Seroprotection after hepatitis a vaccination in patients with drug-induced immunosuppression

J Travel Med. 2013 Sep-Oct;20(5):278-82. doi: 10.1111/jtm.12050. Epub 2013 Jul 9.


Background: Increasing numbers of travelers using immunosuppressive drugs visit hepatitis A endemic countries. Data on protection rates after hepatitis A vaccination in this group are scarce.

Methods: In this retrospective study, records of subjects with hepatitis A serology taken after vaccination were searched for in travel clinic databases. Relation between immunosuppressive drug use, age, gender, and time between vaccination and serology was evaluated.

Results: Seroprotection rates within 4 weeks after primary vaccination (50%) are lower than after 4 weeks (64%). After the complete series of two vaccinations seroprotection rates reach 95% although success depends on the immunosuppressive drug being used. Subjects under anti-TNF alpha treatment have significantly lower seroprotection rates than subjects using classical immunosuppressive drugs after the second vaccination. There is no influence of age or gender on seroprotection rates.

Conclusions: Last-minute vaccination in subjects using immunosuppressive medication is not reliable, only 60% of our subjects had a protective antibody level after a single vaccination. When serology was done within 4 weeks after a single vaccination, seroprotection rates were only 50%, after 4 weeks this number rose to 64%. When persons visit a travel clinic in time for a complete vaccination series, satisfactory seroprotection rates can be reached. Seroprotection rate depends on the drug being used, persons using anti-TNF alpha are less protected.

MeSH terms

  • Adult
  • Aged
  • Female
  • Hepatitis A Vaccines / therapeutic use*
  • Hepatitis A Virus, Human / immunology
  • Hepatitis A* / immunology
  • Hepatitis A* / prevention & control
  • Humans
  • Immunocompromised Host* / drug effects
  • Immunocompromised Host* / immunology
  • Immunosuppression Therapy / methods
  • Immunosuppressive Agents* / classification
  • Immunosuppressive Agents* / therapeutic use
  • Logistic Models
  • Male
  • Middle Aged
  • Netherlands
  • Retrospective Studies
  • Risk Assessment / methods
  • Travel*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Vaccination / methods
  • Vaccination / statistics & numerical data


  • Hepatitis A Vaccines
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha