Low Dose Intradermal Vaccination Is Superior to High Dose Intramuscular Vaccination for Hepatitis B in Unresponsive Hemodialysis Patients

Abstract

After two intramuscular (IM) vaccination protocols (40 μg at 0, 1, 2, and 6 months), patients who were unresponsive to hepatitis B vaccination were collected from three HD centers. The aim of this study was to compare the effectiveness of intradermal (ID) and repeated IM vaccination protocols. Thirty-three of 639 HD patients were found to be unresponsive. Patients were randomly assigned into two groups: one to receive 80 μg ID and the other 160 μg IM vaccination protocol. Both ID (p=0.000) and IM (p=0.03) groups disclosed statistically significant seroconversion rates six months after the last vaccination dose. The seroconversion rate was 94.1% in the ID and 50% in the IM groups-showing a significant improvement in the ID group (p=0.011). A low-dose ID is superior to standard IM vaccination protocol and also more cost-effective in unresponsive HD patients.

Hepatitis B vaccination: The key towards elimination and eradication of hepatitis B

“…The poor response to hepatitis B vaccine can be rescued with reinforced vaccination protocols by increasing the dose or number of the vaccines [39,40]. Changing the route of vaccine administration from intramuscular to intradermal injections has also been claimed to improve the immunogenicity and may be cost-effective [41,42]. However, other studies did not reach the same conclusion.…”

Renal Association Clinical Practice Guideline on Prevention of Blood Borne Virus Infection in the Renal Unit

“…This means that efforts to induce immunity in patients who do not respond to a 4 dose double dose schedule are likely to be associated with an unacceptably high costbenefit ratio. However there is some recent evidence that non-responders to a 4 dose 40 mg schedule might subsequently respond to a 160 mg dose given intradermally [35].…”

Transcutaneous and intradermal vaccination

“…Nonetheless, these vaccines can be classified in two groups: (1) vaccines for which ID injection have induced better humoral response with a lower antigen dose, i.e., the rabies vaccine, 114 HBV (Hepatitis B virus) vaccine in patients on dialysis, 115 seasonal influenza vaccine in the elderly 116 and (2) vaccines for which results conflict, i.e., the trivalent seasonal flu vaccine. On the in numerous clinical trials of more than 12 different vaccines.…”