LOW-DOSE INTRADERMAL VERSUS INTRAMUSCULAR HEPATITIS-B VACCINATION IN PATIENTS WITH END-STAGE RENAL-FAILURE - A PRELIMINARY-STUDY

Patients with end-stage renal disease (ESRD) are at high risk of hepat itis B infection. Only 50-60% of the patients respond adequately to th e routinely performed intramuscular (i.m.) hepatitis B vaccination. We examined whether low dose intradermal (i.d.) application of the vacci ne is equivalent to regular i.m. administration. Thirty-two patients w ith ESRD of different etiologies were investigated at the onset of dia lysis treatment [11 patients on continuous ambulatory peritoneal dialy sis (CAPD) and 21 patients on hemodialysis (HD)]. Patients were vaccin ated at month 0, 1, 3 and 6 with either 40 mu g HBs Ag (2 ml Engerix B , 14 patients) i.m. or with 10 mu g HBsAg (0.5 ml Engerix B, 18 patien ts) i.d. The i.m. vaccination was applied in the deltoid muscle, while for i.d. vaccination the vaccine was injected into the skin of the de ltoid region. Six weeks after the last vaccination anti-HBs titers wer e measured. 61% (11 patients) of the patients vaccinated i.d. and 64% (9 patients) of the patients vaccinated i.m. developed protective tite rs. Neither the height of the titers nor the proportion of patients re sponding to the vaccination differed significantly between the two vac cination schedules. No difference regarding the height of titers achie ved or the rate of seroconversion could be found when CAPD and HD pati ents were analyzed separately. Only minor side effects have been obser ved. According to these preliminary data i.d. hepatitis B vaccination in patients with ESRD may be equivalent to i.m. administration of the vaccine. Given equivalency i.d. vaccination may be a cost-saving alter native to i.m. vaccination (only a quarter of the dose of i.m. adminis tered vaccine is needed) with a good practicability (vaccination can b e performed during HD) and a low rate of side effects.