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Alam El-Din, et al., J Blood Disord Transfus 2012, S1 DOI: 10.4172/2155-9864.S1-008

Open Access

ISSN: 2155-9864 JBDT, an open access journalHematologic Oncology: Diagnosis & TherapeuticsJ Blood Disord Transfus

*Corresponding author: Hanaa M Alam El-Din, Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Fom El-Khalig, Cairo 11796, Egypt, Tel: +20122721081; Email: Halam63@hotmail.com

Received October 03, 2011; Accepted February 07, 2012; Published February 13, 2012

Citation: Alam El-Din HM, Loutfy SA, Abdel-Rahman H, Ali Eldin NH, Ahmed Madani HA, et al. (2012) Measles, Mumps, Varicella Zoster, Diphtheria and Hepatitis B Surface Antibody Status in Pediatric Acute Leukemic Patients. J Blood Disord Transfus S1:008. doi:10.4172/2155-9864.S1-008

Copyright: 2012 Alam El-Din HM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Measles, Mumps, Varicella Zoster, Diphtheria and Hepatitis B Surface DHanaa M Alam El-Din1*, Samah Aly Loutfy1, Hany Abdel-Rahman2, Nelly H. Ali Eldin3, Hanan Ali Ahmed Madani4 and Mohamed Sedky51Virology and Immunology Unit, Cancer Biology Department2Pediatric Oncology Department3Biostatistics & Cancer Epidemiology Department, National Cancer Institute 4Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Egypt5Pediatric Department, National Research Center, Egypt

AbstractBackground and Aim: This is a preliminary study to evaluate the levels of protective antibodies against

some of the vaccine preventable diseases, as a part of the nationwide vaccination program, in Acute Lymphocytic Leukemic children (ALL) and in their non cancer controls of matched age and sex.

Methods: Serum antibody levels of measles, mumps, Varicella zoster, diphtheria, and hepatitis B surface antigen were evaluated by ELISA technique in 120 children with ALL as well as in 60 children with no malignancy as a control group.

Results: A protective serum antibody level to measles, mumps, Varicella zoster, diphtheria and hepatitis B were detected in 53%, 14%, 38%, 83% and 72%, respectively of leukemic children irrelevant to phase of treatment compared to 53%, 20%, 40%, 75% and 67%, in the controls.

Seropositivity rate of diphtheria was not found to be related to age in both ALL patients and controls. A significant decline in seropositivity rate to antiHBs with age in both leukemic and their controls was observed (p=0.02, 0.015 respectively).

On multivariate analysis, seropositivity of varicella and mumps was positively dependent on age (P

Citation: Alam El-Din HM, Loutfy SA, Abdel-Rahman H, Ali Eldin NH, Ahmed Madani HA, et al. (2012) Measles, Mumps, Varicella Zoster, Diphtheria and Hepatitis B Surface Antibody Status in Pediatric Acute Leukemic Patients. J Blood Disord Transfus S1:008. doi:10.4172/2155-9864.S1-008

Page 2 of 5

ISSN: 2155-9864 JBDT, an open access journalHematologic Oncology: Diagnosis & TherapeuticsJ Blood Disord Transfus

newly diagnosed patients, 41 patients under chemotherapy and 39 were under follow up.

Sixty subjects who were free of haematological, immunological, or malignant diseases matched for age and sex were included in the study as controls. They were recruited from general paediatric hospital Abu el Rish within the same draining region as National Cancer Institute. The Institutional Review board (IRB) of NCI approved the protocol. Informed written consent was obtained from guardians of all children enrolled in the study. Ages of both study groups ranged between 12 months and 16 years old of both sexes treated from Acute Lymphoblastic Leukaemia (ALL).

ALL Patients were subjected to a battery of investigations for diagnostic purposes and specific investigations. They were treated according to the Total Therapy Study XV protocol adopted from St. Jude Children Research Hospital [12].

All patients and controls had been previously vaccinated according to the Egyptian national compulsory vaccination program at ages 2, 4, 6 and 18 months to Diphtheria, and hepatitis B virus surface antigen and at age 12 months to measles. Varicella zoster vaccine is not included in the Egyptian vaccination program and it is given on facultative bases. Measles vaccine has been included since 1977, Hepatitis B (HB) vaccine has been added to vaccination schema since 1992 using recombinant variant and booster dose for MMR was introduced at 15 month and 6 years since 1991 [13].

Laboratory methods

Five ml venous blood was withdrawn from each subject under study and sera were separated in aliquots and stored at -20C till examined.

Antibody levels against measles, mumps, Varicella zoster, diphtheria and hepatitis B surface antigen were measured in each subject by ELISA test.

Determination of measles, mumps, Varicella zoster antibodies

Qualitative and semi quantitative determination of IgG-class antibodies to Measles, Mumps and Varicella zoster was performed by DRG ELISA Kit (Marburg, Germany) according to the manufacturers instructions. Negative, cut-off and positive controls were run in each assay. The antibody level was expressed as DRG Units (DU) according to the following equation:

( ) ( )Patient absorbance value x 10 DRG Units DU

CO cut off= =

The cut off value of the test was 10 DU. The individual is considered negative if antibody level is < 9DU and positive when antibody titre is >11DU [14].

Determination of diphtheria antibody

Quantitative determination of IgG antibodies against Diphtheria toxoid in serum was performed using RIDASCEEN ELISA assay kit (K3821) (Darmstadt, Germany) according to manufacturers instructions. Negative, standard, and positive controls were run in each assay. The antibody level was expressed as IU/ml according to the enclosed table of values. The results were interpreted as follows: 2 IU/ml to be checked after 10 years [15].

Determination of antibody against Hepatitis B virus surface antigen

Quantitative determination of anti HBs in serum was carried out by DiaSorin ELISA kit (Saluggia, Italy) according to manufacturers instructions. Negative control, calibrators from 1 to 4 were included in each assay. The antibody level was expressed as IU/ml and was obtained directly from the calibration curve. The results were interpreted as in table 1.

Statistical analysis

SPSS (Chicago, IL, USA) version 12.0 was used for data management. Median and ranges described quantitative data. Chi-square and Fisher exact tested proportion independence. Factors which thought influencing seropositivity (as detected or not detected) included study groups (4 groups as 3 ALL groups and one control), gender and age categories were the predictor variables in multivariate logistic regression analysis. Seropositivity was tested for the 5 vaccine preventable diseases independently. Odds ratio with 95% confidence interval expressed the likelihood of seropositivty adjusted for age, gender and phase of treatment. P value is significant at 0.05 level.

ResultsMedian ages of leukemic children were 6.5 (1-12) years for newly

diagnosed, 7(1-15) years for those under chemotherapy and 8 (3-13) years for cases during follow up. Median age of non malignant control group was 6 (1.9-15) years. Male to female ratio was 1:1.66 and 1:1.2 in ALL patients and control group, respectively.

Anti-HBs concentration after basic immunization Recommended time for revaccination

below 10 IU/L Immediately 10-100 IU/L after 3-6 months 100-1,000 IU/L after one year 1,000-10,000 IU/L after 3.5 year Above 10,000 IU/L after 7 years

Antibody level of 10 IU/L was the clinically recognized immunity threshold (minimal protective level) according to the recommendations of the CDC Immunization Prac-tices Advisory Committee (MMWR, 40 RR13:1-25, 1991) [16].

Table 1: The level of anti-HBS and recommended time for revaccination.

Variables New casesN=40

Chemother-apycasesN=41

Follow up casesN=39

TotalN=120

Age Years (Me-dian, range) 6.5 (1-12) 7 (1-15) 8 (3-13) 7 (1-15)

SexMale 26 26 23 75Female 14 15 16 45M:F ratio 1:1.85 1:1.7 1: 1.4 1:1.66CBC (Median, range)Hb (g/dl) 10.2 (4-14.8) 11.1 (7-14) 12.4 (6.5-14.9) 11.3 (4-14.9)TLC (x109/l) 4.3(0.23-204) 3.8 (2.9-9.2) 7 (2.74-26.7) 5.5 (0.23-204)ANC (x109/l) 1.9(0-16.3) 1.4(0.05-5.9) 2.8(0.80-6.9) 2.4(0-16.3)Lym (x109/l) 1.6(0-8.8) 1.4(1-4.3) 2(0.89-19) 1.7(0-19)Mono (x109/l) 0.5(0-1.4) 0.3(0.04-1.8) 0.7(0.2-1.8) 0.6(0-1.8)Plt (x109/l) 84(8-495) 242(32-3350) 323(42-550) 250(8-3350)

CBC: Complete Blood Count; Hb: Hemoglobin Concentration; TLC: Total leukocytic Count; ANC: Absolute Neutrophilic Count; Lym: Lymphocytes; Mono: Monocyte; Plt: Platelet Count

Table 2: Demographics and Laboratory findings of the pediatric ALL.

http://dx.doi.org/10.4172/2155-9864.S1-008http://dx.doi.org/10.4172/2155-9864.S1-008

Citation: Alam El-Din HM, Loutfy SA, Abdel-Rahman H, Ali Eldin NH, Ahmed Madani HA, et al. (2012) Measles, Mumps, Varicella Zoster, Diphtheria and Hepatitis B Surface Antibody Status in Pediatric Acute Leukemic Patients. J Blood Disord Transfus S1:008. doi:10.4172/2155-9864.S1-008

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ISSN: 2155-9864 JBDT, an open access journalHematologic Oncology: Diagnosis & TherapeuticsJ Blood Disord Transfus

Clinical and laboratory findings of leukemic chil

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