IMMUNOLOGICAL RESPONSE TO HEPATITIS B VACCINE IN END STAGE RENAL DISEASES

Abstract

Background:End stage renal diseases patients have lower seroconversion rates compared with the subjects with intact renal function. Moreover, even after the completion of vaccination schedule anti-hepatitis B titers of responder who kept on dialysis, patients are low and decline logarithmically with time.
Objectives:To determine the response of patients with end stage renal disease undergone hemodialysis to hepatitis B virus vaccination and to identify the factors that could affect this response.
Methods:One hundred patients with an age range from 21 to 75 years complaining of chronic renal failure on regular hemodialysis. Patients negative for hepatitis B antigen and anti-hepatitis C were vaccinated with 40µg of Euvax B intramuscularly in the deltoid muscle by following a schedule of 0, 1 and 2 months. The antibody titer was tested at third month and if titer was <10 or 10-100IU/mL (patients whom regarded as non-responded or poor responded). Then they were given another fourth dose (40µg) of vaccine at sixth month.
Results:The rate of seroconversion to hepatitis B vaccine among individuals with end stage renal disease is 63%. Thirty one (31%) patients were anti hepatitis C virus positive. Eighteen (58%) were responsive to hepatitis B vaccination and 13 (42%) did not response to Hepatitis B vaccination. Advanced age, sex and diabetes mellitus show no effect on response to vaccination. The response to hepatitis B vaccine is significant in patient's well control of hemoglbulin, calcium, albumin and long duration on hemodialysis.
Conclusion:Patients on maintenance dialysis typically show a suboptimal immune response to hepatitis B virus vaccine compared with the non-uraemic population.
Keyword: Hemodialysis, chronic renal failure, HBsAg, vaccination.