الفهرس 
Diabetes mellitus
Quasi-experimental studyOnly 14 pages are availabe for public view
 |  | from | 97 |  |  |
| | | from | 97 | | |
Abstract
The decline of anti-HBs titre to unprotective level is common among type 1 diabetic patients. The link between DM and HBV infection necessitates administration of booster doses once the patient turned unprotected. The aim of this study was to assess the response to HBV booster immunization in type-1 diabetic school students with unprotective level of anti-HBs who have been previously vaccinated under the Compulsory Vaccination Program in Egypt.
In the comparative-case-control phase; 260 school students aged 10-17 years old (130 diabetics and 130 healthy non-diabetics) matched for age and sex were included. They were selected from the outpatient clinic of Al-Shatby Pediatric University hospital and Sporting Students Insurance hospital in Alexandria. Screening for anti-HBs yielded 92 diabetics (70.8%) and 78 non-diabetics students (60%) having anti-HBs<10 mIU/ml. Ninty participants(45 diabetic and 45 healthy ones) with anti-HBs < 10 mIU/mlwere included in the quasi-experimental phase after being consented for enrolling in such phase where HBV boosting was applied.
All participants were subjected to anthropometric and laboratory measurements including FBS and quantitative anti-HBs level (mIU/ml) while post-prandial blood sugar (PPBS), HBsAg, total anti-HBc, and anti-HCV were applied to unprotected participants only. A questionnaire was also used to obtain data on socio-demographic criteria, risk factors for viral hepatitis and diabetes mellitus status.
The following results of the quasi-experimental phase were detected:
1. Students aged (12-<14) years constituted the highest percentage (37.8%) among both diabetic and non-diabetic students. The lowest percentage of diabetics (13.3%) was in the age group (14- <16) years and that of non-diabetics (15.6%) was in the age group (10- <12) years. No significant difference was revealed among both diabetic and non-diabetic students as regards gender and residence.
2. Significantly higher percentage of diabetics had positive history of IV injections, hospitalization, and jaundice (68.9%, 27.3% and 8.9%) as compared to non-diabetics (25.0%, 8.9% and 0.0%) respectively.
3. The shortest duration of DM (<2 years) was represented by 22.2% while the longest duration of DM (7-12 years) was represented by 20.0% of the diabetic students.
4. The majority of both studied groups were of normal body weight.
5. Both groups had a similar HBV exposure rate and none of the studied students was HBsAg positive.Only one diabetic student (2.2%) was positive for anti-HCV versus none of the non-diabetic students.
6. Only one booster dose was needed by 80.0% of diabetics compared to 91.1% of non-diabetics while two booster doses were needed by11.1% of diabetics in comparison to 8.9% of non-diabetic students. Four (8.9%) diabetic students needed a third booster dose to reach full protection in comparison to none of the normal students.
7. Comparing the mean titre of anti- HBs among diabetics after the first, second and third booster doses revealed statistically significant difference (P=0.018) while, no significant difference between the mean titre of anti-HBs was revealed among non-diabetic students after the first and second booster doses of the vaccine.
8. BMI and history of hospitalization due to DM were the only significant factors affecting the response to boosting among diabetic students.
9. Incorporating a booster dose of HBV vaccine would be best timed at age of 12 years old for immunocompromised diabetic students while it remains an optional one at the age of 13.5 years old for immunocompetent healthy students.
from the results of the study we concluded that type 1 DM adolescents express hyporesponsivness to HBV vaccination and show more rapid decline of protective anti-HBs compared to healthy ones. The response to HBV vaccine boosting is affected by both BMI and hospitalization due to DM among diabetic vaccines. For obtaining adequate protection against HBV infection among students with unprotective anti-HBs level, one booster dose and two booster doses are needed for healthy and diabetic students respectively.
from the results of the present study we recommended:
• Implementation of HBV vaccine boosting for type 1 diabetic school students during early adolescence (e.g. start of the preparatory school) perhaps as a component of a combination vaccine with a second optional booster dose at the start of the secondary school. If such implementation could not be achieved, frequent measurements of anti-HBs titre among diabetic students should be carried out to quantitate the loss of vaccination efficacy and application of a vaccine booster dose when anti-HBs falls below 10mIU/ml. While a single optional booster dose for healthy students given at start of the preparatory school is sufficient for protection through adulthood.
• Implementation of preventive training programamong diabetic students for safe use of diabetes diagnostic and treatment tools.
• For further research, we recommended longer term follow-up studies examining the need and the proper time of boosting for type 1 diabetic student at the national level with more focused evaluation of the factors lying behind the response to such boosting.