Vaccination against hepatitis B in patients with chronic renal failure--twenty years follow-up

The efficacy of vaccination against hepatitis B was evaluated in patients with chronic renal failure from 4 dialysis units in 1988-2010. Hepatitis B vaccination was started in 1 271 patients with chronic renal failure (606 female, 665 male). Patients received intramuscularly 3 doses of plasma-derived or since 1990, recombinant vaccine at the interval 0, 1 and 2 months for dialysis patients and 0, 1 and 6 months for pre-dialysis patients. Each vaccine contained 40 microg of hepatitis B surface antigen (HBsAg) in 1 002 patients, however only 20 microg HBsAg in 269 patients till 2000. Blood samples were obtained at the beginning of vaccination, 1-2 month after immunization and biannual thereafter. Serum samples were tested using ELISA methods for HBsAg and antibodies against hepatitis B surface and core antigens (anti-HBs, anti-HBc). The patients without protective anti-HBs level and the patients with waning of anti-HBs antibodies were revaccinated. Anti-HBs antibodies after the third vaccine were investigated in 786 patients. Protective anti-HBs levels (> or = 10 IU/l) were proved in 49%, 65% and 74% patients after the third, fourth and fifth vaccine. The waning of protective anti-HBs antibodies was detected in 47% and 68% of patients during 3 and 5 years after vaccination. The new infections with HBsAg positive status were proved in 28 patients, in 27 of them in period 1988-1994. Anti-HBc seroconversion was observed in 10 patients. Vaccination considerably reduced hepatitis B incidence in the patients with chronic renal failure during nineties. However still approximately one quarter of patients did not produce protective anti-HBs level after immunization with recombinant vaccine and new form of vaccination against hepatitis B may be considered also in the Czech Republic.