P312. Quick schedule and double dose vaccination against hepatitis B virus (HBV) in patients with inflammatory bowel disease (IBD)
M.T. Herranz1, L. Sancho1, S. Lorenzo1, N. Alcaide1, R. Ruiz Zorrilla1, M.A. Marinero1, P. Gil-Simón1, R. Atienza1, J. Barrio1
1Rio Hortega University Hospital, Gastroenterology Department, Valladolid, Spain
Background: Patients with IBD and negative HBV serology, who had been vaccinated in an IBD unit of a tertiary hospital from March 2008 until June 2011, were prospectively included. The protocol of vaccination: double dose of Engerix B at 0, 1, 2 months (quick schedule); 2 months after last dose anti-HBs titers were measured. In the cases where response failed a schedule of revaccination with the same protocol was followed. Response to the vaccination was evaluated considering two different anti-HBs titers as cut off points: anti-HBs >10 UI/l and anti-HBs >100 UI/l.
Methods: Patients with IBD and negative HBV serology, who had been vaccinated in an IBD unit of a tertiary hospital from March-2008 until June-2011, were prospectively included. The protocol of vaccination: double dose of Engerix B at 0, 1, 2 months (quick schedule); 2 months after last dose anti-HBs titers were measured. In the cases where response failed a schedule of revaccination with the same protocol was followed. Response to the vaccination was evaluated considering two different anti-HBs titers as cut off points: anti-HBs >10 UI/l and anti-HBs >100 UI/l.
Results: During the period quoted above 89 patients were vaccinated, of which 17 (20%) were not followed-up. Of the remaining 72, the median age 37 years, 62% were males and 81% were diagnosed with Crohn's disease. 41 patients (56%) had treatment with thiopurines, 12 (16%) had been vaccinated before starting anti‑TNF treatment (8 in combined therapy) and 19 (26%) had other treatments: corticoids, 5‑ASA or cytapheresis. 40 patients (55%) responded; in 29 cases (66%) the values of antibodies were over 100 UI/L. 55% of the patients with negative anti-HBs were revaccinated with 76% response of which 70% had antibodies over 100 UI/l.
60% (7 cases, 5 with combined therapy) of the patients treated with anti‑TNF drugs had no immunological response to vaccination. Revaccination obtained a positive response in 72% of them. Patients treated with immunosuppressant gave lower percentage of response to vaccination.
Conclusions: The response rate to quick schedule vaccination against HBV in patients with IBD is low (55%). Revaccination with the same schedule rescues a high number of patients (76%). Immunosuppressants decrease percentage of response. The result obtained can be improved with: vaccination upon diagnosis, without use of immunosuppressants and with an active attitude in the control of vaccination and revaccination on the physician's part.