COMPLETE SUCCESS OF INTRADERMAL VACCINATION AGAINST HEPATITIS-B IN ADVANCED CHRONIC-RENAL-FAILURE AND HEMODIALYSIS-PATIENTS

Incomplete protection and response variability have been reported in c hronic renal failure (CRF) and hemodialysis (HD) patients vaccinated a gainst hepatitis B with the recombinant vaccine (rHBV). We vaccinated 12 consecutive patients (7 CRF and 5 HD), 7 males and 5 females, 61 ye ars old (range 22-82). HD patients were on treatment from 1 to 12 mont hs. CRF patients had a residual renal function (creatinine clearance) of 11 +/- 3 mL/min. Six patients had been already vaccinated unsuccess fully, as defined by the absence of detectable specific antibody S (Ab s) I month after the completion of vaccination by the classical intram uscular method, with a median of 7 (range 3-18) doses of 20 mu g. rHBV was given intradermally (ID) at the dose of 5 mu g every fortnight up to 8 doses or until titers of Abs rose above 1000 mIU/mL. Levels abov e 10 mIU/mL were considered as protective. Abs titers were monitored d uring the whole vaccination period every 15 days and at the 1st, 3rd, and 6th month after its completion. Median number of ID doses given wa s 7 (range 4-8). Antibody titers rose gradually; surface antibodies (A b(S)) were detected as early as the end of the first month (2nd dose). Age and sex had no influence on the immune response, its duration, or antibody titers. ID administration of rHBV in repeated small injectio ns was found to be absolutely effective, in both CRF and HD patients. Ab(S) titers after multiple ID vaccination rose gradually in CRF and H D patients, and were protective for at least 6 months after the last i njected dose. Protective levels were achieved even in patients not res ponding to multiple-double quantity intramuscular (IM) doses. Patients with stronger initial response to the vaccine (after the 4th dose) ga ve significantly higher Ab(S) titers (at least in 50% of the follow-up measurements), although they received fewer injections and smaller to tal dose of vaccine.