RECOMBINANT HEPATITIS-B VACCINE USE IN CHRONIC-HEMODIALYSIS PATIENTS - LONG-TERM EVALUATION AND COST-EFFECTIVENESS ANALYSIS

The prevalence of hepatitis B virus (HBV) infection in our unit was 45 % (86/190): there were 77 (40.5%) and 9 (4.7%) patients with previous and persistent HBV infection, respectively. Recombinant hepatitis B va ccine was given to 118 chronic HD patients with a regimen of 3 double doses administered intramuscularly at 0, 1 and 2 months, obtaining a s eroprotection rate of 67% (79/118), 57% (45/79) being high responders. At month 24, 78% (40/51) maintained protective levels of anti-HBs, 45 % (18/40) of them being high responders. There was a statistically sig nificant difference between responder and nonresponder patients with r egard to nutritional parameters such as serum total proteins and mean levels of transferrinemia. The number of diabetic patients was signifi cantly increased in the nonresponder group. Patients with persistent a ntibodies ('persistent responders') were younger and had a shorter dur ation of HD treatment compared to those responders who rapidly lost an ti-HBs ('transient responders'). Serological positivity for antibodies against hepatitis B core antigen significantly facilitates the decrea se of anti-HBs antibodies over time. We detected seven episodes of HBV infection among HD patients at our unit before the beginning of the v accination program. On the contrary, there were no episodes of HBV inf ection among responder vaccinees during the 24-month follow-up period. After the initial cost of vaccination, a savings of US$ 3,272 per yea r was realized by the elimination of frequent serologic screening of v accine responders.