Immunogenicity of Four Doses of Double-Strength Intramuscular Hepatitis B

Document Type: Original Research

Authors

1 Dept. of Internal Medicine, Sina hospital, Tehran, Iran

2 Research Development Center, Sina hospital, Tehran, Iran

3 Clinical Research Dept., Pasteur Institute of Iran, Tehran, Iran

4 Urology Research Center, Sina hospital, Tehran, Iran

Abstract

Background: Hepatitis B virus potentially accelerates graft rejection and mortality in renal transplantation population. Vaccination of graft candidates without prior immunization against HBV seems essential before transplantation but some candidates of transplantation have not received HBV vaccine at the time of receiving graft. We aimed to evaluate immunogenicity of an enhanced regimen (4 doses of double-strength intramuscular shots) after kidney transplantation in candidates without history of prior HBV vaccination.
Methods:
This quasi-experimental study was conducted, 49 renal graft recipients in Sina Hospital (Tehran University of Medical Sciences, Tehran, Iran) of age >18, receiving graft within past 6 months and negative history of hepatitis B vaccination from 2010-2011. Participants received 40 μg intramuscular (IM) shots of a recombinant vaccine in the months 0, 1, 2 and 6. The titer of HBsAb was measured 8 weeks after the 3rd and 4th injections. Cases with HBsAb titers less than 10 mIu/ml were considered as non-responder while antiHBs≥10 mIu/ml was considered protective.
Results:
The overall response rate was 57.14% (28/49 patients). Protective HBsAb titers were detected in 44.89% patients following 3rd dose and reached to 57.14% after injecting the 4th shots. The mean HBsAb titers were 50.00 (±88.35) mIu/ml and 229.45 (±356.56) mIu/ml after the 3rd and 4th shots respectively. Responders showed significantly younger age in comparison to non-responders (P=0.013). The vaccine was well tolerated in all patients with no side effects.
Conclusions:
Regarding the relative good response rate following HBV vaccination in graft recipients, we suggest a post-transplantation enhanced regimen of 4-dose double-strength IM shots against HBV in patients without prior immunization.

Keywords


  1. Vallet-Pichard A, Fontaine H, Mallet V, Pol S. Viral hepatitis in solid organ transplantation other than liver. J Hepatol 2011; 55:474-482.
  2. Weikert BC, Blumberg EA. Viral infection after renal transplantation: surveillance and management. Clin J Am Soc Nephrol 2008;3 suppl 2:S76-86.
  3. Agarwal SK. Hepatitis B infection during renal replacement therapy. Hepat Mon 2010;10: 255-257.
  4. Teo EK, Lok ASF. Hepatitis B virus vaccination. 2012. Available from: http://www.uptodate.com/contents/hepatitis-b-virus-vaccination. Accessed: 29 July 2013.
  5. Etemadi J, Somi MH, Ardalan MR, Hashemi SS, Soltani GG, Shoja MM. Prevalence and risk factors of Hepatitis B infection among hemodialysis patients in Tabriz: a multicenter report. Saudi J Kidney Dis Transpl 2012;23:609-613.
  6. Burdick RA, Bragg-Gresham JL, Woods JD, Hedderwick SA, Kurokawa K, Combe C, et al. Patterns of hepatitis prevalence and seroconversion in hemodialysis units from three continents: the DOOPS. Kidney Int 2003;63:2222-9.
  7. Gane E, Pilmore H. Management of chronic viral hepatitis before and after renal transplantation. Transplantation 2002;74:427-437.
  8. Tsai MC, Chen YT, Chien YS, Chen TC, Hu TH. Hepatitis B virus infection and renal transplant. World J Gastroenterol 2010;16:3878-3887.
  9. Fabrizi F, Martin P, Dixit V, Kanwal F, Dulai G. HBsAg seropositive status and survival after renal transplantation: meta-analysis of observational studies. Am J Transplant 2005;5:2913-2921.
  10. Chan TM, Chapman J, Lee CJ, Morad Z, Ona ET, Park K, et al. A survey on the prevalence and management of hepatitis B after renal transplantation in Asian-Pacific countries. Transplant Proc 2004;36:2126-2127.
  11. Urbini Dos Santos C, Sevá-Pereira T, Alves-Filho G, Lorena SL, Soares EC, Mazzali M. Changes in serological markers of hepatitis B virus after renal transplantation. Transplant Proc 2008;40:749-751.
  12. Jacobson IM, Jaffers G, Dienstag JL, Tolkoff-Rubin NE, Cosimi AB, Delmonico F et al. Immunogenicity of hepatitis B vaccine in renal transplant recipients. Transplantation 1985;39:393-395.
  13. Choy BY, Peiris JS, Chan TM, Lo SK, Lui SL, Lai KN. Immunogenicity of intradermal hepatitis B vaccination in renal transplant recipients. Am J Transplant 2002;2:965-969.
  14. Serrano B, Bayas JM, Bruni L, Diez C. Solid organ transplantation and response to vaccination. Vaccine 2007;25:7331-7338.
  15. Feuerhake A, Muller R, Lauchart W, Pichlmayr R, Schmidt FW. HBV-vaccination in recipients of kidney allografts. Vaccine 1984;2:255-256.
  16. Lefebure AF, Verpooten GA, Couttenye MM, De Broe ME. Immunogenicity of a recombinant DNA hepatitis B vaccine in renal transplant patients. Vaccine 1993;11:397-399.
  17. Kotton CN, Fishman JA. Viral Infection in the Renal Transplant Recipient. J Am Soc Nephrol 2005;16:1758-1774.
  18. Chaabane NB, Loghmari H, Melki W, Hellara O, Safer L, Bdioui F et al. Chronic viral hepatitis and kidney failure. Presse Med 2008;37:665-678. [Abstract]
  19. Vlassopoulos D. Recombinant hepatitis B vaccination in renal failure patients. Curr Pharm Biotechnol 2003;4:141-151.
  20. Bock M, Barros E, Veronese FJ. Hepatitis B vaccination in haemodialysis patients: a randomized clinical trial. Nephrology (carlton) 2009;14:267-272.
  21. Ramezani A, Velayati AA, Eslamifar A, Banifazl M, Ahmadi F, Maziar S et al. Persistence of hepatitis B vaccine immunity in hemodialysis patients. Ther Apher Dial 2008;12:143-146.
  22. Potsangbam G, Yadav A, Chandel N, Rathi M, Sharma A, Kohli HS. Challenges in containing the burden of hepatitis B infection in dialysis and transplant patients in India. . Nephrology (carlton) 2011;16:383-388.