Reinforced intradermal hepatitis B vaccination in hemodialysis patients issuperior in antibody response to intramuscular or subcutaneous vaccination

Since 1960, hepatitis B virus-associated chronic liver disease has been con sidered an important problem in dialysis units in both Europe and North Ame rica. Separate dialysis facilities for hepatitis B-infected patients, the i mplementation of universal precautions for the prevention of transmission, and the active immunization against hepatitis B have now reduced the yearly incidence to less than 0.05% in Western countries. However, only 50% to 60 % of patients with renal insufficiency develop sufficient immune response a fter intramuscular hepatitis B vaccination. The aim of the current study wa s to determine whether the mode of Vaccine application plays a role in vacc ination response and whether increasing the vaccine dose of primary intrade rmal hepatitis B vaccination can reduce the number of Vaccine injections in hemodialysis patients. We designed a prospective, randomized study of anti body responses to hepatitis B vaccine given intradermally, subcutaneously, or intramuscularly in 81 hemodialysis patients. Outcome measures were rates of seroconversion, mean levels of anti-Hbs antibodies, and antibody revels 8 years after vaccination. The results show that intradermal hepatitis B v accination response with a higher vaccination dose than previously used in hemodialysis patients is superior to conventional intramuscular and subcuta neous Vaccination and is also well tolerated. Five intradermal injections o f 20 mu g each induced the development of sufficient anti-Hbs antibody tite r, which persisted in 70% of the patients over 3 years. (C) 1998 by the Nat ional Kidney Foundation, Inc.