Poor response to a recombinant hepatitis b vaccine in dialysis patients

Eighty-three dialysis patients were inoculated with 20 μg of the recombinant derived hepatitis B vaccine Engerix-B at 0, 1 and 6 months. Twenty-seven (32·5 %) became seropositive for anti-HBs antibody after the third inoculation. Of the 56 non-responders, 48 received a 40 μg booster dose of vaccine 6 weeks after completion of the initial course and a further eight seroconverted. Six months after the third inoculation only 18/71 patients retested (25·3 %) had demonstrable antibodies. We were unable to identify clinical or laboratory parameters separating responders from non responders to the vaccine. We recommend regular checks of anti-HBs status of vaccinated patients as it cannot be assumed that even initial responders retain their immunity. Those infection control procedures known to have decreased the incidence of hepatitis B infection in dialysis units should not be relaxed.