الفهرس 
AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
HBV infection is a well recognized and a major health problem world wide,
especially in developing countries leading to significant morbidity and mortality. In Egypt
HB vaccine was introduced as integral part of the existing childhood immunization
programe. It is given at 2,4,6 months in conjunction with DPT and oral poliovaccines
schedule.
It was reported that immunogenicity of HB vaccine ranges from (83%-99%).
However, the efficacy of HB vaccine decay with time and there are certain population fail
to mount an adequate protective immune response, such as patients with chronic renal
failure, HIV, cancer, diabetes mellitus and other immunocompromised conditions.
In Egypt, there is shortage in numbers of studies for evaluating efficacy of
HBvaccine after 10 years from primary vaccination, especially in diabetic children.
Therefore the present study was conducted in Alexandria aiming to estimate the state of
HB immunity among diabetic students vs. non diabetics and to study the different factors
affecting their immune response.
The study population comprised 130 diabetic children with age ranging 10-<18 years
and 130 normal children selected from outpatient clinics of EL-Shatby Pediatrics
University Hospital and Insurance Sporting student’s hospitals. A predesigned
questionnaire sheet was filled for all children which included inquires about different
socio-demographic data, history of hepatitis risk factors and of HB vaccine as well as
details about diabetes e.g age of onset, treatment, glycemic state, complications etc.
Sera of all studied population was tested for immunogenicity of HB vaccine
measured by anti-HBs titre in mIU/ml as well as for anti-HCV seropositivity. Sera found
to be anti-HBs titre <10m IU/ ml, were further tested for reactivity to HBsAg and anti-
HBc.
Data were collected, statistically analyzed and the following results, were obtained:
1. Higher percentage of the studied groups were males and of urban residence.
2. Significantly higher percentage of diabetics gave positive history of frequent
hospitalization and injections as compared to non diabetics.
In contrast, positive history of dental manipulation, accidents, going to local barber
and household contact with HCV were more abundant among non diabetics.
3. Among the 260 studied children, 92 (70.8%) of diabetic children vs.78 (60%) of the
normal were non responders (negative for anti-HBs). The median value of anti-
HBs titre was significantly lower (3.0 m IU/mL) among diabetics as compared to
non diabetics (6.8 mIU/mL).
4. All children with anti-HBs titre <10 mIU/ml were negative for HBsAg. HBV
exposure measured by anti-HBc seropositivity revealed no significant difference
between both groups.
Receiving IV injections and hospitalization significantly prevailed among anti-HBc
positive diabetic cases, while going to local barber was the significant risk factor
among anti-HBc positive non diabetics.
Summary and Conclusions
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5. Among the factors affecting the immune response to HB vaccine, the results
revealed that the percentage of children with anti-HBs titre <10mIU/ml was found
to increase with the increase in age. However the difference was statistically
significant only in the diabetic group. The stepwise logistic regression analysis of
risk factors for poor response indicted that increasing age by 1 year increased the
risk for being <10 mIU/ml by about 30%.
6. Gender and BMI categories had no significant effect on HBV vaccine response in
both groups.
7. The stepwise logistic regression analysis of risk factors for poor response indicated
that diabetic children have 60% more risk for being <10 m IU/ml than non
diabetics. The percentage of children with poor response to HBV vaccine was
higher among children having diabetic disease for more than 10 years (75%) as
compared to those with disease duration <10 years (70.3% ). The frequency of poor
vaccine responders was higher among those who had poor metabolic control (31.7%
vs. 25%, p=0.066).
8. Diabetic cases had higher frequency of anti-HCV seropositivity as compared to non
diabetics (4.6% vs. 0.8% ) respectively. The difference was border line significant.
The results revealed that 33.3% of anti-HCV positive diabetic cases had anti-HBs
titre <10 mIU/ml vs. 72.6% of anti-HCV negative diabetics.
CONCLUSIONS
from the previous results it can be concluded that although HB vaccine appears to be
protective after 10-18 years of its compulsory inclusion in EPI, there are a considerable
proportion of evidence of exposure.
The long term immune response to HB vaccine is significantly better in healthy
versus diabetic children.
Being diabetic and time lapse since immunization were the significant independent
risk factors beyond poor response.