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

Abstract

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.

Hepatitis B Virus Infection in Dialysis Patients

“…Several studies [106,113,114,123,132,151] evaluated the long-term efficacy of the vaccine in HD patients and reported a decline of anti-HBs titers within 6 months to 4 years after vaccination. In a recent series [152], 36% (21/ 58) of HD patients showed loss of detectable anti-HBs titers over a 34-month follow-up; older age and longer duration of HD treatment were correlated with the decline of anti-HBs titers over time.…”

Hepatitis B virus infection and related factors in hemodialysis patients in China – systematic review and meta-analysis

“…However, it has been repeatedly observed that chronic uremic patients with or without dialysis treatment have an impaired immune response to the HBV vaccine. 63,64 The seroconversion rate is only 50-73% 65 in contrast to more than 90% in healthy subjects. Some scholars believe that dialysis patients with hypo-responsiveness to the HBV vaccine may be associated with cellular immune dysfunction.…”

Hemodiyaliz ve periton diyalizi hastalarının Hepatit B aşısına karşı cevaplarının karşılaştırılması

“…Bu hastalarda T-lenfosit ve antijen sunan hücrelerde fonksiyon bozukluğu olduğu düşünülmektedir [13][14][15]. Bazı çalışmalarda diyalizsiz takip edilen KBH hastalarında daha yüksek antikor cevabının elde edilmesi, böbrek yetmezliğinin şiddeti ile immün cevabın korele olduğunu düşündürmektedir [13,16,17]. KBH hastalarında hepatit B aşılamasına yeterli cevap alınabilmesi için yüksek doz ve daha sık enjeksiyon yapılması önerilmiştir [10,18].…”