlimited.
HUMAN PARTICIPANT PROTECTION
The Naval Wellness Enquiry Middle institutional review board approved the initial written report (Protocol NHRC.2011.0015). This report was determined to be as non-engaged in human being participant research at CDC.
REFERENCES
1. National Enquiry Quango (United states of america) Committee on Special Immunizations Program for Laboratory Personnel Engaged in Research on Countermeasures for Select Agents. Protecting the Frontline in Biodefense Enquiry: The Special Immunizations Programme. Washington, DC: National Academies Press; 2011. [Google Scholar]
2. Schillie South, Vellozzi C, Reingold A et al. Prevention of hepatitis B virus infection in the United states: recommendations of the Advisory Commission on Immunization Practices. MMWR Recomm Rep. 2018;67(1):1–31. [PMC gratuitous article] [PubMed] [Google Scholar]
three. Advisory Committee on Immunization Practices (ACIP) Fiore AE, Wasley A, Bell BP. Prevention of hepatitis A through agile or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep. 2006;55(RR-seven):1–23. [PubMed] [Google Scholar]
4. Frisch-Niggemeyer W, Ambrosch F, Hofmann H. The assessment of immunity against hepatitis B later vaccination. J Biol Stand up. 1986;xiv(3):255–258. [PubMed] [Google Scholar]
v. Lemon SM. Type A viral hepatitis. New developments in an former affliction. North Engl J Med. 1985;313(17):1059–1067. [PubMed] [Google Scholar]
6. Dentinger CM, McMahon BJ, Butler JC et al. Persistence of antibiotic to hepatitis B and protection from illness amongst Alaska natives immunized at birth. Pediatr Infect Dis J. 2005;24(nine):786–792. [PubMed] [Google Scholar]
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129650/