title: Immunogenicity of Augmented Compared With Standard Dose Hepatitis B Vaccine in Pediatric Patients on Dialysis: a Midwest Pediatric Nephrology Consortium Study.
abstract: OBJECTIVE
  Patients on maintenance dialysis have a higher risk of unresponsiveness to hepatitis B vaccination and loss of hepatitis B immunity. Adult guidelines recommend augmented dosing (40 mcg/dose), resulting in improved response in adults. We sought to determine whether children on dialysis mount a similar antibody response when given standard or augmented dosing of hepatitis B vaccine.
  
  
  METHODS
  This is a retrospective review of patients on dialysis aged <19 years from May 1, 2008 to May 1, 2013 at 12 pediatric dialysis units. Hepatitis B surface antibody (HBsAb) titers ≥10 mIU/ml were defined as protective.
  
  
  RESULTS
  A total of 187 out of 417 patients received one or more hepatitis B vaccine boosters. The median age was 13 years; the cohort was 57% boys and 59% white. Booster dose or HBsAb titers were missing in 17 patients. Conversion to protective HBsAb titers was achieved in 135 out of 170 patients (79%) after their first single-dose booster or multidose booster series. In patients receiving a single-dose booster, the response rate was 53% (nine out of 17) after a 10 mcg dose, 86% (65 out of 76) after a 20 mcg dose, and 65% (17 out of 26) after a 40 mcg hepatitis B vaccine dose. In patients receiving a multidose booster series, the response rate was 95% (19 out of 20) after a 10 mcg/dose series, 83% (20 out of 24) after a 20 mcg/dose series, and 71% (five out of seven) after a 40 mcg/dose series. Patients receiving a multidose booster series had a response rate of 86% (44 out of 51), compared with 76% (91 out of 119) in patients receiving a single-dose booster (P=0.21). Twenty-seven patients received more than one single-dose booster or multidose series, and 26 out of 27 (96%) eventually gained immunity after receiving one to three additional single-dose boosters or multidose booster series.
  
  
  CONCLUSIONS
  There was no clear gradient of increasing seroconversion rate with increasing vaccine dose in this cohort of pediatric patients on dialysis.
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
authors.forename: Jason M
authors.initials: JM
authors.lastname: Misurac
authors.forename: Rene G
authors.initials: RG
authors.lastname: VanDeVoorde
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Kallash
authors.forename: Franca M
authors.initials: FM
authors.lastname: Iorember
authors.forename: Kera E
authors.initials: KE
authors.lastname: Luckritz
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Rheault
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Jetton
authors.forename: Martin A
authors.initials: MA
authors.lastname: Turman
authors.forename: Gaurav
authors.initials: G
authors.lastname: Kapur
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Twombley
authors.forename: Shireen
authors.initials: S
authors.lastname: Hashmat
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Weaver
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Leiser
authors.forename: Corina
authors.initials: C
authors.lastname: Nailescu
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D007117:Immunization, Secondary; D000071497:Immunogenicity, Vaccine; D007674:Kidney Diseases / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D008297:Male; D015146:Midwestern United States; D010530:Peritoneal Dialysis / Q000009:adverse effects; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D000069078:Seroconversion; D013997:Time Factors; D016896:Treatment Outcome; D014611:Vaccination
chemical_list: D015415:Biomarkers; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines
keywords: Adolescent; Adult; Antibody Formation; Child; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Vaccines; Humans; Male; Retrospective Studies; Seroconversion; Vaccination; hemodialysis; nephrology; peritoneal dialysis; renal dialysis