Antibody Response Rates To Hepatitis B Vaccination in Children With Chronic Renal Failure: An Observational Study

Abstract

Introduction: Hepatitis B virus (HBV) infection is one of the most important factors increasing the mortality and the mobility in patients with chronic renal failure (CRF). There are a limited number of studies of pediatric patients with CRF regarding the response to double doses and protection rates. In this study, our aim was to compare the antibody levels and the respond rates to recombinant hepatitis B vaccine in children with chronic renal failure (CRF). Materials and Methods: In this prospective observational study, 36 children were included, who were in follow-up with a diagnosis of CRF, with a negative HBV serology and inadequate protective antibody levels. Prior to the vaccination program, HBV serologic tests and liver transaminase measurements were done in all patients. Patients under 11 years of age were administered 20 mcg, and patients older than 11 years were given 40 mcg of third generation recombinant DNA vaccine Euvax-B (LG Chemical Ltd.-Berk, Seoul-South Korea), into the deltoid muscle at months 0, 1 and 6. After vaccination, antiHBs levels were determined at the 1st, the 3rd, the 7th and the 12th months. A antiHBs level of ≥10 mlU/L was considered protective. Protection against hepatitis B infection as the ratio of ≥ 10 mIU / L. Analysis of variance, chi-square and T-test were used for the statistical analysis. Results: There were 21 female and 15 male patients. The mean age was 14.02 ± 4.2 years. Of all the patients, 11were at predialysis stage, 20 had continuous ambulatory peritoneal dialysis (CAPD), and 5 patients were treated with hemodialysis. In all groups of patients; protection rates of 58% in the 1st month, 92% in the 3rd month, 92% in the 7th month, 97% in the 12th month were achieved. The average vaccination antibody levels in all patients, according to the months were 210 mIU / L, 289 mIU / L, 336 mIU / L, and 336 mIU / L, respectively. There were no significant differences among the groups in terms of gender, protection rates and antibody titers (p> 0.05). The protection rate was found to be 67% in three patients receiving immunosuppressive therapy.The vaccination program was implemented in 18 patients who were on EPO treatment (Table 2). In these patients, the protective ratio was 83% and 94%, at 1 and 3 months, and 100% at 7 and 12 months. All patients with EPO treatment had an adequate antibody response. Conclusion: In our study, although the relative antibody response to hepatitis B vaccine was related to the immune regulation in pediatric patients with CRF, it did not seem to have a relationship with the type of dialysis. In addition, in the first year post-vaccination with a double dose, adequate antibody levels and level of protection is achieved in a substantial proportion of patients.