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  • Title: Hepatitis B vaccine in the Gambian Expanded Programme on Immunization: factors influencing antibody response.
    Author: Inskip HM, Hall AJ, Chotard J, Loik F, Whittle H.
    Journal: Int J Epidemiol; 1991 Sep; 20(3):764-9. PubMed ID: 1835452.
    Abstract:
    Data on over a thousand Gambian children have been analysed to examine factors influencing their antibody levels following immunization with hepatitis B vaccine administered during the first year of life. The dominant effect was the time between the last dose of vaccine and taking the blood sample. There was considerable variation in vaccine response by area of residence which could not be explained by any other factor. The hepatitis B surface antigen (HBsAg) status of the mother and the age at vaccination did not appear to have an effect, but there was some indication that a delay in receiving the second dose of vaccine led to a marginally lower response. As part of The Gambia Hepatitis Intervention Study, researchers took blood samples from 1000 12-18 month old infants from 4 distinct parts of The Gambia who had received the hepatitis B (HB) vaccine to examine HB markers to define factors which influence their response to immunization. 62% of the children had high antibody levels of 1000 mIU/ml compared to only 2% who did not respond to the vaccine (10 mIU/ml). Only .6% of the vaccinated children tested positive for HB surface antigen compared to 7% of unvaccinated children in a previous study in The Gambia. Therefore the vaccination was effective in preventing the carrier state. Time between immunization and bleeding strongly influenced the antibody level (p.001). Indeed a 47% reduction in the level of antibody occurred after 30 days. Nevertheless the antibody level remained high after 12 months, again giving credence to the vaccine's ability to prevent the carrier state. Residence was substantially associated with antibody level (p.01). The differences could not be attributed to ethnic differences, seasonal variation, season of birth, or season of 1st immunization. Specifically, children in Essay in the western section of The Gambia had the highest antibody levels followed by those in Brikama, Badjakunda and Yorobawal, and the Dankunku and Kudang. The greater the interval between the 1st and 2nd doses the lower the antibody response (p=.03). For example, the recommended interval between the 2 doses is 4 weeks, but in those cases where the interval was doubled the antibody response fell 12%. On the other hand, increasing the interval between the 2nd and 3rd doses or the 3rd and the 4th doses die not affect antibody level.
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