Complete Success of Intradermal Vaccination Against Hepatitis B in Advanced Chronic Renal Failure and Hemodialysis Patients

Abstract

Incomplete protection and response variability have been reported in chronic renal failure (CRF) and hemodialysis (HD) patients vaccinated against hepatitis B with the recombinant vaccine (rHBV). We vaccinated 12 consecutive patients (7 CRF and 5 HD), 7 males and 5 females, 61 years old (range 22–82). HD patients were on treatment from 1 to 12 months. CRF patients had a residual renal function (creatinine clearance) of 11 ± 3 mL/min. Six patients had been already vaccinated unsuccessfully, as defined by the absence of detectable specific antibody S (Abs) 1 month after the completion of vaccination by the classical intramuscular method, with a median of 7 (range 3–18) doses of 20 μg. rHBV was given intradermally (ID) at the dose of 5 μg every fortnight up to 8 doses or until titers of Abs rose above 1000 mlU/mL. Levels above 10 mlU/mL were considered as protective. Abs titers were monitored during the whole vaccination period every 15 days and at the 1st, 3rd, and 6th month after its completion. Median number of ID doses given was 7 (range 4–8). Antibody titers rose gradually; surface antibodies (Abs) 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 injections was found to be absolutely effective, in both CRF and HD patients. Abs titers after multiple ID vaccination rose gradually in CRF and HD patients, and were protective for at least 6 months after the last injected dose. Protective levels were achieved even in patients not responding to multiple-double quantity intramuscular (IM) doses. Patients with stronger initial response to the vaccine (after the 4th dose) gave significantly higher Abs titers (at least in 50% of the follow-up measurements), although they received fewer injections and smaller total dose of vaccine.