Syed Shah Hassan, Ahmad Zunnoor, Sarah Sherazi, Hafiz Tariq Rafiq, Israr Bashir, Ammad-ul Islam, Amir Shahzad, Ali Imran, Mujahid Hussain, Sahibzada Syed Masood-us-syed.
Predictors of Impaired Immune Response to Hepatitis B Vaccine in Children under 5 Years of age at Sialkot, Pakistan.
Pak Paed J Jan ;41(4):229-38.

Objective: To find out the predictors of impaired immune response to primary hepatitis B vaccine in children (aged ? 5 years) Design and setting: This cross-sectional study was conducted between May and June, 2015 after getting approval from ethics committee of Govt. Sardar Begam Teaching Hospital, Sialkot, Pakistan. Methodology: Sixty (60) hepatitis B vaccinated children (aged ? 5 years) having endorsed EPI record were recruited from different areas of District Sialkot using 2-stage cluster sampling technique. Documentation of baseline information was followed by blood sampling for estimation of anti-HBs titer though ELISA kit. Results: Of 60 blood samples, 56 i.e. 93.3% (excluding hemolysed samples) showed sero-conversion while 27 (48.2%) had sero-protection. However, comparatively higher sero-protection rate (60%, n = 12) was found in females. Descriptive statistics revealed mean (M) immune response of 80.76 (SD = 117.34) IU/L. Significant decrease in the response was observed with increasing age group (p = 0.0001). A malnourished child was at 5 times more risk of lowered antibody concentration than well-nourished children (RR = 5.35; 95% CI: 2.126 ? 13.479; p = 0.0001). Similarly, the possibility of poor response was approximately 5-fold in a child of smoker parents (RR: 4.84; 95% CI: 2.174 ? 10.783; p = 0.0001) compared to non-smokers. However, insignificant association was found between immunity and socio-economic status (p ?.05). Conclusion: Long post-vaccination time, malnutrition, and smoker parents are the predictors for impaired immune response to hepatitis B vaccine in the children. The risk factors deserve public awareness for increased anti-HBs titer.

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