title: Efficacy and side effects of intradermal hepatitis B vaccination in CAPD patients: a comparison with the intramuscular vaccination.
abstract: BACKGROUND
  This prospective randomized study aims to assess the effectiveness of intradermal (ID) hepatitis B virus (HBV) vaccination in patients on continuous ambulatory peritoneal dialysis (CAPD) therapy.
  
  
  METHODS
  Sixty patients were randomly divided into 2 groups. The ID group was treated with 5 microg of recombinant HBV vaccine intradermally every week for a total of 10 doses, and the intramuscular (IM) group, with 20 microg intramuscularly at 0, 1, and 6 months.
  
  
  RESULTS
  ID HBV vaccination was associated with a greater seroconversion rate (81.5% versus 62.1%), although the difference did not reach statistical significance (P = 0.14). The cumulative seroconversion rate was significantly greater with ID vaccination by 6 months after the first vaccine dose (P = 0.03). There was no difference between the 2 groups in time required to convert, peak antibody to HBV surface antigen (anti-HBs), and proportion of patients with anti-HBs levels maintained at greater than 10 mIU/mL or 100 mIU/mL in the 2-year observation period. Although the ID group achieved a peak anti-HBs titer significantly earlier than the IM group (P = 0.001), we found a significant trend for the ID group to achieve a lower peak anti-HBs titer (chi-square test for trend, P = 0.005). The incidence of local reactions was significantly greater with ID immunization; however, reactions were mild and transient.
  
  
  CONCLUSIONS
  ID HBV vaccination is associated with significant improvement in seroconversion rate in CAPD patients at 6 months, but this difference diminishes at 2 years. Larger studies are warranted to confirm this finding.
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China People's Republic of China.
authors.forename: Ka Foon
authors.initials: KF
authors.lastname: Chau
authors.forename: Yuk Lun
authors.initials: YL
authors.lastname: Cheng
authors.forename: Dominic N C
authors.initials: DN
authors.lastname: Tsang
authors.forename: Koon Shing
authors.initials: KS
authors.lastname: Choi
authors.forename: Kim Ming
authors.initials: KM
authors.lastname: Wong
authors.forename: Wai Leung
authors.initials: WL
authors.lastname: Chak
authors.forename: Yiu Han
authors.initials: YH
authors.lastname: Chan
authors.forename: Chun Sang
authors.initials: CS
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006510:Hepatitis B Antibodies / Q000096:biosynthesis; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D006801:Humans; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011446:Prospective Studies
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines