Persistence of Hepatitis B Vaccine Immunity in Hemodialysis Patients

Abstract

Although the efficacy of hepatitis B vaccines in patients undergoing chronic hemodialysis (HD) treatment has been documented, the persistence of immunity in this population remains largely unknown. In this study we evaluated the persistence of hepatitis B vaccine immunity in HD patients. We followed 37 hepatitis B vaccinated HD patients (following a four-dose vaccination schedule of 40 mug injections intramuscularly in the deltoid muscle at 0, 1, 2, and 6 months) for up to one year to evaluate the persistence of immunity (as indicated by serum levels of hepatitis B surface antibody (anti-HBs) equal to or higher than 10 IU/L). One year after vaccination, 18.9% of patients had lost their anti-HBs (transient responders), while 81.1% still had detectable antibodies in the serum (persistent responders). From 81.1% of persistent responders 11.5% and 88.5% were weak and high responders, respectively. There was no significant difference between persistent and transient responders regarding age, sex, or nutritional factors. We did not find any factors that related to maintaining protective levels of anti-HBs in HD patients. It seems that an antibody titer above 100 IU/L following vaccination is necessary in order to maintain that level of antibody one year later.

Rapid, enhanced, and persistent protection of patients with renal insufficiency by AS02V-adjuvanted hepatitis B vaccine

“…Studies in hemodialysis patients have shown that an anti-HBs concentration of X100 mIU/ml after vaccination is necessary to maintain protective antibody concentrations for 1 year after vaccination and to reduce the need for additional booster doses. [24][25][26] Indeed, this cutoff is considered to be the best surrogate marker of long-term seroprotection in immunocompromized patients by a number of vaccination advisory bodies. 27,28 The higher proportion of subjects achieving anti-HBs antibody concentrations of X100 mIU/ml after primary vaccination with the HB-AS04 vaccine compared with a conventional recombinant HBV vaccine has been shown to translate into a reduced need for a booster dose over long-term follow-up (up to 42 months).…”

Safety and immunogenicity of an investigational adjuvanted hepatitis B vaccine (HB-AS02V) in healthy adults

“…Studies in hemodialysis patients have shown anti-HBs antibody concentrations ≥100 mIU/ml following vaccination to be predictive of long-term persistence of circulating antibodies. [12][13][14] Indeed, this cut-off is considered to be the best surrogate marker of long-term seroprotection in immunocompromised patients by a number of vaccination advisory bodies. 15,16 Results of an earlier study of the HB-AS02 vaccine in a smaller group of healthy volunteers also found all subjects to be seroprotected after two vaccine doses.…”

Do We Have to Shift Three Doses of Hepatitis B Vaccine Instead of Four Doses in Chronic Renal Failure: Think Before Action

“…Further randomized and long lasting studies are needed whether three doses are as effective as four doses. Until then, 4 doses of vaccination will be suitable in these patients as suggested (2, 3). …”