Low dose intradermal versus high dose intramuscular hepatitis B vaccination in patients on chronic hemodialysis.
Patients with end-stage renal disease on hemodialysis (HD) are at high risk for hepatitis B infection. We randomly assigned 86 new patients on HD to receive either 40 microg intramuscular (group 1) or 20 microg intradermal (group 2) recombinant hepatitis B vaccine, in three doses at 0, 1, and 4 months. All patients were seronegative at baseline for hepatitis B surface antigen (HBs-Ag), hepatitis B surface antibody (HBs-Ab), and hepatitis B core antibody (HBc-Ab). HBs-Ab seroconversion rate and antibody titer (ELISA assay) were compared in 27 patients of group 1 and 35 patients of group 2 at 1 month, and in 20 patients of group 1 and 26 patients of group 2 at 6 months after the last vaccine dose. The seroconversion rates (HBs-Ab titer >10 IU/L) were 55.6% and 50% in group 1, and 54.3% and 50% in group 2, at 1 and 6 months, respectively (p = NS). Patients' age, body mass index, serum albumin concentration, and sex distribution were similar in the responders and nonresponders. Intradermal hepatitis B vaccination used at half dose may be a cost saving alternative to intramuscular vaccination in patients on HD. However, the low overall seroconversion rate mandates seeking alternative ways of vaccination in this patient population.
Roozbeh
Jamshid
J
Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Moini
Maryam
M
Lankarani
Kamran Bagheri
KB
Sagheb
Mohamad Medhi
MM
Shahpoori
Sedigheh
S
Bastani
Bahar
B
D000328:Adult; D000368:Aged; D005260:Female; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D007676:Kidney Failure, Chronic / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014611:Vaccination
D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines