Hepat Mon. 2011;11(1):32-35 Journal home page: www.HepatMon.ir KOWSAR The effect of zinc sulfate on immunologic response to recombinant hepatitis B vaccine in elderly Mandana Afsharian 1, Siavash Vaziri 1, Ali Reza Janbakhsh 1, Babak Sayad 1, Feizollah Mansouri 1*, Javad Nourbakhsh 1, Keyghobad Qadiri 2, Farid Najafi 3, Maria Shirvanii 1 1 Kermanshah Liver Disease and Hepatitis Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran 2 Kermanshah Infectious Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran 3 Kermanshah Health Research Center (KHRC), Kermanshah University of Medical Sciences, Kermanshah, IR Iran A R T I C L E I N F O Article Type: Original Article Article history: Received: 27 July 2010 Revised: 01 Sep 2010 Accepted: 07 Sep 2010 Keywords: Hepatitis B Vaccination Zinc sulfate Immunity A B S T R A C T Background: Hepatitis B is the major cause of chronic hepatitis and cirrhosis in Iran. Sanitation and immunization is one of the most effective measures for prevention of the disease which is now wide- ly used in developing countries. However, the immune response to the vaccine varies by age. Objectives: To determine the effect of zinc sulfate on immune response to hepatitis-B vaccine in eld- erly. Patients and Methods: In a clinical trial on 140 subjects aged ≥40 years with a body mass index (BMI) <30 kg/m2, and without any co-morbid disease were recruited. Those who had negative hepatitis B core antibody (102 persons) were randomly allocated to two groups. The trial group received hepa- titis B vaccine plus 200 mg zinc sulfate daily for 30 days and the control group received vaccine plus placebo. Results: 52 of 102 people were female (51%). The two studied groups were comparable in terms of age, gender, and smoking habits. The mean antibody production in the intervention and control groups was 116.93 and 157.37 mIU/mL, respectively (p=0.22). No statistical differences were observed between the two groups in terms of proportion of people who were protected after vaccination (26.0% and 36.5% in people with and without zinc, respectively). Conclusions: This study revealed that zinc sulfate has no effect in level of immunity among elderly. c 2011 Kowsar M.P.Co. All rights reserved. Implication for Health policy/practice/research/medical education: This article shows the effect of adding trace elements in response to routine vaccination program against hepatitis B virus. Reading this article is recommended especially for the personnel involved as primary health car workers. Please cite this paper as: Afsharian M, Vaziri S, Janbakhsh AR, Sayad B, Mansouri F, Nourbakhsh J, et al. The effect of zinc sulfate on immunologic response to recombinant hepatitis B vaccine in elderly. Hepat Mon. 2011;11(1):32-35. Background Hepatitis B is a major public health problem with two billion people infected worldwide (1). HBV is the most important cause of viral hepatitis in the world that can cause cirrhosis and liver cancer. More than 350 million people are chronic carriers of HBV and approximately 75% of them live in Asia and Africa (2). Two million people die of the disease annually in the world (3). The major routes of HBV transmission are via blood transfusion and hemodialysis, dental surgery, tattooing and drug abuse (IDU). About 1.5 million people in Iran are living with HBV infec- tion (2). The prevalence of infection in Iran is estimated to be 2.14% in men and 2.55% in women. However, the prevalence of people with positive HBsAg varies between different provinces: Golestan (6.3%), Tehran (2.2%), East Azerbaijan (1.3%), Hamadan (2.3%), Isfahan (1.3%), Kermanshah province (1.3%) and Hormoz- gan (2.4%) (4). It has been reported that the prevalence of people with positive HbsAg in Iran decreased from 2003 to 2005 (5). Vac- * Corresponding author at: Feizollah Mansouri, Kermanshah Liver Disease and Hepatitis Research Center, Kermanshah University of Medical Sciences, Kermanshah, IR Iran. Tel: +98-831-427-6342, Fax: +98-8314276315. E-mail address: fmansoury@yahoo.com c 2011 Kowsar M.P.Co. All rights reserved. cination is one of the most effective way of preventing disease, decreasing disability, and death from all infectious diseases (6). It seems that in endemic regions hepatitis B vaccination have a significant effect on reducing the chronic infection and carrier state, but may not reduce the infection rate (7). However, the im- mune response to the vaccine is age dependent. Different stud- ies as well as meta-analyses have shown that immune response to vaccines decreases by increasing age. This is why hospital ad- mission rate has been increasing in elderly people. According to such studies between10% and 50% of the old age people can- not be protected even after vaccination (6). In order to improve the immunogenicity of vaccination, different methods such as changes in vaccination method and adding supplements such as, levamisole, cimetidine, zinc sulfate and some other drugs have been investigated (8). Objectives This study was conducted to evaluate the effect of zinc sulfate as an adjuvant to increase the level of antibody production after hepatitis B vaccination in elderly.