Successful vaccination with intradermal hepatitis B vaccine in hemodialysis patients previously nonresponsive to intramuscular hepatitis B vaccine.
Seventy-seven chronic hemodialysis patients were vaccinated against hepatitis B virus with an intramuscular (im) hepatitis B vaccine (HBV), 40 micrograms at 0, 1, 2, and 6 months. Fifty-seven patients (74%) developed antibodies (anti-HBs). The im-responsive patients were significantly younger than the nonresponsive patients (P < 0.05). Nineteen of the 20 im nonresponders received HBV intradermally (id), 5 micrograms every 2 wk until anti-HBs developed; the 20th patient died before receiving the id vaccine. Three patients were lost to follow-up. Fifteen (94%) of the 16 developed anti-HBs after 5.2 +/- 4.7 months. The peak anti-HBs titers were 726 +/- 426 (im) and 211 +/- 260 (id) IU/L (P < 0.05). Twelve (21%) of the 57 im-responsive patients and 8 (53%) of the 15 id-responsive patients had anti-HBs less than 20 IU/L at 18 and 8 months postvaccination, respectively (P < 0.05). Further preliminary data indicate that more prolonged id vaccination can increase both the titer and the duration of anti-HBs in im-nonresponsive patients.
Waite
N M
NM
St. Michael's Hospital, Toronto, Ontario, Canada.
Thomson
L G
LG
Goldstein
M B
MB
D000328:Adult; D000368:Aged; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000096:biosynthesis*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D006801:Humans; D007115:Immunization Schedule; D007117:Immunization, Secondary; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014611:Vaccination / Q000379:methods*; D014614:Vaccines, Synthetic / Q000008:administration & dosage / Q000276:immunology*
C075654:Engerix-B; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic