More about Response to Hepatitis B Vaccine in Hemodialysis Patients

Vagelli, G; Calabrese, G; Mazzotta, Annamaria; Pratesi, Giovanni; Gonella, M.

doi:10.1159/000185047

Cited by 21 publications

(16 citation statements)

References 4 publications

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“…We provide evidence for the close relation between the immunogenicity and other non-modifiable host factors, which are consistent with those of previously published studies that showed impaired immune response to hepatitis B virus vaccine in subjects with older age [5,6,7,8,9,10], obesity [9, 11, 12] and diabetes mellitus [13, 14]. The hepatitis B antibody response rate had also been shown to diminish with increasing severity of renal failure [14, 15] and ineffective dialysis [16].…”

Section: Discussionsupporting

confidence: 91%

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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Section: Discussionsupporting

confidence: 91%

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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“…sex, duration of HD treatment, body weight, age, history of blood transfusions, and type of renal disease do not seem to play any role on the response to recombinant vac cine in our population. That is partially in contrast with other groups who used plasma-derived vaccine [29][30][31][32][33][34], Furthermore, responder vaccinees showed a length of time on HD slightly longer than non-responders: that is in keeping with the study of Steketee et al [35], Patients who survive on HD for longer periods are generally healthier and may be better able to develop an antibody response. Thus, subjects who have been on HD for a prolonged time should not be excluded from vaccination against hepatitis B. Immunogenicity to Engerix-B was not affected by the presence of anti-HCV, in contrast with other authors [36]: such a finding is a potential cost saving in an area where HCV prevalence is high.…”

Section: Discussionsupporting

confidence: 66%

Recombinant Hepatitis B Vaccine Use in Chronic Hemodialysis Patients

Fabrizi

Filippo

Marcelli

et al. 1996

Nephron

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The prevalence of hepatitis B virus (HBV) infection in our unit was 45% (86/190): there were 77 (40.5%) and 9 (4.7%) patients with previous and persistent HBV infection, respectively. Recombinant hepatitis B vaccine was given to 118 chronic HD patients with a regimen of 3 double doses administered intramuscularly at 0, 1 and 2 months, obtaining a seroprotection rate of 67% (79/118), 57% (45/79) being high responders. At month 24, 78% (40/51) maintained protective levels of anti-HBs, 45% (18/40) of them being high responders. There was a statistically significant difference between responder and non-responder patients with regard to nutritional parameters such as serum total proteins and mean levels of transferrinemia. The number of diabetic patients was significantly increased in the nonresponder group. Patients with persistent antibodies (‘persistent responders’) were younger and had a shorter duration of HD treatment compared to those responders who rapidly lost anti-HBs (‘transient responders’). Serological positivity for antibodies against hepatitis B core antigen significantly facilitates the decrease of anti-HBs antibodies over time. We detected seven episodes of HBV infection among HD patients at our unit before the beginning of the vaccination program. On the contrary, there were no episodes of HBV infection among responder vaccinees during the 24-month follow-up period. After the initial cost of vaccination, a savings of US$ 3,272 per year was realized by the elimination of frequent serologic screening of vaccine responders.

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“…One study reported by multivariate analysis a significant and independent relationship between poor nutritional status and failure to seroconvert after HBV vaccination among dialysis patients but was excluded as aRR and 95% CI were not given [17]. At least seven reports [18][19][20][21][22][23][24] found a significant relationship between under-nutrition, as assessed mostly by serum albumin levels, and failure to develop anti-HBs antibody after HBV vaccination but were not included as only univariate analysis was carried out. There was a 100% concordance between reviewers with respect to final inclusion and exclusion of studies reviewed based on the predefined inclusion and exclusion criteria.…”

Section: Literature Reviewmentioning

confidence: 99%