The hepatitis B virus (HBV) induces chronic liver infections, raising the risk of cirrhosis and liver cancer.
Healthcare providers should consider missed-dose vaccination for those with incomplete HBV vaccination to prevent long-term complications like liver cancer and chronic infection.
The hepatitis B virus (HBV) induces chronic liver infections, raising the risk of cirrhosis and liver cancer. While a three-dose HBV vaccine from birth is effective, the benefit of catch-up vaccination for those with unfinished or no vaccination is ambiguous. This investigation aimed to examine the impact of HBV catch-up vaccination on lowering morbidity in children and adults.
A search of ChinaXiv, MEDLINE, Cochrane Central Register of Controlled Trials, MedRXIV, BioRXIV, Google Scholar and; ongoing and finished trials on the USA, China, and WHO platforms was conducted, with the last search on June 30, 2023. Experimental and observational studies, meta-analyses/systematic reviews, completed trials, and preprints that evaluated the effectiveness of catch-up hepatitis vaccination in lowering morbidity from hepatitis B viral infection [including acute and chronic hepatitis B, cirrhosis and hepatocellular carcinoma (HCC)], without age or language limitations were assessed.
The grade of the included studies was independently assessed using the Newcastle-Ottawa Scale for cohort and cross-sectional studies. Evidence certainty was defined using the GRADE approach. Categorical data were presented as numbers (%) and differences between groups as relative risk (RR) or odds ratio (OR). The Review Manager 5.4 was used to pool the data.
Out of 4 included observational studies, one provided data for both children and adults [two studies focused on children (one with data on adults), and three on adults]. The cross-sectional study was evaluated as high quality, while the 3 cohort studies as fair to good.
A high-certainty pediatric study showed that catch-up vaccination for those aged 9 to 18 years reduced hepatitis B surface antigen (HBsAg) positivity [RR: 0.09], lowered HBV DNA detection [RR: 0.084], and increased anti-HBs seroconversion [RR: 2.08], with high-quality evidence due to the large treatment effect. The mass HBV immunization for children aged 0 to 10 years decreased HBsAg and anti-HBc prevalence while increasing anti-HBs seroconversion after vaccination as per a separate low-certainty Italian study.
As for the adults, 3 studies with low-certainty evidence were included. Two studies informed a decreased rate of acute hepatitis B [OR: 0.08 (0.05, 0.12), I2=33%]. Another study showed HBV vaccination reduced HCC prevalence (incidence ratio: 0.04), highlighting its benefit in preventing HCC with chronic HBV avoidance. Due to issues with directness and study design, these studies were rated as low quality.
Catch-up hepatitis B vaccination in adult populations effectively reduces the occurrence of acute hepatitis B and HCC. It also lowers the prevalence of HBsAg and anti-HBc while providing anti-HBs protection in individuals aged 0 to 18 years.
Acta Medica Philippina
HBV Catch-up Vaccination in Children and Adults with Incomplete or Unknown Vaccination to Reduce Hepatitis B-related Morbidity: A Systematic Review
Germana Emerita V. Gregorio, Sarah Jane G. Velasco-Aro
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