Efficacy of the accelerated hepatitis B vaccination schedule used in haemodialysis patients post-exposure to virus: a single-centre experience.

Background: The hepatitis B (HB) vaccination regime currently recommended for use in the UK for both preventative and post-exposure purposes is the accelerated regime, although there have been no recent reports of its efficacy. This observational study reports on the response rate achieved and longevity of protection conferred with this regime in a large number of haemodialysis patients following an episode of HB exposure.

Methods: One-hundred and five patients received primary vaccination (vaccine administered at 0, 1 and 2 months). Eighty-six completed the regime, receiving a booster dose at month 12. Measuring antibodies to HB surface antigen (anti-HBS) 6 weeks after receiving the third and fourth doses assessed patients' response. Seventy-seven patients subsequently had anti-HBs measured at month 24.

Results: The response rate (anti-HBS >10 mIU/ml) to primary vaccination and the complete regime was 33 and 73%, respectively. Non-European patients responded better to primary vaccination than Europeans (P=0.014). Those receiving steroids responded less well to the complete vaccination regime (P=0.007). Patient's age, sex, renal diagnosis, diabetes mellitus, time on dialysis, dialysis adequacy, erythropoietin dose, hepatitis C or body weight did not affect response rates. By month 24, 24 responders (44%) had lost seroprotection. Antibody levels achieved with vaccination by transient responders was significantly lower than persistent responders. No patients became HB surface antigen positive during the 2-year study.

Conclusion: Reserving the accelerated vaccination to the post-exposure scenario will expose many more patients to the risk of HB cross-infection than if used prophylactically. Regular monitoring is required if seroprotection is to be maintained.