SECONDARY IMMUNE-RESPONSE TO HEPATITIS-B VIRUS-VACCINE IN ALCOHOLICS

The efficacy of full vaccination against hepatitis B virus (i.e., incl uding the 1-year booster injection) was evaluated in 28 alcoholic pati ents with minimal liver disease. Although such patients are reportedly poor responders, the proportion of those protected (anti-HBs titer > = 10 mIU/ml) rose from 42.8% after primary immunization to 82% after t he booster. The mean anti-HBs titer, which remained low in the overall group, was significantly lower in the subjects who resumed drinking d uring the follow-up period than in those who did not. This suggests a direct influence of alcohol itself on the response, because none of ou r patients had cirrhosis and none were clearly malnourished. Among the 17 patients for whom the 2-year post-booster anti-HBs titer could be determined, all those with a 1-month postbooster titer above 1000 mIU/ ml still had a high anti-HBs level (>100), whereas 80% of those with a 1-month postbooster titer <1000 had 2 years later only a low (<100) o r even an unprotective anti-HBs level; this means that only the latter should be considered for a new booster injection. Our data indicate t hat protection against hepatitis B virus can be achieved in a good pro portion of alcoholics with a full vaccination protocol. We suggest tha t efficacy should be evaluated 1 month after the booster, and that pat ients with low postbooster anti-HBs titers should be tested at regular intervals, because they can also be protected provided an adapted sch edule of further injections is conducted.