title: Comparing immune response of intradermal low dose versus intramuscular high dose of hepatitis B vaccination in hemodialysis patients.
abstract: BACKGROUND
  Hepatitis B is the most important cause of cirrhosis in developing countries. Hemodialysis patients are susceptible to infection due to repeated contact with dialysis machines and blood products. The aim of this study was to compare the efficacy of intradermal low dose with intramuscular high dose hepatitis B vaccination in hemodialysis patients.
  
  
  METHODS
  In a cross-sectional study on 24 hemodialysis patients that not responded to conventional method of vaccination in this center (double dose in 0, 1 and 6 months) and have antibody titer less than 10 mu/ml were enrolled to intramuscular or intradermal group, randomly. In intradermal (ID) group 10 μg (0.5 ml) recombinant vaccine, every 2 weeks to 6 months and in intramuscular (IM) group 40 μg (2 ml) at 0, 1, 2, and 6 months were prescribed and antibody titer were checked after 1 and 3 months of the end of vaccination.
  
  
  RESULTS
  Mean HBS antibody titer in patients was 4.4 ± 3.1 mu/ml at the beginning of study (minimum: 1.1 mu/ml and maximum: 9.2 mu/ml) and after 1 month and 3 months, mean HBS antibody were 190.4 ± 59 and 223.3 ± 83.9, respectively (p < 0.001). After one month, in intradermal and intramuscular groups, mean HBS antibody was 198.8 ± 75.6 mu/ml and 181.2 ± 61.8 mu/ml, respectively (p = 0.5) and after 3 months it was 230 ± 76 mu/ml and 216.2 ± 94.3 mu/ml, respectively (p = 0.83).
  
  
  CONCLUSIONS
  Antibody titer was high (> 50 mu/ml) in two groups after 1 and 3 months of vaccination and no significant difference was found between the 2 groups. Therefore, two methods of vaccination (high dose IM and low dose SC) are equally effective and the selection of vaccination method is based on health policy.
authors.affiliation: Department of Internal Medicine, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Momeni
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rajaei
references.citation: Nephrology (Carlton). 2009 Apr;14(3):267-72
references.pmid: 19207871
references.citation: Am J Transplant. 2002 Nov;2(10):965-9
references.pmid: 12482150
references.citation: Curr Pharm Biotechnol. 2003 Apr;4(2):141-51
references.pmid: 12678888
references.citation: Postgrad Med J. 2002 Sep;78(923):538-40
references.pmid: 12357014
references.citation: BMC Public Health. 2004 Apr 27;4:13
references.pmid: 15113436
references.citation: Hemodial Int. 2006 Jan;10(1):49-55
references.pmid: 16441827
references.citation: Braz J Infect Dis. 2003 Aug;7(4):262-7
references.pmid: 14533987
references.citation: Aliment Pharmacol Ther. 2007 Apr 1;25(7):849-55
references.pmid: 17373924
references.citation: Artif Organs. 2002 Jun;26(6):492-6
references.pmid: 12072104
references.citation: J Med Assoc Thai. 2006 Oct;89(10):1648-53
references.pmid: 17128839
references.citation: Kidney Int. 1991 Jul;40(1):121-8
references.pmid: 1921147
references.citation: Vaccine. 2005 Jul 14;23(32):4142-7
references.pmid: 15913854
references.citation: Am J Kidney Dis. 2004 May;43(5):910-7
references.pmid: 15112182
references.citation: Ren Fail. 2010 Jan;32(1):74-7
references.pmid: 20113270
references.citation: Aliment Pharmacol Ther. 2006 Aug 1;24(3):497-506
references.pmid: 16886915
references.citation: Nephron. 1996;72(4):536-43
references.pmid: 8730417
references.citation: Aliment Pharmacol Ther. 2004 Nov 15;20(10):1053-62
references.pmid: 15569107
references.citation: Nephrology (Carlton). 2010 Mar;15(2):137-45
references.pmid: 20470270
references.citation: J Med Assoc Thai. 2003 Dec;86(12):1122-7
references.pmid: 14971519