Hepatitis B virus infection in chronic uremia: long-term follow-up of a two-step integrated protocol of vaccination.
Active immunization is crucial for eradicating hepatitis B virus infection from dialysis units. A prospective study was performed in 63 consecutive chronic uremic patients, which included the following: (1) the intramuscular (IM) administration of 40 micrograms of a DNA-recombinant vaccine (Engerix-B, Smith Kline & French Laboratories, Milan, Italy) to all chronic uremic patients at 0, 1, 2, and 6 months; (2) the antibody titer determination at the seventh month (chronic uremic patients with a titer > 100 mIU/mL received an IM booster dose of 40 micrograms at 18 months [group A], and those with a titer < 100 mIU/mL received a further IM dose of 40 micrograms at 12 months [group B]); and (3) the intradermal inoculation of 5 micrograms of vaccine every 2 weeks until the protective titer (> or = 10 mIU/mL) was achieved, and then monthly for 6 months, in chronic uremic patients who did not have a protective titer even after 19 months (group C). Thus, 41, 17, and five chronic uremic patients were allocated to groups A, B, and C, respectively. All developed a protective titer: 79.4%, 84.0%, and 87.5% after the fourth, fifth, and sixth IM dose at 7, 13, and 19 months, respectively. Five chronic uremic patients (group C) achieved seroprotection after 3.8 +/- 0.5 (SEM) intradermal inoculations.(ABSTRACT TRUNCATED AT 250 WORDS)
Marangi
A L
AL
Division of Nephrology, Hospital of Martina Franca, Italy.
Giordano
R
R
Montanaro
A
A
De Padova
F
F
Schiavone
M G
MG
Dongiovanni
G
G
Basile
C
C
D002908:Chronic Disease; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000096:biosynthesis; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007117:Immunization, Secondary / Q000379:methods; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D014511:Uremia / Q000150:complications* / Q000276:immunology / Q000628:therapy; D014611:Vaccination / Q000379:methods*
D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines