Low Dose Intradermal Versus High Dose Intramuscular Hepatitis B Vaccination in Patients on Chronic Hemodialysis

Abstract

Patients with end-stage renal disease on hemodialysis (HD) are at high risk for hepatitis B infection. We randomly assigned 86 new patients on HD to receive either 40 microg intramuscular (group 1) or 20 microg intradermal (group 2) recombinant hepatitis B vaccine, in three doses at 0, 1, and 4 months. All patients were seronegative at baseline for hepatitis B surface antigen (HBs-Ag), hepatitis B surface antibody (HBs-Ab), and hepatitis B core antibody (HBc-Ab). HBs-Ab seroconversion rate and antibody titer (ELISA assay) were compared in 27 patients of group 1 and 35 patients of group 2 at 1 month, and in 20 patients of group 1 and 26 patients of group 2 at 6 months after the last vaccine dose. The seroconversion rates (HBs-Ab titer >10 IU/L) were 55.6% and 50% in group 1, and 54.3% and 50% in group 2, at 1 and 6 months, respectively (p = NS). Patients' age, body mass index, serum albumin concentration, and sex distribution were similar in the responders and nonresponders. Intradermal hepatitis B vaccination used at half dose may be a cost saving alternative to intramuscular vaccination in patients on HD. However, the low overall seroconversion rate mandates seeking alternative ways of vaccination in this patient population.