Long-term Evaluation of the Hepatitis B vaccine (Heptavax-B) in Hemodialysis Patients

Pasko, Mary T.; Bartholomew, William R.; Beam, Thomas R.; Amsterdam, Daniel; Cunningham, Eugene

doi:10.1016/s0272-6386(88)80138-0

Cited by 29 publications

(17 citation statements)

References 6 publications

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“…Our study shows a rapid anti-HBs loss in hemodialyzed patients, being undetectable in as much as 41 % of them 3 years after an initial response to the vac cine, a significantly higher rate than that observed in healthy adults. These data are in agreement with those of Pasko et al [ 12] who reported transitory responses in 35% of the vaccinees and a progressive decrease of anti-HBs levels in 61 % of the cases within 24-27 months. Similar outcomes in successfully immunized patients under dialy sis therapy were reported by Stevens et al [2]: 15% lost their antibodies, and 84% had a progressive drop in their anti-HBs level throughout a 24-month follow-up period.…”

Section: Discussionsupporting

confidence: 93%

“…How ever, although the risk for HBV infection increases with low or undetectable anti-HBs levels, resultant infections are usually asymptomatic and cause neither liver disease nor detectable viremia in previously immune subjects who subsequently lost their antibodies; detection of these events relies on an anti-HBs elevation/reappearance cou pled with an anti-HBc seroconversion. Data concerning persistence of immunity, its linkage to anti-HBs, and the value of booster doses in hemodialyzed patients are lim ited [2,12,13]. Our study shows a rapid anti-HBs loss in hemodialyzed patients, being undetectable in as much as 41 % of them 3 years after an initial response to the vac cine, a significantly higher rate than that observed in healthy adults.…”

Section: Discussionmentioning

confidence: 53%

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Long-Term Immunogenicity and Efficacy of Hepatitis B Vaccine in Hemodialysis Patients

et al. 1992

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Although the efficacy of hepatitis B vaccines in patients under chronic hemodialysis treatment has been well documented, the persistence of immunity in this population remains largely unknown. In this study we have followed 60 hemodiaysis patients up to 3 years after primary hepatitis B vaccination (four doses of recombinant hepatitis B vaccine; Engerix B, 20 mg/dose) to evaluate the persistence of immunity (as indicated by serum levels of antibody to hepatitis B surface antigen – anti-HBs – higher than or equal to 10 mlU/ml). Four-ty-four (73%) patients developed anti-HBs levels above 10 mlU/ml after vaccination; the remaining 16 (27%) vaccinees were considered nonresponders and were given a booster dose that again failed to elicit an immunoresponse. After 3 years of follow-up, 18 out of 44 (41 %) responders had no detectable anti-HBs levels in the serum (antibody loss occurring within 8 and 12 months in 3 cases, within 1 and 2 years in 13, and within 2 and 3 years in 2 other cases). When compared with the responders that lost their antibodies during the follow-up period, those who remained immunoreactive 3 years after vaccination was initiated were younger and had higher anti-HBs levels at 8 months of follow-up. Two hepatitis B virus infections were detected among nonresponders during the follow-up period. Based on these data, we conclude that patients undergoing chronic hemodialysis therapy not only have lower response rates to hepatitis B vaccination than healthy adults, but also that these are frequently transient. We then recommend for this population (1) anti-HBs testing soon after vaccination and (in case of response) every 6 months thereafter and (2) to give a booster dose to primary responders whenever their antibody levels decrease below 10 mlU/ml.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 53%

Long-Term Immunogenicity and Efficacy of Hepatitis B Vaccine in Hemodialysis Patients

et al. 1992

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“…Thus, at the end of vaccination, antibody titer level > 50 U 1/1 rather than >10 UI/1 should discriminate respon ders from nonresponders. This conclusion is in keeping with the literature data [1,3,4,[10][11][12].…”

Section: Methodssupporting

confidence: 93%

Hepatitis B Vaccination in Dialysis Patients and Nutritional Status

Lombardi¹,

Pizzarelli²,

Righi³

et al. 1992

Nephron

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35 dialysis patients underwent anti-HBV vaccination. We classified patients in responders or non-responders using an anti-HBs titer of 50 UI/l as the discriminating serum level and tried to assess whether the antibody response bears any relationship with the nutritional status. 26 patients (74%) reached the target atb titer, which was maintained during follow-up (average 360 UI/l). The weak response in the other 9, with values never exceeding 20 UI/l, was short-lived. Anthropometric and impedenziometric parameters were higher in responders than in nonresponders, but the difference did not reach statistical significance. We conclude that the atb titer which discriminates uremics in responders or not must be > 50 UI/l and that the nutritional status may interfere with the seroconversion rate, but this conclusion needs to be validated in a wider population.

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“…On the basis of our data that administering double-dose Engerix-B to 5.6 patients should prevent 1 patient from losing the protective antibody at 1 year, this dosing strategy appears to result in substantial additional benefits at minimal additional costs. These beneficial effects are particularly relevant in high-risk subjects [23, 24] with predilection to decline in anti-HBs and hepatitis B infection. However, our calculation is based on a retrospective study, and is to be confirmed in a randomized trial.…”

Section: Discussionmentioning

confidence: 99%

Antibody Response to Hepatitis B Vaccine in End-Stage Renal Disease Patients

Chow¹,

Law²,

Leung³

et al. 2006

Nephron Clin Pract

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Background: This retrospective and comparative study evaluated the relationship between different factors which may contribute to suboptimal immunological response to intramuscular recombinant hepatitis B vaccine in end-stage renal disease (ESRD) subjects. Methods: From a cohort of 64 dialysis subjects undergoing primary vaccination with Engerix-B^®, we determined the predictive factors that impinged on patients’ response to vaccine, as defined by anti-HBs level ≧10 mIU/l. Dose efficacy was further evaluated by comparing three historical cohorts vaccinated by the regimens of 20, 40 and 80 µg/dose, respectively. Results: We identified 64 ESRD patients (mean age 43 ± 12 years, 81% receiving peritoneal dialysis) who received primary vaccination from April 1997 to September 2004. Median follow-up was 6.5 years. They achieved 81% seroconversion rate. Older age, diabetes mellitus, obesity and low Engerix-B dose were risk factors of inadequate anti-HBs response by univariate analysis. By stepwise logistic regression analysis, hepatitis B vaccine dose was the only independent predictive factor of impaired antibody response. An Engerix-B vaccine dose of 20 µg was associated with more than tenfold increase in risk of non-response to hepatitis B vaccine (hazards ratio 32.2 (95% CI 3.85–250.0)). Immunization with 80 µg of Engerix-B increased the likelihood of persistent protective antibody (log-rank test, p = 0.014). Immunization with Engerix-B 80-µg dose is estimated to prevent one extra ESRD subject who would lose seroprotective anti-HBs level at 1 year for every 5.6 patients treated (number needed to treat to benefit, 5.6 (95% CI 5.4–5.8)). Conclusions: Our results suggest the potential for the three-dose schedule of recombinant vaccine Engerix-B 80 µg to prolong the immune response among ESRD population.

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Long-term Evaluation of the Hepatitis B vaccine (Heptavax-B) in Hemodialysis Patients

Cited by 29 publications

References 6 publications

Long-Term Immunogenicity and Efficacy of Hepatitis B Vaccine in Hemodialysis Patients

Long-Term Immunogenicity and Efficacy of Hepatitis B Vaccine in Hemodialysis Patients

Hepatitis B Vaccination in Dialysis Patients and Nutritional Status

Antibody Response to Hepatitis B Vaccine in End-Stage Renal Disease Patients

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