—Alan Franciscus, Editor-in-Chief
In a small study (abstract below), the efficacy of
a standard dose of the hepatitis B vaccine was compared to a double
dose of the same vaccine. There were three arms in the study:
Group A—hepatitis C patients who received the standard dose
Group B—hepatitis C patients who received the double dose
Group C—healthy people who received the standard dose (control arm)
The aim of the study was to find
out what strategy provided the best protection from hepatitis B
infection in people infected with hepatitis C. The three groups were
similar in age and sex.
In the group that received the double dose (group B) and the standard dose in healthy people (Group C)
100% of the people developed antibody titers—a marker that meant they
were protected against acquiring hepatitis B infection. However, 12.5%
of the people with hepatitis C who received the standard dose of the
vaccine (Group A) were not protected.
Although this is a small study
it definitely warrants additional studies to confirm these results. If
confirmed it will change the way that people infected with hepatitis C
are vaccinated against hepatitis B.
Additional Information about the Vaccines:
Acquiring hepatitis A or hepatitis B if you have
hepatitis C can be dangerous and even life-threatening. It is highly
recommended that people with hepatitis C who are not already protected
should be vaccinated.
There are separate vaccines for hepatitis A and hepatitis B.
The hepatitis A vaccine is a two-shot series (initial 1st dose, then 2nd dose 6 months following the first dose)
The hepatitis B is a
three-dose series(initial 1st dose, 2nd dose one month after the first
dose and the 3rd dose is given 6 months following the first dose)
If you miss a dose the dosing
schedule is picked up where it was left off. It is believed that once
protective antibody titers are development, protection is life-long.
There is also a combination
hepatitis A and hepatitis B vaccine—Twinrix. It has the same dosing
schedule as the regular hepatitis B vaccine (three doses within 6
months). Twinrix is also approved for accelerated dosing (4 doses
given on day 0, 7, and 21-30 days followed by one dose at one-year).
The hepatitis A and hepatitis B vaccines are considered safe and effective.
Efficacy of double dose recombinant hepatitis B
vaccination in chronic hepatitis C patients, compared to standard dose
Hepatitis B virus (HBV) vaccination is a well-known,
safe and effective way for protection against HBV infection; however,
non-responders remain susceptible to infection with HBV. This is so
important in patients with any kind of chronic liver disease, especially
chronic hepatitis C virus (HCV) patients in whom acute HBV infection
may lead to decompensation of liver disease. Some of the studies have
shown that immunogenicity of HBV vaccination is decreased in these
patients. The aim of this study was to evaluate the efficacy and safety
of double dose vaccination of HBV in these patients, compared with
standard dose vaccination in similar patients and healthy adults.
A total of 64 patients with chronic HCV infection
were randomized into 2 groups of 32. Group A received standard dose HBV
vaccine, at 0, 1, 6 months, whereas group B received double dose HBV
vaccine. Group C consisted of 32 healthy adults who also received
standard dose vaccination. At 1 month after the end of vaccination,
Hepatitis B surface antibody (HBsAb) titer was checked in all
participants and the results were compared.
There was no significant difference in age or sex
among three groups. The response rate in groups B and C was 100% (all
had HBsAb titer >10 mIU/mL), while in group A, 4 patients (12.5%)
were non-responders (HBsAb titer < 10 mIU/mL). The difference in
response rate was statistically significant between Group A and the
other two groups (P < 0.05).
The efficacy of standard dose HBV vaccination in
patients with chronic HCV infection was suboptimal. Using double dose
vaccination in these patients was an effective way to increase the
Int J Prev Med. 2014 Feb;5(2):145-51.
Minakari, M. et al.