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Effect of type 2 diabetes mellitus on efficacy of hepatitis B vaccine and revaccination strategy

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Author(s): Wen-shu LI | Zhen-man WEI | Lan-ping CAI | Li TANG | Hong-ye REN | Hai-bin WANG | Ya LI | Yu-lai ZHAO

Journal: Medical Journal of Chinese People's Liberation Army
ISSN 0577-7402

Volume: 36;
Issue: 10;
Start page: 1068;
Date: 2011;
Original page

Keywords: hepatitis B | chronic;diabetes mellitus | type 2;immunotherapy | active

ABSTRACT
Objective To investigate the effects of type 2 diabetes mellitus on vaccination efficacy of hepatitis B vaccine,and explore the effective revaccination strategy.Methods Seventy-six adults with type 2 diabetes mellitus and 70 sex-and age-matched healthy individuals from 4 vaccination centers,who were vaccinated for one standard schedule(month 0,1,6) with gene recombinant yeast hepatitis B vaccine,were enrolled in present study.The serum anti-HBs and geometric mean titer(GMT) thereof were assayed before and month 1,12,24 after completion of one standard schedule of vaccination.The profiles of serum cytokines including interferon-γ(IFN-γ),interleukin(IL)-2,-4 and-10 were determined before and after vaccination.To improve the vaccine efficacy of non-or lower-response patients with type 2 diabetes mellitus,a dose of 20μg gene recombinant yeast hepatitis B vaccine were used to revaccinate intramuscularly or subcutaneously plus intramuscularly.Results One month after completion of one standard schedule of vaccination,the positive conversion rates of anti-HBs in diabetes mellitus group and healthy group were 98.6 and 92.1%(P < 0.05),the anti-HBs GMT were 106.78 mU/ml and 167.14 mU/ml(P < 0.01),and the non-or lower-response rate were 19.7% and 7.1%,respectively(P < 0.05).The mean levels of serum IFN-γ,IL-2 and IL-4 were lower in diabetes mellitus group(P < 0.05 or P < 0.01),especially in non-or lower-response individuals,than in healthy group before and after a standard schedule of vaccination.Patients with non-or lower-response type 2 diabetes mellitus received revaccination with 20μg hepatitis B vaccine,the positive conversion rates of anti-HBs were 60.0% and 73.3%,respectively(P < 0.05),when injected subcutaneously plus intramuscularly or only intramuscularly.Conclusions Type 2 diabetes mellitus could influence the vaccination efficacy of hepatitis B vaccine,probably through a mechanism of down-regulating Th1 and Th2 mediated immune response.Revaccination with 20μg gene recombinant yeast hepatitis B vaccine subcutaneously plus intramuscularly can successfully improve the vaccination efficacy.
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