The evaluation of Tetanus-diphtheria (Td) vaccine impacts on immune response to hepatitis B (HB) vaccine in non-responder dialysis patients

The Hepatitis B (HB) vaccine response in hemodialysis patients is less than healthy individuals. Different strategies have been taken into account to improve the response rate. This study aimed to evaluate the effect of tetanus and diphtheria (Td) vaccine as an adjuvant therapy to HB vaccination. Sixty three end-stage renal disease patients were recruited on dialysis that were older than 18 years and had passed at least 3 doses of HB vaccination schedule, and had HBS antibody (Ab) with titer less than 10 IU/L. The patients were divided into two groups; A (30 patients) and B (33 patients). Both of the groups received a 3-dose HB vaccination schedule of 40 µg intramuscularly in the left deltoid muscle at 0, 1 and 6 months. Group A also received Td vaccine intramuscularly simultaneous with the first dose of HB vaccine. HBS Ab was measured in periods of 1 and 6 months after completion of the vaccination. One month after completion of the vaccination, group A had better but not significant response rate than group B (96% vs. 83.9%) (p > 0.05); in addition, after 6 month there was no difference between the two groups (87.5% vs. 83.3%) (p > 0.05). Patients with HCV infection had lower response rate than patients who did not have HCV infection (33.3% vs. 92.5%) (p < 0.05). Age had negative effect on immune response to HB vaccination (r = -0.339 and p = 0.005). The use of Td vaccine concurrent with HB vaccination may increase the response rate in non-responder individuals; however, it seems it does not have any role in the persistence of immune response. Age and HCV infection negatively affected the response to HB vaccination in dialysis patients.