Third Time’s a Charm: Immunization Strategies for Hepatitis B in Immunosuppressed Patients with Inflammatory Bowel Disease

Excerpt

The clinical spectrum of hepatitis B (HepB) virus infection ranges from asymptomatic infection to fulminant hepatitis. Since both mild and fulminant hepatitis B infections have been reported in previously vaccinated patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapies [1], current gastroenterology preventive care guidelines recommend HepB vaccination for all patients with IBD [2]. Indeed, patients receiving tumor necrosis factor (TNF) blocking antibodies were less likely to have protective hepatitis B surface antibody (HBsAb) levels following HepB vaccination [3]. Current evidence points to lifelong protection with HBsAb > 10 mIU/mL measured 1–2 months after HepB vaccine series completion in immunocompetent adults; revaccination may be needed for individuals who fail to achieve that goal [4]. Previously immunized individuals may not have had an antibody level measured upon completion of the series. A single dose of HepB vaccine followed by HBsAb measurement in 1 month is used to document an anamnestic response and long-term immunity. HBsAb < 10 mIU/mL after a single dose is considered an absence of an anamnestic response, requiring two more doses to complete a second series. Little work has been done to consider the optimal revaccination strategy in immunosuppressed patients with IBD, including how many additional doses of HepB vaccine are needed. …