Immunogenicity of Augmented Compared With Standard Dose Hepatitis B Vaccine in Pediatric Patients on Dialysis: a Midwest Pediatric Nephrology Consortium Study. Clin J Am Soc Nephrol 2017 May 08;12(5):772-778
Date
03/09/2017Pubmed ID
28270432Pubmed Central ID
PMC5477206DOI
10.2215/CJN.04750416Scopus ID
2-s2.0-85021722076 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
BACKGROUND AND OBJECTIVES: Patients on maintenance dialysis have a higher risk of unresponsiveness to hepatitis B vaccination and loss of hepatitis B immunity. Adult guidelines recommend augmented dosing (40 mcg/dose), resulting in improved response in adults. We sought to determine whether children on dialysis mount a similar antibody response when given standard or augmented dosing of hepatitis B vaccine.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a retrospective review of patients on dialysis aged <19 years from May 1, 2008 to May 1, 2013 at 12 pediatric dialysis units. Hepatitis B surface antibody (HBsAb) titers ≥10 mIU/ml were defined as protective.
RESULTS: A total of 187 out of 417 patients received one or more hepatitis B vaccine boosters. The median age was 13 years; the cohort was 57% boys and 59% white. Booster dose or HBsAb titers were missing in 17 patients. Conversion to protective HBsAb titers was achieved in 135 out of 170 patients (79%) after their first single-dose booster or multidose booster series. In patients receiving a single-dose booster, the response rate was 53% (nine out of 17) after a 10 mcg dose, 86% (65 out of 76) after a 20 mcg dose, and 65% (17 out of 26) after a 40 mcg hepatitis B vaccine dose. In patients receiving a multidose booster series, the response rate was 95% (19 out of 20) after a 10 mcg/dose series, 83% (20 out of 24) after a 20 mcg/dose series, and 71% (five out of seven) after a 40 mcg/dose series. Patients receiving a multidose booster series had a response rate of 86% (44 out of 51), compared with 76% (91 out of 119) in patients receiving a single-dose booster (P=0.21). Twenty-seven patients received more than one single-dose booster or multidose series, and 26 out of 27 (96%) eventually gained immunity after receiving one to three additional single-dose boosters or multidose booster series.
CONCLUSIONS: There was no clear gradient of increasing seroconversion rate with increasing vaccine dose in this cohort of pediatric patients on dialysis.
Author List
Misurac JM, VanDeVoorde RG, Kallash M, Iorember FM, Luckritz KE, Rheault MN, Jetton JG, Turman MA, Kapur G, Twombley KE, Hashmat S, Weaver DJ, Leiser JD, Nailescu CAuthor
Jennifer G. Jetton MD Chief, Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAge Factors
Biomarkers
Child
Child, Preschool
Female
Hepatitis B
Hepatitis B Antibodies
Hepatitis B Vaccines
Humans
Immunization, Secondary
Immunogenicity, Vaccine
Kidney Diseases
Male
Midwestern United States
Peritoneal Dialysis
Renal Dialysis
Retrospective Studies
Seroconversion
Time Factors
Treatment Outcome
Vaccination
