High coverage of hepatitis B vaccination and low prevalence of chronic hepatitis B in migrant children dictate a new catch-up vaccination strategy. | LitMetric
Unit of Pediatric Infectious Diseases and Vaccinology, Department Women-Mother-Child, Lausanne University Hospital, Switzerland.
Published: July 2018
AI Article Synopsis
Article Abstract
Background: Worldwide coverage of hepatitis B (HB) vaccination is increasing. This should be considered when determining the best strategy for catch-up HB vaccination in migrant children, who rarely have written proof of past immunizations. This study aimed to estimate HB vaccine protection, chronic HB prevalence and to identify determinants of vaccine protection.
Methods: Newly arrived migrant children at Lausanne University Hospital from October 2014 to July 2017 were prospectively enrolled. Children and adolescents aged 1-18 years were approached for inclusion if they had no proof of past vaccinations and accepted a single dose of injected HB vaccine. HB surface antibody (anti-HBs) serology was performed after 4-6 weeks. Anti-HBs ≥100 IU/L were considered consistent with a booster-type antibody response. Patients with anti-HBs <100 IU/L received additional dose(s) of HB vaccine, after exclusion of chronic HB in children with anti-HBs <10 IU/L. Potential determinants of vaccine response were compared between children with and without booster-type response.
Results: Two hundred children were available for analysis. Median age was 8.9 years (IQR 4.8-12.9), and 97 (49%) were female. The majority (n = 124, 62%) came from the region classified by the WHO as eastern Mediterranean. One hundred and sixty-one children (81%) had a booster-type antibody response. Only 1 patient (<1%) had chronic HB. In the multivariate analysis, younger age (OR per decreasing-year, 1.28; 95%CI, 1.05-1.57; p = 0.017) and migration from an urban area (OR 1.16; 95%CI, 1.01-1.33; p = 0.043) were the only significant determinants of booster-type response.
Conclusion: Post-vaccine serology may be used to identify a high proportion of individuals in our pediatric migrant population with previous immunization for HB. Our study also showed extremely low prevalence of chronic HB. No variable could definitively determine the results of serology. Post-vaccine serology represents the most effective strategy in this context of high vaccine coverage.
The Research Center for Women's, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Buskerud, Norway.
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The current narrative of a "migration crisis" has so severely misdirected the understanding of the fundamental human safety, security, and health challenges that confront migrants, that we feel compelled to reframe the issue as a public health and humanitarian emergency. By looking at migrants as an economic threat or as an "invasion" that threatens the American way of life," it becomes difficult to view their humanity as vulnerable individuals who confront a host of challenges at the border, including abuse, dehumanization, and incarceration. The forced migration of thousands of individuals and families who flee their countries of origin to escape violence and insecurity to then be demonized and retraumatized at the border is a public health emergency.
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