title: Low-dose intradermal and subcutaneous versus intramuscular hepatitis B vaccination in primary non-responding hemodialysis patients.
abstract: OBJECTIVE
  Patients with end-stage renal failure are at high risk of hepatitis B virus (HB V) infection. They have impaired immune response to HBV intramuscular (i.m.) vaccine. Non-response (anti HBs titer < 100mIU/ml) hemodialysis patients (HD) with the previous three-dose i.m. vaccination were examined with booster dose vaccine by i.m. , intradermal (i.d) and subcutaneous (s.c.) routes.
  
  
  METHODS
  Thirty-four HD patients who had been vaccinated with three-dose vaccine (40 microgram, 2 ml, Engerix B, i. m.) and had anti-HBs titer less than 100mlU/ml were selected. They were randomly divided into three groups and received a fourth dose of vaccine by i.m. (40 microgram, 2 ml), i.d (10 microgram. 0. 5 ml) and s.c. (10 microgram, 0. 5 ml). Then, serum anti-HBs titer was determined after 45 days and 6 months.
  
  
  RESULTS
  Forty five days after completion of the re-vaccination course, anti-HBs titer was above 100 mIU/ml in 6/11, 3/11 and 4/12 of i.m. s.c. and i. d groups, respectively (p > 0.05). After six months, 4/11, 3/11 and 2/12 of patients had anti-HBs titer above l00mlU/ml (p > 0.05).
  
  
  CONCLUSIONS
  With lower dose of vaccine (10 microgram) in s.c. groups, these patients had lower change in their anti-HBs titer. Therefore, it is cost effective and practical to offer other vaccination schemes.
authors.affiliation: Department of Pediatric Nephrology, Amirkola Hospital, Babol Medical University, Iran. hadisorkhi@pednephir.org
authors.forename: Hadi
authors.initials: H
authors.lastname: Sorkhi
authors.forename: Mohammad Reza Esmaeli
authors.initials: MR
authors.lastname: Dooki
authors.forename: Mina Sadat
authors.initials: MS
authors.lastname: Ebrahimnejad
mesh_terms: D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000032:analysis; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors; D014611:Vaccination / Q000379:methods*
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines