2nd congress of the Spanish transplantation societyKidney transplantation: CandidatesEfficacy of a Hepatitis B Vaccination Schedule With Two Cycles of Four Double Doses of Conventional Vaccine and Four Doses of Adjuvanted Vaccine in Chronic Kidney Disease Patients Evaluated for Renal Transplantation
Section snippets
Methods
In this prospective study, we consecutively recruited chronic kidney disease patients evaluated for renal transplantation from January 2009 to January 2012. Nonimmunized patients received four 40 μg doses of hepatitis B virus vaccine (Engerix) at 0, 1, 2 and 6 months, four 40-μg doses of hepatitis B virus vaccine (Engerix) if they were nonresponders, and four 20-μg doses of adjuvanted vaccine (Fendrix) if they remained nonresponders. AntiHBs titers were analyzed before every vaccine dose and 1
Results
One hundred fifty-five patients were enrolled in the study (Table 1).
The response to the vaccination increased until the seventh dose (first dose, 5.4%; second, 29.5%; third, 66.7%; fourth, 75.9%; fifth, 83.3%; sixth, 87.3%; seventh, 92.5%; and eighth, 93.8%) (Fig 1). AntiHBs titers after the first and second vaccination with Engerix were 10 to 99 mIU/mL in the 12% and 7.7%, 100 to 999 mIU/mL in the 30.1% and 46.2%, and 1000 mIU/mL in the 34.9% and 15.4% (mean, 469 mIU/mL and 252 mIU/mL),
Discussion
Chronic kidney disease patients have a suboptimal response to hepatitis B vaccination due to their impared immune system. Uremia induces defects in phagocytosis and T- and B-cell function. To improve vaccination response, patients should be vaccinated as soon as possible in the course of renal disease, using a 4-double dose vaccine schedule.
This study shows that chronic kidney disease patients can reach a high response rate to hepatitis B vaccination with a different revaccination schedule. In
References (8)
- et al.
National surveillance of dialysis-associated diseases in the United States, 2002
Semin Dial
(2005) - et al.
Hemodialysis-associated hepatitis: report of an epidemic with further evidence on mechanisms of transmission
Am J Epidemiol
(1976) - et al.
A common-source outbreak of hepatitis B in a hemodialysis unit
Dial Transplant
(1983) - et al.
Hepatitis B virus transmission associated with a multiple-dose vial in a hemodialysis unit
Ann Intern Med
(1983)
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Hepatitis B virus vaccine and chronic kidney disease. The advances
2021, NefrologiaCitation Excerpt :Antibody persistence was greater in the HBV-AS04 than in the standard HBV vaccine group (78.4% vs. 51.4%, P = 0.023).58 The efficacy and safety of recombinant adjuvanted HBV vaccine (HBV-AS04) has been explored in additional RCTs and observational studies (Table 2).59–62 The conclusion is that HBV-AS04 provides greater immunogenicity than conventional recombinant HB vaccines.
Vaccination adjuvated against hepatitis B in Spanish National Healthcare System (SNS) workers typed as non-responders to conventional vaccines
2021, VaccineCitation Excerpt :Fendrix®, the hepatitis B vaccine formulated with the new AS04 adjuvant (MPL + aluminum salts) by GlaxoSmithKline, may provide a good alternative [19,26–28]. The vaccine is indicated for patients with renal insufficiency, especially those on hemodialysis and pre-hemodialysis aged over 15 years old [19,22,28–35]. It has been reported that revaccination with Fendrix® has a high success rate in HIV patients who do not respond to other vaccination strategies against hepatitis B [30,34–35].
Adjuvanted recombinant HBV vaccine (HBV-AS04) is effective over extended follow-up in dialysis population. An open-label non randomized trial
2020, Clinics and Research in Hepatology and GastroenterologyHBV vaccination with Fendrix is effective and safe in pre-dialysis CKD population
2020, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :Numerous approaches have been adopted to improve the immunogenicity of recombinant HBV vaccine in patients with CKD including reinforced HB vaccine schedule [7], concomitant use of immuno-modulatory agents [8,9], vaccination by ID route [10], and administration of vaccine at pre-dialysis stage [11], among others. A recombinant HB vaccine containing an improved adjuvant system (AS04) has been introduced in the market specifically for patients with CKD [12–17]; it contains as active substance 20 mcg recombinant hepatitis B surface antigen which is adjuvanted by AS04C (containing 3-0-desacyl-4′-monophosphoryl lipid A, MPL), adsorbed on aluminium phosphate and produced in Saccharomyces cerevisiae by recombinant DNA technology. MPL is a powerful stimulant of the immune system and acts through binding on the Toll-like receptor 4 on antigen-presenting cells.
Variables linked to hepatitis B vaccination success in non-dialyzed chronic kidney disease patients: Use of a bayesian model
2019, Nephrologie et TherapeutiqueCitation Excerpt :The factors responsible for this poor outcome are ambiguous and vary according to different studies. Some studies identify factors such as age [5,6], degree of kidney failure [6–8], diabetes [9,10], male sex [11], malnutrition [12], vitamin D deficiency [10] and specific human leukocyte antigen (HLA) profiles [13]. There are contradictions in these studies, for example, the effect of renal function is not reported in one study [14] while another does not find any predictive factor of poor immune response [15].