Antibody Response Rates To Hepatitis B Vaccination in Children With Chronic Renal Failure: An Observational Study

Year 2013, Volume: 5 , - , 16.06.2013

İbrahim Ece , Ayse Kibar , Burhan Oflaz , Nilgun Cakar Sevket Balli , Nermin Akkok Nazli Kara

Abstract

Introduction: Hepatitis B virus (HBV) infection is one of the most important factors increasing the mortality and the mobility in patients with chronic renal failure (CRF). There are a limited number of studies of pediatric patients with CRF regarding the response to double doses and protection rates. In this study, our aim was to compare the antibody levels and the respond rates to recombinant hepatitis B vaccine in children with chronic renal failure (CRF).

Materials and Methods: In this prospective observational study, 36 children were included, who were in follow-up with a diagnosis of CRF, with a negative HBV serology and inadequate protective antibody levels. Prior to the vaccination program, HBV serologic tests and liver transaminase measurements were done in all patients. Patients under 11 years of age were administered 20 mcg, and patients older than 11 years were given 40 mcg of third generation recombinant DNA vaccine Euvax-B (LG Chemical Ltd.-Berk, Seoul-South Korea),  into the deltoid muscle at months 0, 1 and 6. After vaccination, antiHBs levels were determined at the 1st, the 3rd, the 7th and the 12th months. A antiHBs level of ≥10 mlU/L was considered protective. Protection against hepatitis B infection as the ratio of ≥ 10 mIU / L. Analysis of variance, chi-square and T-test were used for the statistical analysis.

Results: There were 21 female and 15 male patients. The mean age was 14.02 ± 4.2 years. Of all the patients, 11were at predialysis stage, 20 had continuous ambulatory peritoneal dialysis (CAPD), and 5 patients were treated with hemodialysis. In all groups of patients; protection rates of 58% in the 1st month, 92% in the 3rd month, 92% in the 7th month, 97% in the 12th month were achieved. The average vaccination antibody levels in all patients, according to the months were 210 mIU / L, 289 mIU / L, 336 mIU / L, and 336 mIU / L, respectively. There were no significant differences among the groups in terms of gender, protection rates and antibody titers (p> 0.05). The protection rate was found to be 67% in three patients receiving immunosuppressive therapy.The vaccination program was implemented in 18 patients who were on EPO treatment (Table 2). In these patients, the protective ratio was 83% and 94%, at 1 and 3 months, and 100% at 7 and 12 months. All patients with EPO treatment had an adequate antibody response.

Conclusion: In our study, although the relative antibody response to hepatitis B vaccine was related to the immune regulation in pediatric patients with CRF, it did not seem to have a relationship with the type of dialysis. In addition, in the first year post-vaccination with a double dose, adequate antibody levels and level of protection is achieved in a substantial proportion of patients.

Keywords

Hepatitis B, Chronic Renal Failure, Dialysis, Vaccination,

References

• Cengiz B. Hepatit B aşıları. Katkı Pediatri Dergisi 2006; 28: 590-603.
• Koşan C. Aşıların kronik diyaliz hastalarında kullanımı. AÜTD 2002; 34:25-29.
• Ferreira C. Silveira T. Viral hepatitis prevention by immunization. J Pediatr 2006; 82: 55-66.
• Özen M, Yologlu S, Işık Y, Yetkin G. Turgut Özal Tıp Merkezi’ne başvuran 0-16 yaş grubu çocuklarda Anti-HBs seropozitifliği. Türk Pediatri Arşivi 2006; 41: 31- 5.
• Gündüz Z. Düşünsel R, Patıroglu T, Utaş C,Kılıc H. Kronik hemodiyaliz hastalarında hepatit B aşı uygulaması ve immün cevabın değerlendirilmesi. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 1995; 4: 25-32
• Fabrizi F. Lunghi G. Hepatitis B virus infection in hemodialysis: recent discoveries. J Nephrol. 2002;15: 463-8.
• Kaygusuz TÖ. Kronik Hemodiyaliz Hastalarında HBsAg ve Anti-HBs Seroprevalansı. F.Ü. Sağ. Bil. Derg. 2007:21:55-57.
• Assarehzadegan MA, Shakerinejad G, Noroozkohnejad R, Amini A, Rahim Rezaee SA. Prevalence of hepatitis C and B infection and HCV genotypes among hemodialysis patients in Khuzestan province, southwest Iran. Saudi J Kidney Dis Transpl. 2009;20:681-4.
• Edward L. Pesanti MD. Immunologic defects and vaccination with chronic renal failure. İnfect Dis Clin North Am. 2001;15: 813Hörl WH. Neutrophil function in renal failure. Adv Nephrol Necker Hosp. 2001; 31: 173-92
• Rangel MC, Coronado VG, Euler GL, Strikas RA. Vaccine recommendations for patients on chronic dialysis. The Advisory Committee on Immunization Practices and the American Academy of Pediatrics. Semin Dial 2000;13:101-107.
• Angeleni D. Carlini A. Immunologic disturbances and levels of parathyroid hormone in uremic patients in replacement dialysis therapy. Clin Nephrol 1994;42: 24650
• Singh AB. Singh M. The effects of recombinant human erythropoietin on the cell mediated immune response of renal failure patients. J Med. 1992; 23: 289-302
• Liu YL, Kao MT, Huang CC. A comparison of responsiveness to hepatitis B vaccination in patients on hemodialysis and peritoneal dialysis. Vaccine 2005; 23:3957-3960.
• Ayvaz A, Nur N, Engin A, Çetinkaya S. Sivas il merkezinde yaşayan ilkokul birinci sınıf öğrencisi çocuklarda hepatit B ve hepatit C yaygınlığı. Türk Ped Ars 2010;45:132-6.
• Van Geelen J.A. Schalm S.W. Immune response to hepatitis B vaccine in hemodialysis Patients. Nephron. 1987; 45: 216-8, Kandemir Ö, Bayarslan C, Kaya A. İzole anti-HBc pozitif olgular ve hepatit B aşısına yanıtlar. Viral Hepatit Dergisi 2000; 8: 4304
• Özacar T, Zeytinoğlu A, Erensoy S, Yapar N, Hoşgör M, Bilgiç A. Hepatit B virüs serolojisinde salt anti-HBc olumluluğu ve HBV aşısına yanıt. Viral Hepatit Dergisi 1995;2:69-71.
• Vogt B. Avner E. Renal failure, in Nelson Textbook of Pediatrics, 17th Edition Richard E Behrman, MD, Saunders 2004: 1771-4
• Somer AA, Nayır A, Alpay H, Tanman F, Şirin A, Sunar H. Kronik böbrek yetmezliği olan çocuklarda hepatit B virus aşılaması ve sonuçları. Türk Nefroloji ve Transplantasyon Dergisi 1994; 2: 59-62.
• Gündüz Z. Düşünsel R, Patıroglu T, Utaş C,Kılıc H. Kronik hemodiyaliz hastalarında hepatit B aşı uygulaması ve immün cevabın değerlendirilmesi. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 1995; 4: 25-32
• Pesanti EL. Immunologic defects and vaccination with chronic renal failure. Infect Dis Clin North Am. 2001;15: 813-32.
• Nayır A. Kronik Böbrek Yetersizlikli Çocuklarda Aşıların Kullanımı. Türk Pediatri Arşivi 1995;30:4-9.
• Drachman R, Isacsohn M, Rudensky B, Drukker A. Vaccination aganist hepatitis B in children and adolescent patients on dialysis. Nephrol Dial Transplant. 1989; 4: 372-4.
• Koşar A. Yeksan M, Dalmaz M, Koşar M. Hemodiyaliz hastalarında değişik iki doz rekombinant hepatit B aşısı uygulamasının karşılaştırılması. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 1995; 4: 97-100
• Bak M. Aksu N, Kabasakal C, Cura A. Hemodiyaliz hastalarında hepatit B, hepatit C ve hepatit B aşı uygulaması. Türk Pediatri Arşivi 1993, 28: 229-32
• Atabek A. Nayır A, Alpay H, Tanman F, Şirin A, Sunar H. Kronik böbrek yetersizliği olan çocuklarda hepatit B aşılaması ve sonuçları. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 1994;3: 59-62. Taal MW, van Zyl-Smit R. Costeffectiveness of hepatitis B vaccination in haemodialysis patients. S Afr Med J. 2001; 91: 340-4.
• Doğukan A, Taşkapan H, Güven M, Tokgöz B, Oymak O, Utaş C. Prediyaliz, hemodiyaliz ve sürekli ayaktan periton diyalizi hastalarında çift doz hepatit B aşısına yanıt. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi 1999;8:192-4.
• Mitwalli A. Responsiveness to hepatitis B vaccine in immunocompromised patients by doubling the dose scheduling. Nephron. 1996; 73: 417-20.
• Liu Y-L, Kao M-T, Huanq CC. A comparison of responsivenss to hepatitis B vaccination in patients on hemodialysis and peritoneal dialysis. Vaccine. 2005; 23: 3957
• Navarro JF, Teruel JL, Mateos ML, Marcen R, Ortuno J. Antibody level after hepatitis B vaccination in hemodialysis patients: influence of hepatitis C virüs infection. Am J Nephrol. 1996;16: 95-7
• Bel'eed K, Wright M, Eadington D, Farr M, Sellars L. Vaccination aganist hepatitis B infection in patients with end stage renal disease. Postgrad Med J. 2002;78: 538-40
• Angelini D, Carlini A, Mazzotta L et al. Immunologic disturbances and levels of parathyroid hormone in uremic patients in replacement dialysis therapy. Clin Nephrol 1994;42: 246-50.
• Anandh U, Thomas PP, Shastry JC, Jacob CK. A randomised controlled trial of intradermal hepatitis B vaccination and augmentation of response with erythropoetin. J Assoc Physicians India. 2000; 48:1061-3.
• Drachman R, Isacsohn M, Rudensky B, Drukker A. Vaccination aganist hepatitis B in children and adolescent patients on dialysis. Nephrol Dial Transplant. 1989; 4: 372-4.