title: Low response to intradermal hepatitis B vaccination in incident hemodialysis patients.
abstract: BACKGROUND
  Hepatitis B (HB) may progress to cirrhosis and liver carcinoma. Its prevalence is estimated at 3.2 % in hemodialysis (HD) patients. HB vaccine when applied intramuscularly (IM) in end-stage renal disease patients often does not induce appropriate antibody titers. However, there has been suggestion for intradermal (ID) to be a more effective inoculation method.
  
  
  OBJECTIVE
  To compare the immune response to IM or ID vaccine administration on HD patients.
  
  
  METHODS
  Thirty one incident HD patients were randomly assigned alternately to IM or ID vaccine inoculation. Vaccine doses were applied at three monthly intervals, with patients being followed-up for six months. Sixteen patients were assigned to IM (40 mg/dose) and 15 to ID (4 mg/dose) vaccine administration. HB-virus surface antibody titer, hematimetric parameters, serum urea level and Kt/V were monthly evaluated. C-reactive protein, parathormone, ferritin, aminotransferases and albumin serum levels were evaluated before and at the sixth month of the initial inoculation.
  
  
  RESULTS
  Urea levels were significantly higher in the ID group (P(1) = 0.031); ferritin levels were higher in the IM (P(2) = 0.037) and C-reactive protein levels tended to be higher in the ID group. An interim evaluation by the Safety Monitoring Committee recommended discontinuing the study as IM vaccination had converted 62.5% of the exposed subjects, while ID inoculation converted only 13.3%.
  
  
  CONCLUSIONS
  As performed, ID applied vaccine was inferior to the IM inoculation. Such result may depend on the inoculated doses or some other factor, such as inflammation.
authors.affiliation: Post-Graduation in Medicine and Health Sciences, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, RS, Brazil.
authors.forename: Regina H
authors.initials: RH
authors.lastname: Medeiros
authors.forename: Ana Elizabeth Pl
authors.initials: AE
authors.lastname: Figueiredo
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Poli-de-Figueiredo
authors.forename: Domingos Otávio
authors.initials: DO
authors.lastname: d'Avila
authors.forename: Carlos Abaeté
authors.initials: CA
authors.lastname: de los Santos
mesh_terms: D005260:Female; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D006801:Humans; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
chemical_list: D017325:Hepatitis B Vaccines