RECOMBINANT HEPATITIS-B VACCINE - ADVANTAGES OF INTRADERMAL ROUTE IN NONRESPONSIVE DIALYSIS PATIENTS

Objectives :Approximately 16-27% of dialysis patients (DP) have no detectable antibodies after 5 intramuscular injections of hepatitis B vaccine and represent a group at high risk to contract hepatitis B virus. We report the efficacy of the intradermal route of a recombinant hepatitis B vaccine (r-HBV) in non-responsive dialysis patients in our dialysis unit. Methods: Intradermal vaccinations were performed in 20 dialysis patients (mean age 62 years) non-responsive to the intramuscular injections (mean 6.8). Five mu g of r-HBV (Engerix B, SK and Fl were administered intradermally every two weeks (maximum 70 mu g) until a level of anti-HBV antibodies (anti-HBs) arbitrarily choosen of greater than or equal to 230 mUI/ml was attained. Anti HBs was determined after the fourth and subsequent intradermal injections (IMX, Abbott). Results: Fourteen dialysis patients (70%) developed anti-HBs > 10 mUI/ml (geometric mean titers of 330 mIU/ml). Among these, 9 developed seroprotective levels before the fifth injection, Five patients developed anti HBs greater than or equal to 1000 mUI/ml and 6 others developed anti-HBs greater than or equal to 230 mUI/ml. After the intradermal injections were discontinued, 11 patients were monthly monitored for at least 3 months, and 6 for one year. The geometric mean antibody level was at 3 months: 157 (n=11), at 6 months: 122 (n=8), at nine months: 117 (n=6), and at 12 months: 66 mIU/ml (n=6). The age and the sex, haemodialysis duration, albumin levels or treatment by erythropoietin did not seem to play a role in appearance of anti-HBs. Conclusions: Our experience in 20 dialysis patients shows that repeated low dose intradermal injections resulted in long-term sero protection in a substantial number of dialysis patients non-responsive to the intramuscular vaccinations.