HIV-Infected or -Exposed Children Exhibit Lower Immunogenicity to Hepatitis B Vaccine in Yaoundé, Cameroon: An Appeal for Revised Policies in Tropical Settings?

Autor: Njom Nlend AE; Pediatric Service, National Insurance Fund Welfare Hospital, Yaoundé, Cameroon.; Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon., Nguwoh PS; Higher Institute of Health Professions, Yaoundé, Cameroon.; Ministry of Public Health, Yaoundé, Cameroon.; Institute of Science and Technology Applied to Health, Yaoundé, Cameroon., Ngounouh CT; Institute of Science and Technology Applied to Health, Yaoundé, Cameroon., Tchidjou HK; Bambino Gesu Paediatric Hospital, Rome, Italy., Pieme CA; Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.; Higher Institute of Health Professions, Yaoundé, Cameroon., Otélé JM; Higher Institute of Health Professions, Yaoundé, Cameroon., Penlap V; Higher Institute of Health Professions, Yaoundé, Cameroon.; Department of Biochemistry and Microbiology, Faculty of Science, University of Yaoundé 1, Yaoundé, Cameroon., Colizzi V; Chantal BIYA International Reference Centre for Research on HIV/AIDS prevention and management, Yaoundé, Cameroon.; University of Rome Tor Vergata, Rome, Italy.; UNESCO Interdisciplinary Board of Biotechnology, Rome, Italy., Moyou RS; Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.; Chantal BIYA International Reference Centre for Research on HIV/AIDS prevention and management, Yaoundé, Cameroon.; Institute of Research in Medicine and Medicinal plants, Yaoundé, Cameroon., Fokam J; Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.; Chantal BIYA International Reference Centre for Research on HIV/AIDS prevention and management, Yaoundé, Cameroon.; University of Rome Tor Vergata, Rome, Italy.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2016 Sep 22; Vol. 11 (9), pp. e0161714. Date of Electronic Publication: 2016 Sep 22 (Print Publication: 2016).
DOI: 10.1371/journal.pone.0161714
Abstrakt: Background: Since 2005, anti-hepatitis B virus (anti-HBV) vaccine is part of the Expanded Program on Immunization (EPI) for infants born in Cameroon, with 99% anti-HBV coverage. In a context of generalized HIV epidemiology, we assessed paediatric anti-HBV vaccine response according to HIV status, feeding option and age in a tropical context.
Methodology: Prospective, observational and cross-sectional study conducted among 82 children (27 [IQR: 9-47] months, min-max: 6-59), after complete anti-HBV vaccination (Zilbrix Hepta: 10μg AgHBs) at the Essos Health Centre in Yaounde, Cameroon, classified as group-A: HIV unexposed (28), group-B: HIV-exposed/uninfected (29), group-C: HIV-infected (25). Quantitative anti-HBs ELISA was interpreted as "no", "low-" or "protective-response" with <1, 1-10, or ≥10 IU/L respectively; with p-value<0.05 considered significant.
Results: Children were all HBV-unexposed (AcHBc-negative) and uninfected (HBsAg-negative). Response to anti-HBV vaccine was 80.49% (66/82), with only 45.12% (37/82) developed a protective-response (≥10IU/L). According to HIV status, 60.71% (17/28) developed a protective-response in group-A, vs. 51.72% (15/29) and 20% (5/25) in group-B and group-C respectively, Odds Ratio (OR): 2.627 [CI95% 0.933-7.500], p = 0.041. According to feeding option during first six months of life, 47.67% (21/45) developed a protective-response on exclusive breastfeeding vs. 43.24% (16/37) on mixed or formula feeding, OR: 1.148 [CI95% 0.437-3.026], p = 0.757. According to age, protective-response decreased significantly as children grow older: 58.33% (28/48) <24 months vs. 26.47% (9/34) ≥24 months, OR: 3.889 [CI95% 1.362-11.356], p = 0.004; and specifically 67.65% (23/34) ≤6 months vs. 0%, (0/5) 33-41 months, p = 0.008.
Conclusions: Anti-HBV vaccine provides low rate of protection (<50%) among children in general, and particularly if HIV-exposed, infected and/or older children. Implementing policies for early vaccination, specific immunization algorithm for HIV-exposed/infected children, and monitoring vaccine response would ensure effective protection in tropical settings, pending extensive/confirmatory investigations.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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