Perlukah dilakukan test darah pada si kecil untuk mengetahui apakah vaksinasi hepatitis B yang sudah terlaksana sudah berhasil atau tidak ? Apakah Post-Vaccination Testing merupakan prosedur baku yang harus dilalui oleh semua anak ataukah pada anak anak yang memiliki orang tua beriwayat hepatitis?

Berikut rangkuman diskusi tentang tema terkait yang berlangsung di milist wrm-indonesia.

Perlu tidak sih dilakukan post vaccination test untuk melihat daya rangsang imunisasi (immunogenic) hepatitis B?

Tidak perlu dilakukan tes darah bila tidak ada riwayat orang tua yang terkena hepatitis. Bila DSA meminta si kecil melakukan test darah untuk pembuktian apakah imunisasinya gagal atau tidak, bisa jadi sang DSA ragu ragu akan keberhasilan vaksinasinya. Minta penjelasan tentang faktor yang meragukannya ini beserta alasannya dilakukannya test darah tersebut. Bila ia tidak bersedia memberikan penjelasan, cari second opinion.

Apa saja faktor yang berperan terhadap kegagalan imunisasi?

Ada beberapa faktor yang berperan terhadap kegagalan imunisasi yaitu: faktor vaksin, cara pemberian dan individu nya sendiri.

FAKTOR VAKSIN: misal, ada vaksin yang kadaluarsa; cold chain nya tidak benar
FAKTOR TEKNIS: misal, harusnya intra muskular dalam alias disuntik dalam ke otot bukan hanya sedikit di bawah permukaan
FAKTOR INDIVIDU: Individu nya tergolong non responder

Dimana dapat dicari informasi terpercaya tentang serba serbi hepatitis B?

Coba cari di situs CDC ini

Kalau tentang post vaccination testing?

Dapat juga di browsing ke alamat CDC ini.

After routine vaccination of infants, children, adolescents, or adults post-vaccination testing for adequate antibody response is not necessary.

Post-vaccination testing IS recommended for persons whose medical management will depend on knowledge of their immune status. This includes persons who:
1.are immunocompromised (e.g., hemodialysis patients)
2.received the vaccine in the buttock
3.are infants born to HBsAg (hepatitis B surface antigen)-positive mothers
4.are healthcare workers who have contact with blood
5.are sex partners of persons with chronic hepatitis B virus infection

Post-vaccination testing should be completed 1-2 months after the third vaccine dose for results to be meaningful. A protective antibody response is 10 or more milliinternational units (>=10mIU/mL).

Ada alamat lainnya?

Ya. Coba lihat di sini.

How much protection is provided for babies, teens, and adults after each dose of hepatitis B vaccine? The data depicted below represent the percentage of persons at various ages who develop anti-HBs of at least 10 mIU/mL after their first, second, and third doses of hepatitis B vaccine. (4/03)

Dose Infants* Teens and Adults**
#1 16-40% 20-30%
#2 80-95% 75-80%
#3 98-100% 90-95%
*Pre-term infants under 2 kg have been shown to respond to vaccination less often.
**Factors that may lower vaccine response rates are age >40 years, male gender, smoking, obesity, and immune deficiency.

juga di sini

Hepatitis B Vaccine Post-vaccination Testing for Immune Response

Hepatitis B surface antibody (anti-HBs) titer (test for immune response) is recommended after three doses of vaccine are given, only for persons in the following risk groups:

1.health care workers who have the risk of exposure to blood or body fluids in the workplace (to guide post-exposure prophylaxis *)

2.infants born to hepatitis B surface antigen (HBsAg)-positive mothers (to ensure ongoing protection)

3.immunocompromised persons, e.g., dialysis patients, AIDS patients (to ensure protection)

4.sex partners of HBsAg-positive persons (to assure adequate response to vaccination).

