ORIGINAL ARTICLE

Vaccination against hepatitis B infection in patients with end stage renal disease

K Bel’eed, M Wright, D Eadington, M Farr, L Sellars

Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK

Correspondence to:
Correspondence to:
Dr Khalid Bel’eed, Department of Renal Medicine, Hull Royal Infirmary, Hull HU3 2JZ, UK;
khb0663{at}hotmail.com

Background: Experience of hepatitis B vaccination in a contemporary renal replacement programme is reported.

Methods: A total of 406 patients were involved: 214 on haemodialysis, 97 on continuous ambulatory peritoneal dialysis, 67 predialysis (serum creatinine >400 µmol/l), and 28 with a failing transplant. Primary vaccination comprised recombinant hepatitis B vaccine (Engerix B) 40 µg intramuscularly at 0, 1, 2, and 3 months. Booster doses were administered three monthly if anti-HBs titre was <100 IU/l.

Results: Uptake of vaccine was 61% (haemodialysis 70%, continuous ambulatory peritoneal dialysis 62%, predialysis 31%, transplant 61%, p<0.0001). Primary seroconversion occurred in 64% of vaccinated patients (anti-HBs; 10–100 U/l, 33%; >100 U/l, 31%). Booster doses led to further improvement in immunity in 66/115 (57%) patients after a first and 8/20 (40%) patients after a second booster dose, but uptake was again poor (first booster 74%, second 31%). Seroprotection declined unexpectedly rapidly; after a mean of 16 months 71/115 patients (62 %) had a significant fall in their anti-HBs titres; 30/115 (26%) lost detectable antibody.

Conclusions: Routine hepatitis B vaccination of patients with end stage renal failure is logistically difficult to administer on a large scale; primary seroconversion is relatively poor, but improves after repeated booster doses; protective anti-HBs titres decline rapidly, and yearly antibody checks with selective booster doses will be required to maintain seroprotection. The cost effectiveness of a vaccination programme will vary greatly depending on the prevalence of hepatitis B in the population at risk.

Keywords: end stage renal disease; haemodialysis; hepatitis B infection; vaccination

Abbreviations: ESRD, end stage renal disease; HBsAg; hepatitis B surface antigen; HBV, hepatitis B virus

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This article has been cited by other articles:

• Janus, N., Vacher, L.-V., Karie, S., Ledneva, E., Deray, G. (2008). Vaccination and chronic kidney disease. Nephrol Dial Transplant 23: 800-807 [Full Text]