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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.
Keywords: hepatitis B vaccination, hemodialysis patients, re-vaccination, Non-responder