title: Efficacy of intradermal hepatitis B vaccination compared to intramuscular vaccination in hemodialysis patients.
abstract: BACKGROUND
  Hepatitis B virus infection remains an important problem in hemodialysis patients. Only 50 to 60% of the patients develop seroconversion (anti-HBs Ab titer > 10 IU/L) after intramuscular hepatitis B vaccination. Small dose intradermal inoculation method of hepatitis B vaccine has been reported to be effective as well as economical, and could provide rapid seroconvesion of immunity. The aim of the present study was to compare the efficacy of intradermal hepatitis B vaccination with intramuscular vaccination in hemodialysis patients.
  
  
  METHODS
  Fifty one hemodialysis patients were randomly assigned to two groups, 25 patients received a total 7 doses of 10 mmicrog of recombinant hepatitis B vaccine (Engerix B) intradermally every 2 weeks (ID group), whereas 26 patients received 40 microg intramuscularly at 0, 1, 2 and 6 months (IM group). Anti-HBs Ab titer was measured at 2, 3, 4 and 7 months after the first vaccination in both groups. Vaccination responses were classified into 3 subgroups according to anti-HBs Ab titer and these included excellent response (> 1,000 IU/L), good response (10-999 IU/L) and non-response (< 10 IU/L).
  
  
  RESULTS
  The seroconversion rates at 2, 3, 4, and 7 months in the ID group were 56%, 76%, 88%, and 92% compared with 31%, 42%, 65%, and 69% in the IM group, respectively. Only the seroconversion rates at 3 months were significantly higher in the ID group (76% versus 42%, p = 0.03). At 7 months after the first vaccination, good and excellent responders in the ID group were 72% (18/25) and 20% (5/25) compared with 34.5% (9/26) and 34.5% (9/26), respectively (p > 0.05). Only minor side effects were observed.
  
  
  CONCLUSIONS
  Seven doses of 10 mg intradermal vaccination induced a high seroconversion rate and were comparable with intramuscular regimen. Intradermal vaccination may be helpful for the rapid induction of protective level of antibodies and may be a cost-saving alternative to intramuscular vaccination in hemodilaysis patients.
authors.affiliation: Renal Division, Department of Medicine, Siriraj Hospital, Bangkok, Thailand.
authors.forename: Thawee
authors.initials: T
authors.lastname: Chanchairujira
authors.forename: Narumol
authors.initials: N
authors.lastname: Chantaphakul
authors.forename: Thaweesak
authors.initials: T
authors.lastname: Thanwandee
authors.forename: Leena
authors.initials: L
authors.lastname: Ong-Ajyooth
mesh_terms: D005260:Female; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D006801:Humans; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014611:Vaccination / Q000379:methods
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines