Enhancement of vitamin A combined vitamin D supplementation on immune response to Bacille Calmette-Guerin vaccine revaccinated in Chinese infants

Objective:To investigate whether there is an association between diameter of bacille CalmetteGuerin(BCG)sears and effect of purified protein derivative(PPD)reaction anil to determine whether vitamin A(VA)combined vitamin I)(VD)supplementation influences the immune response to BCG revueeinated in Chinese infants.Methods:A cross-section and 3-month community-randomised trial was conducted.A total of 5 629 infants at 3,6 and 12 months of age in Junan County of China were examined for BCG scar fonnation.Then,597 revuccinated infants were randomly assigned to supplementation(n=307)and control(n=290)groups.The supplementation group were daily assigned to 1 500 IU VA and 500 IU VD for 3 months.Then all infants were subjected to skin test with PPD.Results:The diameter of BCG sears was positively con-elated with diameter of skin indurations of PPD(r=0.17,P<0.05)in the 5 629 infants.The rate of positive response to PP1)was higher in the supplementation group than in the control group(96.1%versus 89.7%,P<0.05,prevalence ratio 1.07.95%CI 1.02-1.12).The prevalence ralio of PPD response for the supplementation group compared with that for the control group was 1.07(95%CI 1.01-1.13)for the males and 1.08(95%CI 1.00-1.17)for the females.For the supplementation group,the males got larger tuberculin induration than the females[(0.73±0.2l)cm versus(0.67±0.20)cm.P<0.05)after intervention.Conclusions:The diameter of BCG scars was effectively correlated with PPD response,which indicates BCG scar formation may be an useful tool Io evaluate the effect of tuberculosis prevention.VA combined VD supplementation may play an immunoregulatory rale in BCG revuecination.This may contribute to the prevention of childhood tuberculosis.

Revaccination after Acute Kidney Injury Associated with Prior COVID-19 Vaccination: Case Report

Background: Acute kidney injury associated with proteinuria has been reported following vaccination against SARS-CoV-2 several times since 2021. Decisions about subsequent revaccination in these patients have been difficult because of the uncertainty of the consequences of doing so, and the absence of publications to help determine whether revaccination may be considered safe or not. Purpose: We present a case report of a 59-year-old Canadian man who developed severe acute kidney injury associated with moderate proteinuria following his first COVID-19 vaccine with the Moderna vaccine (an mRNA vaccine). He required haemodialysis for 2 weeks, which was initiated when his creatinine reached 1002 μmol/l. A kidney biopsy showed changes consistent with acute tubular necrosis. The patient was cautioned that repeat vaccination might result in further kidney injury which might be irreversible. However, he badly wanted to attempt a second COVID-19 vaccination, to facilitate a family vacation across several countries in Europe, at a time when travel restrictions were in place in many countries for persons who had not completed a course of vaccines. Method: Following deliberations, the patient chose to try a different type of Covid-19 vaccine. On this occasion, he was vaccinated with the Novavax vaccine (a subunit COVID-19 vaccine). Following this, close monitoring of his urine to detect proteinuria and blood testing for acute kidney injury were carried out on days 1, 3, 7, and 60 after vaccination. Furthermore, a year after his repeat vaccination, his kidney function and urinalysis were again assessed. Result and Conclusions: The patient did not develop acute kidney injury or worsening proteinuria following repeat vaccination. It remains unclear if acute kidney injury with proteinuria is caused by Covid-19 vaccination, or simply an incidental association. This case report suggests that it is may be reasonable for patients with acute kidney injury after COVID-19 vaccination to consider trying a different type of vaccine. In situations where a new virulent strain of virus emerges or in patients at risk of severe complication from infection, it may be reasonable to consider revaccination following appropriate counselling with close monitoring of renal function.

THREE－YEAR FOLLOW－UP AFTER A SINGLE BOOSTER DOSE OF VACCINE IN THE NONRESPONDERS AND HYPORESPONDERS TO HEPATITIS B VACCINE

Immuuoresponsiveness of revacclnation in nonresponders and hyporesponders to hepatitis B vaccine was evaluated.10 nonresponders and kyporesponders as well as 18 normal responders to the primary vaccination were offered a 10μg dose or blood-derived vaccine in May 1989,three years after a 3-dose primary vaccine schedule,and were rollowed up and checked at 2,6,12 and 36 months after the booster dose.The results showed that Anti-HBs titre increased in both poor and normal responders,but the antibody level in nonresponders and hyporesponders was lower and the duration of persistence was much shorter,while the antibody GMT in normal responders remained above protective level at 36 months arter revaccination.Thererore,it is difficult to say,according to the data,that revaccination can satisfactorily boost anti-HBs level in the poor responders.

INTRAMUSCULAR VERSUS INTRADERMAL HEPATITIS B REVACCINATIONIN HEALTHY NON-RESPONDER CHILDREN: A 5-YEAR PROSPECTIVE RANDOMIZED STUDY

Objective With the same times of injection to compare low-dose intradermal regimen with routine-dose intramuscular inoculation in revaccination of non-responders to hepatitis B vaccine. Methods 40 healthy non-responder children collected by screening were administrated a three-dose revaccination randomly by intramuscular or intradermal route (10vs 2g per dose), and regularly tested for serologic markers up to five years. By the end of follow-up, a booster dose (5μg) was given to those who had lost anti-HBs of ≥10mIU/mL (seroprotection) and anamnestic response was estimated thereafter. Results All 17 intramuscular and 22 of 23 intradermal children effected seroprotection after revaccination. Intradermal children lost seroprotection over time significantly rapider compared with intramuscular children (Log Rank test, P= 0.029). In year 5, 50% of intramuscular but only 18.2% of intradermal children still maintained seroprotection (P=0.075). 12-14 days after the booster dose, all the eight intramuscular children developed an anamnestic response with anti-HBs titer increasing greater, but two of the 18 intradermal children failed to mount seroprotective level. Conclusion Three-routine-dose intramuscular revaccination was significantly effective than low-dose intradermal one with the same times of injection, especially in long-term immunity. We recommend routine-dose intramuscular protocol in revaccination of non-responders.

Efficacy and safety of COVID-19 vaccination in patients with cirrhosis

BACKGROUND The clinical efficacy and safety of vaccination against novel coronavirus disease 2019(COVID-19)in patients with cirrhosis have not been evaluated yet.AIM To evaluate the clinical efficacy and safety of vaccination against COVID-19 in patients with cirrhosis.METHODS This was a retrospective cohort study of patients with cirrhosis.The first cohort included patients vaccinated with Gam-COVID-Vac(Sputnik V);the second one consisted of unvaccinated controls.RESULTS The study included 89 vaccinated patients and 148 unvaccinated ones.There were 4 cases of COVID-19 in the vaccinated group and 24 cases in the unvaccinated group(P=0.035).No severe cases of COVID-19 were revealed in the vaccinated group,while there were 12 ones in the unvaccinated group(P=0.012)with 10 deaths detected(P=0.012).The vaccine efficacy was 69.5%(95%confidence interval[CI]:18.5%-94.4%)against symptomatic cases of COVID-19,100%(95%CI:25.1%-100.0%)against severe cases,and 100%(95%CI:1.6%-100.0%)against death associated with COVID-19.The efficacy of full vaccination with revaccination against symptomatic cases of COVID-19 was 88.3%(95%CI:48.0%-99.6%).The overall mortality rate was higher in the unvaccinated group than in the vaccinated group(17.1%vs 3.0%;P=0.001).Higher Child-Turcotte-Pugh class cirrhosis(hazard ratio[HR]=4.13,95%CI:1.82-9.35)and higher age(HR=1.08,95%CI:1.04-1.15)were independent predictors of overall mortality,while vaccination had a protective effect(HR=0.09,95%CI:0.01-0.76).There was no significant difference in liver-related mortality(P=0.135)or the incidence of liver decompensation(P=0.077),bleeding esophageal varices(P=0.397),and vascular events(P=0.651)between the two groups of patients.CONCLUSION Vaccination against COVID-19 in patients with cirrhosis is effective and safe.

SIX-YEAR EFFICACY OF HEPATITIS B REVACCINATION:A DOUBLE-BLIND,PLACEBO-CONTROLLED AND RANDOMIZED FIELD TRIAL

in order to observe the efficacy or a booster dose of hepatitis B vaccine, ic4 primaryschool children with a good response were enrolled in a double-bind, placebo-controlled and randomized field trial three years after the primary vaccination. At the end of the 6-year follow-up anti-HBspositive rate and GMT (of S/N value) In the revaccinated group were 54. 5% and 12. 0. still higherthan those in the control group (40. 5 % & 4. 8), but the difference of the positive rates was not statistically significant this time. Anti-HBs I,osltlve rate and GMT not only in the control group but inthe revaccinated group had dramatically declined against those 3 years arter the revaccination (thecontrol group: 69. 4 % & 20. 6 1 the revaccinated group: 87' 8% & 43. 3) (P < 0. of ). The higher anti-HBs titer before the revaccination, the better the persistence of anti-HBs after the revaccination.HBV infection rate (calculated by person-year) In the revacclnated group was l' 44%, without statistical difference from 3. 19% In the control group (P > 0. 05) as before. Considering the perfect longterm efficacy of hepatitis B vaccine, we concluded that a booster dose 9 years arter the primary immunization seems unnecessary.