Note: Testing is not recommended after routine vaccination of infants, children, or adolescents.

dan disini

Post-vaccination Testing The level of circulating anti-HBs is used to determine the effectiveness of vaccination. The hepatitis B vaccine is designed to induce only anti-HBs (the protective antibody) and will not induce an anti-HBc response. Outside the US, other levels of antibody may be used to determine immunity. These levels may vary from country to country.

The minimum protective level of anti-HBs is 10 IU/ml.

Post vaccination testing is advised only for:

1. Persons whose clinical management depends on knowledge of their immune status (e.g., infants born to HbsAg-positive mothers, dialysis patients, patients with HIV infection), and

2. Persons at occupational risk (dialysis and other health care workers).

3. Persons who are non-responders to the vaccine are usually candidates for revaccination (e.g., repeat 3-dose series) and post-vaccination retesting.

Also, older age, obesity, heavy smoking, and gluteal administration have been associated with lower antibody responses to vaccination.

Following vaccination, antibody titers may diminish over time, and may fall below the limits of detection by standard immuno-assays. However, there has not been documentation of clinical HBV infection or chronic infection among vaccinated adults who were exposed to HBV many years after primary vaccination. Thus, protective immunity may be life-long due to an anamnestic immune response to HBV, and currently the CDC does not recommend a late booster dose of HBV vaccine.

Nevertheless, if a vaccinated person has a documented exposure to Hepatitis B, and titers are undetectable at the time of exposure, it is reasonable to offer HBIG and a booster dose of vaccine to the exposed individual.

juga di alamat ini

Post-Vaccination Testing. After completing the series, most children, adolescents, and adults do not need to be tested for hepatitis B antibodies. However, the following groups should be post-tested:

1.Infants of HBsAG+ mothers. After completion of the series at 6 months, infants should be tested at 9-15 months for HBsAG anti-HBs

2.Health care workers. Test 1-2 months after completion of the series.

3.People with HIV, hemodialysis patients, transplant recipients and sex partners of HBsAG persons: Do not start the series over. Test 1-2 months after completion of the series.

If A Patient Is Not Immune After Vaccination: Although rare, up to 5% of those who complete the vaccination series may not acquire immunity (HBsAb levels < 10mIU/ml). If immunity is not induced after completing the series, the following steps should be taken: Adminster another 3-shot series at the normal intervals using a different HBV vaccine. Test the patient again after completion of this series to make sure he/she is now immune

Sampai berapa tahun efektifitas vaksin hepatitis B?

Vaksin hepatitis b bisa efektif sampai 15 tahun.  

Vaccine Stops Hepatitis B for 15 Years

Longer Protection May Reduce Need for Booster Shots

The hepatitis B vaccine works for at least 15 years -- longer than once thought.

The vaccine thwarts the virus that causes hepatitis B, a liver disease that can lead to liver cirrhosis or cancer. Most countries include the vaccine in their infant immunization programs. It's given in a series of three shots and was known to protect against hepatitis B for five to 10 years. But no one knew if it worked beyond that point.

Jadi intinya, siapa sih yang perlu melakukan post-vaccination testing hepatitis B ini?

Lengkapnya dapat dilihat di alamat maya ini . Untuk hep B hanya dianjurkan untuk orang orang tertentu, seperti misalnya, bayi yang dilahirkan dari ibu yg positif terkena hep B, immune compromised persons , healthcare worker, atau orang orang yang sex partnernya positif terkena hep B.

Kalaupun pada orang orang tersebut dilakukan post-vactination testing, pelaksanaannya adalah 1-2 bulan setelah divaksin. Khusus untuk bayi yang ibunya positif terkena hep B, post-vactination testing dilakukan 3-9 bulan setelah seri terakhir divaksin hep B.

Bahkan rutin booster untuk hep B ini sebenarnya tidak perlu, karena vaksin hep B berdasarkan penelitian efektif sampe 15 thn, walaupun antibody levelnya menurun. (DaI/WRM)