Low Dose Intradermal Versus High Dose Intramuscular Hepatitis B Vaccination in Patients on Chronic Hemodialysis

Abstract

Patients with end-stage renal disease on hemodialysis (HD) are at high risk for hepatitis B infection. We randomly assigned 86 new patients on HD to receive either 40 microg intramuscular (group 1) or 20 microg intradermal (group 2) recombinant hepatitis B vaccine, in three doses at 0, 1, and 4 months. All patients were seronegative at baseline for hepatitis B surface antigen (HBs-Ag), hepatitis B surface antibody (HBs-Ab), and hepatitis B core antibody (HBc-Ab). HBs-Ab seroconversion rate and antibody titer (ELISA assay) were compared in 27 patients of group 1 and 35 patients of group 2 at 1 month, and in 20 patients of group 1 and 26 patients of group 2 at 6 months after the last vaccine dose. The seroconversion rates (HBs-Ab titer >10 IU/L) were 55.6% and 50% in group 1, and 54.3% and 50% in group 2, at 1 and 6 months, respectively (p = NS). Patients' age, body mass index, serum albumin concentration, and sex distribution were similar in the responders and nonresponders. Intradermal hepatitis B vaccination used at half dose may be a cost saving alternative to intramuscular vaccination in patients on HD. However, the low overall seroconversion rate mandates seeking alternative ways of vaccination in this patient population.

Phase I Randomized Clinical Trial of VRC DNA and rAd5 HIV-1 Vaccine Delivery by Intramuscular (IM), Subcutaneous (SC) and Intradermal (ID) Administration (VRC 011)

“…Biologically, vaccine deposited in the skin or subcutaneous tissue may induce a different pattern of immune responses than vaccine deposited in muscle and may affect the functional properties of the immune response, including the pattern of cytokine production by lymphocytes [8]. Langerhans cells are the primary antigen presenting cell (APC) in the skin [9], [10] and antigen presentation exclusively by Langerhans cells may be more efficient in antigen presentation than other dendritic cell (DC) subpopulations, perhaps requiring a smaller quantity of antigen to become activated and migrate to regional lymph nodes where adaptive immune responses can be initiated [11], [12]. In order to better control and observe the effect of depositing the vaccine in a particular layer of tissue, only needle injection was used in this study.…”

Vaccine-Induced Anti-HBs Level in 5-6 Year-Old Malnourished Children

“…Frequent studies surveyed the effect of malnutrition in response to HBV vaccine in hemodialysis patients. In some of these studies, impact of malnutrition on seroconversion has been shown (39, 40) but some others found no effect (13, 41-44). Based on our study, severity of malnutrition has no effect on seroprotection rate and mean level of anti-HBs after HBV vaccination in 5-6 years old children, and there is no need to additional booster doses or periodic laboratory rechecks.…”

Sex bias in response to hepatitis B vaccination in end-stage renal disease patients: Meta-analysis

“…After excluding studies not fulfilling inclusion criteria, 19 clinical trials [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] have been remained whose demoKhedmat H et al . Sex and HBV vaccine immunogenicity graphic data is summarized in Table 1.…”