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Travel Med Infect Dis. 2018 Jan - Feb;21:43-50. doi: 10.1016/j.tmaid.2017.12.004. Epub 2017 Dec 8.

An extra priming dose of hepatitis A vaccine to adult patients with rheumatoid arthritis and drug induced immunosuppression - A prospective, open-label, multi-center study.

Author information

1
School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden; Dept. of Infectious Diseases, Örebro University Hospital, SE 701 85 Örebro, Sweden. Electronic address: anja.rosdahl@regionorebrolan.se.
2
Swiss Tropical and Public Health Institute, CH 4051 Basel, Switzerland; University of Basel, CH 4001 Basel, Switzerland. Electronic address: herzog.ch47@gmail.com.
3
Institute of Virology, Technical University of Munich / Helmholtz Zentrum München, 81675 Munich, Germany. Electronic address: gfrosner@gmx.net.
4
School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden; Dept. of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, SE 701 85 Örebro, Sweden. Electronic address: torbjorn.noren@regionorebolan.se.
5
Centre for Clinical Research, Sörmland, Uppsala University, SE 631 88 Eskilstuna, Sweden. Electronic address: lars.rombo@gmail.com.
6
Karolinska Institutet, Dept. of Medicine/Solna, Unit for Infectious Diseases, SE 171 76 Stockholm, Sweden; Dept. of Communicable Diseases Control and Prevention, Sörmland, SE 631 88 Eskilstuna, Sweden. Electronic address: helena.hervius.askling@ki.se.

Abstract

BACKGROUND:

Previous studies have indicated that a pre-travel single dose of hepatitis A vaccine is not sufficient as protection against hepatitis A in immunocompromised travelers. We evaluated if an extra dose of hepatitis A vaccine given shortly prior to traveling ensures seroconversion.

METHOD:

Patients with rheumatoid arthritis (n = 69, median age = 55 years) treated with Tumor Necrosis Factor inhibitor(TNFi) and/or Methotrexate (MTX) were immunized with two doses of hepatitis A vaccine, either as double dose or four weeks apart, followed by a booster dose at six months. Furthermore, 48 healthy individuals, median age = 60 years were immunized with two doses, six months apart. Anti-hepatitis A antibodies were measured at 0, 1, 2, 6, 7 and 12 months.

RESULTS:

Two months after the initial vaccination, 84% of the RA patients had protective antibodies, compared to 85% of the healthy individuals. There was no significant difference between the two vaccine schedules. At twelve months, 99% of RA patients and 100% of healthy individuals had seroprotective antibodies.

CONCLUSION:

An extra priming dos of hepatitis A vaccine prior to traveling offered an acceptable protection in individuals treated with TNFi and/or MTX. This constitutes an attractive pre-travel solution to this vulnerable group of patients.

KEYWORDS:

Hepatitis A; Immunosuppression; Methotrexate; Rheumatoid arthritis; TNF-Inhibitors; Vaccine

PMID:
29229311
DOI:
10.1016/j.tmaid.2017.12.004
[Indexed for MEDLINE]

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