Hepatitis B Immunity in Children on Immunomodulators: Implications From a Pediatric Dermatology Cohort and Review of the Literature.
Roughly 40% of children on immunomodulators lacked hepatitis B immunity
Hepatitis B Immunity in Children on Immunomodulators: Implications From a Pediatric Dermatology Cohort and Review of the Literature.
This study aims to determine the level of hepatitis B virus (hepatitis B virus) immunity in patients who had hepatitis B virus serologic testing prior to starting immunomodulatory medication for dermatologic conditions at a single institution and to review evidence on waning immunity, serologic interpretation, and revaccination.
We performed a retrospective chart review of pediatric and young adult patients initiated on immunomodulatory therapy for dermatologic conditions who had hepatitis B virus serologic testing prior to initiation.
Prior studies demonstrated that antibody-mediated protection is heterogeneous and anti-HBs titers decline over time.
Existing guidelines are largely derived from adult populations.
Evidence regarding revaccination strategies is mixed.
Notably, absence of detectable anti-HBs antibodies does not always equate to loss of immune memory or susceptibility to infection.
Anti-HBs titers are variable and wane over time. Experts agree that patients should receive all recommended vaccinations before starting immunomodulatory therapy and be screened for hepatitis B virus beforehand, based on adult guidelines.
It is uncertain how well these recommendations apply to children, who generally have lower hepatitis B virus risk and prevalence.
Guidance is needed on how to manage pediatric patients without serologic evidence of hepatitis B virus immunity before beginning biologic treatments.