Low-Dose Intradermal and Subcutaneous Versus Intramuscular Hepatitis B Vaccination in Primary Non-Responding Hemodialysis Patients
Hadi Sorkhi MD*, Mohammad Reza Esmaeli Dooki MD**, Mina Sadat Ebrahimnejad MD*
Affiliation : * Department of Nephrology, Babol Medical University, Iran ** Department of Gastroenterology, Babol Medical University, Iran
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.
Materials and Methods : Thirty-four HD patients who had been vaccinated with three-dose vaccine (40 micro-
gram, 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 micro-
gram.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
