Low response to intradermal hepatitis B vaccination in incident hemodialysis patients.
| Autor: | Medeiros RH; Post-Graduation in Medicine and Health Sciences, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre, RS, Brazil., Figueiredo AE, Poli-de-Figueiredo CE, d'Avila DO, de los Santos CA |
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| Jazyk: | English; Portuguese |
| Zdroj: | Jornal brasileiro de nefrologia [J Bras Nefrol] 2011 Mar; Vol. 33 (1), pp. 45-9. |
| Abstrakt: | Introduction: Hepatitis B (HB) may progress to cirrhosis and liver carcinoma. Its prevalence is estimated at 3.2 % in hemodialysis (HD) patients. HB vaccine when applied intramuscularly (IM) in end-stage renal disease patients often does not induce appropriate antibody titers. However, there has been suggestion for intradermal (ID) to be a more effective inoculation method. Objective: To compare the immune response to IM or ID vaccine administration on HD patients. Patients and Methods: Thirty one incident HD patients were randomly assigned alternately to IM or ID vaccine inoculation. Vaccine doses were applied at three monthly intervals, with patients being followed-up for six months. Sixteen patients were assigned to IM (40 mg/dose) and 15 to ID (4 mg/dose) vaccine administration. HB-virus surface antibody titer, hematimetric parameters, serum urea level and Kt/V were monthly evaluated. C-reactive protein, parathormone, ferritin, aminotransferases and albumin serum levels were evaluated before and at the sixth month of the initial inoculation. Results: Urea levels were significantly higher in the ID group (P(1) = 0.031); ferritin levels were higher in the IM (P(2) = 0.037) and C-reactive protein levels tended to be higher in the ID group. An interim evaluation by the Safety Monitoring Committee recommended discontinuing the study as IM vaccination had converted 62.5% of the exposed subjects, while ID inoculation converted only 13.3%. Conclusion: As performed, ID applied vaccine was inferior to the IM inoculation. Such result may depend on the inoculated doses or some other factor, such as inflammation. |
| Databáze: | MEDLINE |
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