Hepatitis B vaccination in hemodialysis patients: protective level of HBV antibodies could be achieved by the ordinary schedule?

ABSTRACT

Hepatits B vaccine is effective in producing protection against hepatitis B virus [HBV] infection in hemodialysis [HD] patients, but the antibody response is variable, so different vaccine regimens were adopted. The aim of the present work is to assess the immune response to HBV vaccine in 67 HD patients receiving 20 micro g of recombinant HBV vaccine / dose for 3 doses, intramuscularly [IM], at 0, 1, and 6- month intervals, compared with 36 medical staff members in the same unit as control receiving the same regimen. The results showed the presence of anti-HBc antibodies in 34 patients and 11 control subjects, those were exculded from the study so as to assess the effect of the vaccine only and not the natural infection. The antibody response is defined as protective when the level of anti-HBs antibodies exceeds or equals to 10 mlU/ml. The response rate was significantly lower in HD patients [51.5%] than in control subjects [96%] [P= 0.0002]. To months after the last dose of the vaccine the difference in seroprotection rate was insigificant being 62.5% in HD patients versus 66.7% in the control [P = 0.89], while after 6 and 12 months, the difference was statistically significant being 56.3%, 33.3% in HD patients versus 100%, and 100% in the control subjects respectively [P = 0.003, 0.006]. On the whole, the levels of anti-HBs, expressed as geometric mean titres and 95% confidence intervals [GMT [95% Cl]], were non-significantly lower in HD patients 125.64 [58.37-269.99] mlU/ml, than controls 239.67 [137.88-416.63] mlU/ml respectively [P = 0.149]. The gender, age, cause of renal failure, HCV co-infection, duration of HD, HD frequency, dialyzer membrane and dialysate buffer did not show a significant influence on the response to HBV vaccine. There were significant positive correlations between the level of anti-HBs antibodies and both serum albumin and predialysis urea [P = 0.00] indicating the improtant role of malnutrition on the poor response to the vaccine in HD patients. From this study it was concluded that the ordinary three-doses regimen is not enough for protection in a good proportion of HD patients, and other regimens should be assessed