Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
Vaccine non-responders and Hepatits B
I became interested in the area of vaccine non-responders after a comment one of my nurses had made when I was completing my vaccine requirements for medical school. Some of my titers had returned negative, and I was receiving several series again. She had told me, “You might end up being one of the ‘lucky ones’ that just don’t respond.” In my readings, I stumbled onto this article from the World Journal of Hepatology detailing options for non-responders of the Hep B vaccine specifically.
To put some perspective to this, Hepatitis B is a virus that is responsible for nearly 1 million deaths yearly worldwide. It is found abundantly in body fluids. The vaccine is usually administered as an intramuscular dose in three doses of 0, 1, and 6 months at 10 mg. This vaccine produces a positive response for 95 percent of immune-competent individuals, leaving 5 percent of individuals that do not respond.
The article details that individuals who “do not respond to the standard regimen as well as the additional booster or repeated course regimen are labeled as true non-responders.” The article further indicates that there may be a genetic predisposition in which subjects may have a defect in the antigen presentation or the stimulation of T-helper cells. A non-responder should prevent exposure to blood and body fluids, which would prove difficult for those of us in health care, so what other options are there?
The following were a few strategies that are being explored and could potentially be considered for those who do not respond to the standard vaccine:
- Increased dosage or increased frequency of the vaccine, which appeared to help individuals at high-risk.
- Intradermal injection instead of intramuscular injection of the vaccine. However, intradermal injection tends to be more difficult to perform effectively. Other routes of administration are also being looked into.
- Use of other adjuvants (substances used to help the immune response) in conjunction with aluminum.
- Both nasal and oral vaccines are being considered and tested.
These were not the only strategies outlined, but a few that I found interesting. What I found more interesting though was that I could find very few credible articles containing helpful information for individuals who did not respond to other vaccinations aside from Hep B. Has anyone found any information on this in their own research? If not, non-responders of vaccines could certainly benefit from “herd immunity” idea presented in the Immunization Basics PowerPoint.
This is a very good and highly relevant post. Every year I meet students who have no or poor serum titers following vaccination. I suspect MHC subtypes have a lot to do with it but I have not found much research on this.
@Aubrey Graham Your post immediately caught my eye because I had the same experience with my Hep B titer. I had the complete series as a young child, but when my titers were drawn this summer I was not reactive. I actually spoke with some of my friends that were attending other medical schools, as well of some of our current classmates, and it seems that many of us came up short concerning our reactiveness to Hep B. While your post took the direction of finding solutions to non-reactors as a whole, I also think that your experience raises the question, at least as far as Hep B is concerned, of the best timeline for Hep B infection. It is understandable that the series is given in childhood, when most other vaccinations are given, but it seems that the series does not confer immunity long-term for many of its recipients. I think it would be interesting to determine just how many people entering the medical field/having titers drawn in young adulthood needed boosters or to repeat their Hep B series. It may be plausible to consider the idea that Hep B vaccination is occurring too early in childhood, and should instead be given in adolescence, when contact with other's bodily fluids becomes more of a prevalent danger, so that the immunity lasts longer, when the danger becomes even higher.
@Aubrey Graham I think you have composed an excellent post on the topic. I thought you maintained a balance between the basic sciences while keeping it personable. It was a post that could be understood by anyone who remembers the concepts from their immunology courses. While I have heard from healthcare professionals that there is variation in how long people retain immunity (as determined by titer tests), this was the first time I heard about non-responders. I'm glad you made that distinction clear. Also @Nadia Churchill-Gilstrap you bring up an excellent point as it relates to herd immunity as well.
@Aubrey Graham Your update caught my attention, not only because of your personal connection, but also the different perspective on vaccines and immunity. I think you made an extremely good point about the benefit of herd immunity in the case of non-responders. This presents an interesting argument for the necessity of general vaccinations for the public. I haven't heard the case of non-responders widely publicized and wonder how the arguments against vaccines would result if this were brought up. I would also be interested to see what further techniques and ideas are developed on this front and in the delivery of vaccines for non-responders.