Is a hepatitis B immunity check needed for IBD patients?
Inflammatory bowel disease (IBD), an autoimmune disease that involves chronic inflammation of tissues in the digestive tract, affects about 1.6 million Americans, including as many as 80,000 children. Treatment guidelines call for patients newly diagnosed with IBD (Crohn's disease and ulcerative colitis) to delay treatment until they can be screened for immunity against the hepatitis B virus and potentially revaccinated.
Patients with celiac disease, another autoimmune disorder that affects the digestive tract in about 2 million Americans, faced similar treatment delays until a 2021 Mayo Clinic study found that immunity testing or revaccination was not needed. Now, a new study confirms and extends that finding to patients with IBD.
In this latest study, researchers found that screening previously vaccinated patients for hepatitis B immunity is not needed and instead recommend a more individualized approach.
"Our initial study aimed to address the issue of inconsistent practices among health care providers with respect to the need for revaccination with the hepatitis B vaccine in patients diagnosed with celiac disease. We aimed to provide evidence-based guidance for health care providers in determining when revaccination is necessary for people with celiac disease, and ultimately improve the quality of care for this patient population," explains Nawras Habash, M.B.B.S., a Mayo Clinic pediatric gastroenterologist. "This new study investigates the same notion but focuses on IBD patients."
Dr. Habash says while the study suggested previously vaccinated individuals' antibody levels decrease over time, there is no evidence this will create an increased risk of hepatitis B among people with IBD compared to healthy people.
"Our goal is to help shape future guidelines and clinical practices, which could reduce the need for unnecessary blood tests and vaccinations, especially for children," he says.
Using data from the Rochester Epidemiology Project from 2000-2019, researchers compared the effectiveness of hepatitis B vaccination in patients with either inflammatory bowel disease or celiac disease versus patients without those diagnoses who were matched for sex, date of birth and date of vaccination. They analyzed infection rates and antibody titers, which assess the presence and amount of antibodies in blood as a measure of immune response across those groups.
The researchers found that hepatitis B infection rates did not increase for patients with either inflammatory bowel disease or celiac disease compared to those without those diseases. They also found that immunity rates as measured by antibody titers declined in both populations over time.
The population included in this study was predominantly white and had low rates of hepatitis B infection. Additional studies are needed in populations with greater infection rates or greater demographic diversity.
The Rochester Epidemiology Project is a Minnesota medical records-linkage system that has linked electronic health record data for research purposes for the past 50 years.
See the paper for a full list of authors, disclosures and funding information.