Low-dose intradermal and subcutaneous versus intramuscular hepatitis B vaccination in primary non-responding hemodialysis patients
Sorkhi, H.; Dooki, M.Reza.Esmaeli.; Ebrahimnejad, M.Sadat.
Journal of the Medical Association of Thailand 89(10): 1648-1653
2006
ISSN/ISBN: 0125-2208 PMID: 17128839 Document Number: 2647
Objective: Patients with end-stage renal failure are at high risk of hepatitis B virus (HBV) infection. They have impaired immune response to HBV intramuscular (i.m.) vaccine. Non-response (anti HBs titer < 100mIU/ml) hemodialysis patients (HD) with the previous three-dose i.m. vaccination were examined with booster dose vaccine by i.m., intradermal (i.d) and subcutaneous (s.c.) routes.Material and Method: Thirty-four HD patients who had been vaccinated with three-dose vaccine (40 microgram, 2 ml, Engerix B, i.m.) and had anti-HBs titer less than 100mIU/ml were selected They were randomly divided into three groups and received a fourth dose of vaccine by i.m. (40 microgram, 2 ml), i.d (10 microgram. 0.5 ml) and s.c. (10 microgram, 0.5 ml). Then, serum anti-HBs titer was determined after 45 days and 6 months.Results: Forty five days after completion of the re-vaccination course, anti-HBs titer was above 100 mIU/ml in 6/11, 3/11 and 4/12 of i.m. s.c. and i.d groups, respectively (p > 0.05). After six months, 4/11,3/11 and 2/12 of patients had anti-HBs titer above 100mIU/ml (p > 0.05).Conclusion: With lower dose of vaccine (10 microgram) in s.c. groups, these patients had lower change in their anti-HBs titer Therefore, it is cost effective and practical to offer other vaccination schemes.
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