Vaccination against hepatitis B in patients with chronic renal failure – twenty years follow-up

Česká verzia

Authors: L. Rožnovský ¹; J. Tvrdík ²; L. Kabieszová ¹; L. Petroušová ¹; I. Orságová ¹; L. Hozáková ¹; I. Lochman ³; A. Kloudová ³; I. Valkovský ^4,5; P. Letocha ⁶; S. Schwarzová ⁷; M. Hladík ⁸; A. Zjevíková ¹
Authors place of work: Klinika infekčního lékařství Fakultní nemocnice Ostrava, přednosta prim. MUDr. Luděk Rožnovský, CSc. ¹; Katedra informatiky a počítačů Ostravské univerzity v Ostravě, vedoucí doc. Ing. Cyril Klimeš, CSc. ²; Oddělení imunologie a alergologie Zdravotního ústavu Ostrava, vedoucí RNDr. Ivo Lochman, CSc. ³; Interní klinika Fakultní nemocnice Ostrava, přednosta doc. MUDr. Arnošt Martínek, CSc. ⁴; Katedra interních oborů Lékařské fakulty Ostravské univerzity v Ostravě, vedoucí MUDr. Ivo Valkovský ⁵; Interní oddělení Městské nemocnice Ostrava, přednosta prim. MUDr. Radim Kryza ⁶; Dialyzační středisko B. Braun Avitum Ostrava-Vítkovice, vedoucí lékařka MUDr. Sylvie Schwarzová ⁷; Klinika dětského lékařství Fakultní nemocnice Ostrava, přednosta doc. MUDr. Michal Hladík, Ph. D. ⁸
Published in the journal: Vnitř Lék 2011; 57(10): 808-814
Category: Original Contributions

Summary

Aim:
The efficacy of vaccination against hepatitis B was evaluated in patients with chronic renal failure from 4 dialysis units in 1988–2010.

Patients and Methods:
Hepatitis B vaccination was started in 1 271 patients with chronic renal failure (606 female, 665 male). Patients received intramuscularly 3 doses of plasma-derived or since 1990, recombinant vaccine at the interval 0, 1 and 2 months for dialysis patients and 0, 1 and 6 months for pre-dialysis patients. Each vaccine contained 40 μg of hepatitis B surface antigen (HBsAg) in 1 002 patients, however only 20 μg HBsAg in 269 patients till 2000. Blood samples were obtained at the beginning of vaccination, 1–2 month after immunization and biannual thereafter. Serum samples were tested using ELISA methods for HBsAg and antibodies against hepatitis B surface and core antigens (anti-HBs, anti-HBc). The patients without protective anti-HBs level and the patients with waning of anti-HBs antibodies were revaccinated.

Results:
Anti-HBs antibodies after the third vaccine were investigated in 786 patients. Protective anti-HBs levels (≥ 10 IU/l) were proved in 49%, 65% and 74% patients after the third, fourth and fifth vaccine. The waning of protective anti-HBs antibodies was detected in 47% and 68% of patients during 3 and 5 years after vaccination. The new infections with HBsAg positive status were proved in 28 patients, in 27 of them in period 1988–1994. Anti-HBc seroconversion was observed in 10 patients.

Conclusion:
Vaccination considerably reduced hepatitis B incidence in the patients with chronic renal failure during nineties. However still approximately one quarter of patients did not produce protective anti-HBs level after immunization with recombinant vaccine and new form of vaccination against hepatitis B may be considered also in the Czech Republic.

Key words:
hepatitis B – vaccine – renal failure – anti-HBs antibodies – HBsAg

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