Abstract

PIN, M. et al. Long-term evaluation of inmune response to hepatitis b vaccine in 136 patients undergoing hemodialysis. Nefrología (Madr.) [online]. 2009, vol.29, n.5, pp.415-420. ISSN 1989-2284.

Hemodialysis (HD) patients have an impaired response to hepatitis B (HB) vaccines, and the persistence of immunity, the efficacy of revaccination and the periodicity of postvaccination testing are not well defined. We present the experience during 18 years in an outpatient dialysis center of 136 HD patients who completed a HB vaccination program consisting in 3 doses of 40 µg intramuscular recombinant B vaccine (Engerix-B). In all patients anti-HBs titers were determined annually and in 31 patients every 6 months. Nonresponders patients and responders patients that lost their antibodies (<10 UI/ml) received annually a booster double dose of vaccine. Seventy-four patients (54.4%) developed immunity and the remaining 62 patients were considered nonresponders. When compared both groups, gender and the etiology of chronic kidney disease did not differ between the two groups; nevertheless, nonresponders patients were significantly older than responders. After 1 year of followup, 32% of responders had no detectable anti-HBs levels, and only 18% of patients remained immunoreactive 6 years afer vaccination. The peak anti-HBs titer immediately after completion of the vaccination schedule was found to be a major predictor of maintaining immunity: 75% of patients with anti-HBs titers greater than 1000 IU/ml remained immunoreactive 3 years after vaccination compared to 47% of patients with titers between 100-999 IU/ml (p = 0.08) and 34% of patients with titers between 11-99 IU/ml (p = 0.02). The administration of additional doses of vaccine were effective in 24% of the nonresponders patients, and 69% of them remained seropositive at the end of the 1-year follow up. Repeated booster doses of vaccine in nonresponders patients to the first booster dose afforded seroconversion in 19.6% of the patients. Performing post-vaccination testing every six months it would have allowed to give booster doses of vaccine in 16% of responder patients before the annual period. Conclusion: This current study demonstrates that a HB vaccination schedule with a regular serological followup and repeated booster doses , affords an acceptable seroprotection in HD patients.

Keywords : Hepatitis B; Vaccination; Seroprotection; Hemodialysis.

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