[Vaccination against hepatitis B virus. Value of intradermal administration in dialysed patients non responsive to intramuscular approach].
OBJECTIVE
Approximately 16-27% of dialysis patients (DP) have no detectable antibodies after 5 intramuscular injections of hepatitis B vaccine and represent a group at high risk to contract hepatitis B virus. We report the efficacy of the intradermal route of a recombinant hepatitis B vaccine (r-HBV) in non-responsive dialysis patients in our dialysis unit.


METHODS
Intradermal vaccinations were performed in 20 dialysis patients (mean age 62 years) non-responsive to the intramuscular injections (mean 6.8). Five micrograms of r-HBV (Engerix B, SK and F) were administered intradermally every two weeks (maximum 70 micrograms) until a level of anti-HBV antibodies (anti-HBs) arbitrarily choosen of > or = 230 mUI/ml was attained. Anti-HBs was determined after the fourth and subsequent intradermal injections (IMX, Abbott).


RESULTS
Fourteen dialysis patients (70%) developed anti-HBs > 10 mUI/ml (geometric mean titers of 330 mIU/ml). Among these, 9 developed seroprotective levels before the fifth injection. Five patients developed anti-HBs > or = 1000 mUI/ml and 6 others developed anti-HBs > or = 230 mUI/ml. After the intradermal injections were discontinued, 11 patients were monthly monitored for at least 3 months, and 6 for one year. The geometric mean antibody level was at 3 months: 157 (n = 11), at 6 months: 122 (n = 8), at nine months: 117 (n = 6), and at 12 months: 66 mIU/ml (n = 6). The age and the sex, haemodialysis duration, albumin levels or treatment by erythropoietin did not seem to play a role in appearance of anti-HBs.


CONCLUSIONS
Our experience in 20 dialysis patients shows that repeated low-dose intradermal injections resulted in long-term seroprotection in a substantial number of dialysis patients non-responsive to the intramuscular vaccinations.
Poux
J M
JM
Service de Néphrologie, ALURAD, Limoges.
Ranger-Rogez
S
S
Lagarde
C
C
Benevent
D
D
Denis
F
F
Leroux-Robert
C
C
D000328:Adult; D000368:Aged; D005260:Female; D006508:Hepatitis Antibodies / Q000032:analysis; D006509:Hepatitis B / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D006435:Renal Dialysis / Q000009:adverse effects*; D017211:Treatment Failure
D006508:Hepatitis Antibodies; D017325:Hepatitis B Vaccines
Vaccination contre le virus de l'hépatite B. Intérêt de l'administration intradermique chez les dialysés non répondeurs par voie intramusculaire.