Improving Hepatitis B Vaccine Efficacy in End-Stage Renal Diseases Patients and Role of Adjuvants

Abstract

Hepatitis B virus (HBV) infection is a serious global health problem.The prevalence of viral hepatitis is higher in dialysis patients than in the general population because of the opportunity for exposure during the dialysis procedure. Immunization is the most effective way to prevent transmission of hepatitis B virus (HBV) and hence the development of acute or chronic hepatitis B. It is well established that patients with end-stage renal disease including dialysis-dependent patients, have an impaired immune response to hepatitis B vaccine. End stage renal diseases (ESRD) patients have lower seroconversion rates compared with the subjects with intact renal function. Moreover, even after the completion of vaccination schedule anti-hepatitis B (anti-HBs) titers of responder dialysis, patients are low and decline logarithmically with time. The impaired efficacy of HBV vaccine in patients with ESRD has been attributed to numerous factors such as immune compromise because of uremia and some other factors. One approach to improve the immunogenicity of existing HBV vaccines is adjuvantation, and it's very important to find more effective adjutants for improving HBV vaccine efficacy. In this paper we have a brief review on recently known new ways for improving HBV vaccine efficacy.

Vaccinated Hemodialysis Patients; The Status of Immunity Against the Hepatitis B Virus, at a Tertiary Care Hospital

“…After full administration of the vaccination, 45.6% of patients revealed high antibody response (>100 IU/L). Past research studies have noted fluctuating hepatitis-B vaccination response rates that ranged between 47-73% in hemodialysis 4 patient populations. In comparison, satisfactory responses to the hepatitis-B vaccine among dialysis patients have also been monitored in regions with endemicity (prevalence 2-8%) of HBV, an example includes Brazil, which came within reach of 89.5% in a study.…”

“…Patients with Chronic uremic, although dialysis or not, have a reduced immune to hepatitis B vaccine. 4 Although vaccination of hepatitis B virus (HBV) in healthy subjects resulted in a seroconversion rate of 90% to 100% for patients with end-stage renal disease have reduced responses to HBV vaccination with sufficient surface anti-hepatitis B (anti-HBs) unaffected by the amount of from 50% to 60%. 5 Several methods have been tried to improve the immune seroconversion including adding additional capacity of inoculum injection four 2 lines and doubling the dose of the vaccine at / 40 mcg dose.…”

Variantes de escape del virus de la hepatitis B

“…Actualmente las vacunas recombinantes contra el VHB se producen en levaduras o la línea celular CHO; estas vacunas contienen las formas S y M del HBsAg, tanto en su forma glicosilada como no glicosilada [14][15] . La vacuna recombinante contra el VHB confiere protección en más de 95% de los individuos vacunados; sin embargo, ciertos individuos no desarrollan respuesta inmune protectora luego de recibir la vacuna 16 . La respuesta inmune a la vacuna contra el VHB está relacionada con la inducción de anticuerpos anti-HBs y el desarrollo de células T de memoria.…”

“…La respuesta inmune a la vacuna contra el VHB está relacionada con la inducción de anticuerpos anti-HBs y el desarrollo de células T de memoria. Títulos de anti-HBs de 10 mUI/mL medidos entre los primeros tres meses después de la administración de la última dosis, es considerado un marcador de protección contra la infección por el VHB [14][15][16] . El primer programa universal de vacunación a escala nacional contra el VHB en niños, se desarrolló en Taiwán en julio de 1984, con un esquema de cuatro dosis de vacuna derivada de plasma (0, 1, 2 y 12 meses de edad).…”

“…Aunque la mayoría de las mutaciones en el HBsAg son silenciosas, es decir, no producen cambio de aminoácidos, mutaciones no sinónimas en la región que codifica el epítope inmunodominante pueden llevar a la propagación del VHB en personas vacunadas y convertirse en un grave problema de salud pública. 16,32,43 . En los estudios realizados en Taiwán se identificaron variantes de escape con aislados de VHB provenientes de niños vacunados, hijos de madres HBsAg positivas.…”