title: Hemodialysis and hepatitis B vaccination: a challenge to physicians.
abstract: Hepatitis B is responsible for the development of half of hepatocellular carcinoma cases and is a major cause of hepatic insufficiency. The vaccine against hepatitis B virus does not exhibit the same high efficacy in patients on hemodialysis as it does in immunocompetent individuals. The medical literature recommends vaccination with four doses (40 mg each) of the hepatitis B virus vaccine before beginning hemodialysis; however, approximately one-third of hemodialysis patients do not respond to this vaccination schedule. A new serologic test should be performed each year for individuals who respond adequately, whereas a booster dose should be offered to those with antibody titers below 10 mIU/mL. In this study, we followed 83 hemodialysis patients and collected quantitative serologic measurements every 2 months over a 1-year period. We made the measurements 1 month after the vaccination period. We found that 41% of the patients had antibody titers below 10 mIU/mL (nonresponders), 21.7% had antibody titers between 10 mIU/mL and 100 mIU/mL (poor responders), and 37.3% had antibody titers higher than 100 mIU/mL (good responders). Patients with diabetes and/or hypertension exhibited worse response to vaccination. All subjects displayed decreasing antibody titers during the observation period. The group of poorly responsive patients had antibody titers below 10 mIU/mL at the 6-month follow-up period.
authors: Department of Infectology, Faculdade de Medicina do ABC, Santo André-São Paulo, Brazil.
authors: Munir Akar
authors: MA
authors: Ayub
authors: Department of General Practice, Faculdade de Medicina do ABC, Santo André-São Paulo, Brazil.
authors: Marcelo Rodrigues
authors: MR
authors: Bacci
authors: Department of Morphology, Faculdade de Medicina do ABC, Santo André-São Paulo, Brazil.
authors: Fernando Luiz Affonso
authors: FL
authors: Fonseca
authors: Department of Gastroenterology, Faculdade de Medicina do ABC, Santo André-São Paulo, Brazil.
authors: Ethel Zimberg
authors: EZ
authors: Chehter
keywords: chronic kidney disease; hemodialysis; hepatitis B vaccination