Hepatitis B Seroprevalence among Children with Transfusion Dependent Thalassemia
ไวรัสตับอักเสบ บี ในผู้ป่วยธาลัสซีเมีย
Keywords:
hepatitis B, transfusion-dependent thalassemia, HBV immunizationAbstract
Introduction: Patients with transfusion-dependent thalassemia are at risk of contracting transfusion-associated hepatitis B virus infection although every Thai infant has received hepatitis B vaccine according to the Expanded Program of Immunization since 1992 and the National Blood Centre, the Thai Red Cross Society has performed individual nucleic acid test (NAT) for hepatitis B virus among blood donors since 2008. Objective: The study aimed to determine the hepatitis B seroprevalence among children with transfusion-dependent thalassemia. Methods: A retrospective analysis was conducted in 252 transfusion-dependent thalassemia cases from 1994 to 2019; the majority involved beta-thalassemia/hemoglobin E. The mean±SD age of initial blood transfusion was 1.8±1.6 years and the mean±SD duration of follow-up was 8.0±5.3 years. The laboratory investigation including HBsAg, anti-HBs, and anti-HBc was performed before blood transfusion and during follow-up. Results: Every patient had completed the routine hepatitis B vaccination and was negative for HBsAg before blood transfusion and during annual follow-up. Before transfusion, a total of 156 of 252 patients (61.9%) had positive anti-HBs while 96 patients (38.1%) had negative anti-HBs. In all, 92 of 96 patients with negative anti-HBs (95.8%) exhibited a protective anti-HBs after receiving 1-3 booster hepatitis B vaccines. The remaining 4 patients with anti-HBs negative patients (4.2%) did not receive the booster vaccination. Additional anti-HBc determination during follow-up period revealed positive among 9 patients (9/183 = 4.9%) who were classified as previous hepatitis B infection in 5 patients (5/183 = 2.7%) and seroconversion in 4 patients (4/183 = 2.2%). These 4 seroconversion patients were receiving transfusion before 2008 with initial negative anti-HBs and did not receive booster vaccination. The seroconversion rate among patients receiving transfusion before 2008 significantly differed from no seroconversion among those receiving transfusion after 2008 (p = 0.005) when the individual NAT of hepatitis B virus among blood donors was initiated. The relative risk was 0.94 with 95%CI of 0.87-0.99. Conclusion: The combined individual NAT of hepatitis B virus among blood donors and appropriate hepatitis B vaccination was helpful in decreasing the seroprevalence among children with transfusion-dependent thalassemia
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