Vaccination against hepatitis B virus in hemodialysis patients: trends in dialysis centers of Northern Pakistan

Abstract

Background: Chronic kidney disease (CKD) patients, especially those on hemodialysis, are at increased risk of developing hepatitis B virus (HBV) infection. Guidelines suggest that all patients with CKD should be vaccinated against HBV, but these guidelines are usually not followed. We conducted this study to know the status of vaccination against HBV in CKD patients on regular hemodialysis. Methods: This observational descriptive study was conducted at the Department of Medicine, Sheikh Khalifa Bin Zayed Teaching Hospital, Poonch Medical College Rawalakot , and POF Teaching Hospital, Wah Medical College Wah Cantt, from March to July 2019. Patients reporting to the dialysis center of both hospitals on regular dialysis were included in the study. Patient information (HBV vaccination status, age, gender, education, socioeconomic status, duration of CKD and duration of dialysis) were collected on a specially designed questionnaire. The statistical analysis of data was done in SPSS for Windows, version 20. Results: A total 149 patients were included in the study, 63.1% were male and 36.9% were female. Out of these 24.2% were uneducated, 33.6% had 1-10 years school education, 38.2% had 10-14 years education, and 4% had more than 14 years education. About 35% patients were from low socioeconomic class, 54% from middle and 11% from higher class. Only 45.6% (n=68) of patients were vaccinated and 54.4% (n=81) were not vaccinated against HBV. Vaccination status was significantly associated with education (p=0.004) and socioeconomic status (p=0.008). Conclusion: The HBV status of patients on regular hemodialysis is not satisfactory at the two centers observed. It is associated with education and socioeconomic status of the patient.

Hepatitis B vaccination in patients with stage 4/5 chronic kidney disease – a scoping review

“…patients were vaccinated in a study conducted in Pakistan (Nadeem et al, 2021). Besides preventing transmission in the dialysis unit, successful Hepatitis B vaccination also allows for renal transplantation recipient from an anti-HBc positive donor (Holt et al, 2021).…”

“…Despite widespread HBV vaccine use since 1982 with a clear benefit to Hepatitis B vaccination in CKD patients -in particular the immunocompromised HD patients who are at higher risk of the infection due to frequent blood exposure and skin breaches -there have been limited published studies on vaccination implementation strategies and clinical practice guidelines (Mysore, 2021). Vaccination regime variations and a lack of optimal policy between countries continues to be recognised in recent literature (Haddiya, 2020;Nadeem et al, 2021). Although the CDC guidelines strongly recommend all CKD patients should be vaccinated against HBV, studies have shown the range of CKD patients vaccinated to vary greatly, between 20-73.1%: 20% in Pakistan (Nadeem et al, 2021); 31% in Belgium (Boey et al, 2020); 46% in the UK (Ray et al, 2002); and 73.1% in the US (Ayoola et al, 2019).…”

“…Vaccination regime variations and a lack of optimal policy between countries continues to be recognised in recent literature (Haddiya, 2020;Nadeem et al, 2021). Although the CDC guidelines strongly recommend all CKD patients should be vaccinated against HBV, studies have shown the range of CKD patients vaccinated to vary greatly, between 20-73.1%: 20% in Pakistan (Nadeem et al, 2021); 31% in Belgium (Boey et al, 2020); 46% in the UK (Ray et al, 2002); and 73.1% in the US (Ayoola et al, 2019).…”

Current Policy on Hepatitis B Vaccination Among Tertiary Care Hospital Hemodialysis Patients

“…Chronic kidney disease (CKD) imposes a giant fitness burden globally, with a multitude of headaches affecting patients, including an increased susceptibility to infectious diseases. Among those, hepatitis B virus (HBV) contamination provides a considerable risk, especially in people undergoing hemodialysis (Nadeem et al, 2021;Shrestha et al, 2021). The problematic interaction among compromised renal characteristics and immune system changes in CKD sufferers underscores the importance of exploring the effectiveness of hepatitis B vaccination on this precise population (Shrestha et al, 2021).…”