Study of Immune Response and Efficacy of Intradermal Injection of Hepatitis B Vaccine in Hemodialysis Patients

Hepatitis B virus (HBV) is the underlying cause for chronic and acute hepatitis. Chronic hepatic can progress toward cirrhosis and hepatocellular carcinoma. Vaccination against HBV is one of the important ways in the prevention of these conditions. Because of suppressed immune system, dialysis patients are less responsive to vaccination. However, there are several ways for increasing the immune response in these patients, one of them is intradermal injection of HBV vaccine. The aim of this study was, therefore to evaluate the degree of immune response and determining efficacy of intradermal injection of HBV vaccine in these patients. Subjects and One hundred and nine hemodialysis patients who fitted the conditions for entry in this study were evaluated. Necessary information including age, sex, number of vaccine injections, time of last vaccine injection, frequency of dialysis, dialysis product, duration of dialysis, serum albumin level, HCVAb and HBCAb was collected. From these data, immunity level as well as the immunity against HBV were estimated by monitoring of HBSAb. The selected groups were those patients with negative Ab, who were divided into two groups: the first group received 20g intradermal HBV vaccine and the second group the vaccine was administered intramuscularly. The results showed that 45% of patients were antibody positive and 55% had no appropriate response to vaccine. There was no relation between age, sex, serum albumin level and dialysis product and the degree of immune response. However, there was a significant relationship between the duration of dialysis and the time last vaccine injection with the degree of immune response. Immune response in patients who were injected intradermaly was statistically different from those who had intramuscular injections It recommended that the protocol for the national HB vaccination should change from injections to 4 times and with a double dose. Furthermore, in patients who can not achieve appropriate response, vaccination should be given intradermaly.