Kidney Week

Abstract: FR-PO771

Successful Hepatitis B Seroconversion Using Intradermal Engerix-B in Hemodialysis Patients Unresponsive to Two Courses of Standard Double-Dose Intramuscular Vaccine - Real World Experience

Session Information

• Dialysis: Inflammation and Infection
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Landry, Daniel L., Baystate Medical Center, Springfield, Massachusetts, United States

Daniel L. Landry,

• Braden, Gregory Lee, Baystate Medical Center, Springfield, Massachusetts, United States

Gregory Lee Braden,

• Hodgins, Spencer, Baystate Medical Center, Springfield, Massachusetts, United States

Spencer Hodgins,

• Mulhern, Jeffrey, Kidney Care and Transplant Services of New England, Springfield, Massachusetts, United States

Jeffrey Mulhern,

Background

Double dose intramuscular (DDIM) hepatitis B vaccination of nonimmune incident hemodialysis patients remains standard of care. Given best case reported seroconversion rates of only 70 percent in this population following a standard DDIM regimen, a significant number of hemodialysis patients are deemed non-responders, remain at risk for infection and ultimately require cohorting away from isolation rooms when an actively infected patient is present. Multiple protocols have been recommended to convert these non-responders including administration of a single DDIM booster dose, repetition of an entire DDIM series or conversion to an intradermal delivery protocol. We report our experience with short-term intradermal hepatitis B vaccination in 28 patients who failed to respond to two courses of standard DDIM hepatitis B vaccination.

Methods

Non-responder patients were defined as those with an anti-HBsAg titer < 10 mIU/mL 30 days after receiving two DDIM series consisting of Engerix-B (GlaxoSmithKline) 40 mcg at months 0, 1, 2 and 6. All non-responders subsequently received 5-10 mcg intradermal Engerix-B every two weeks for a total of 8 doses. An anti-HBsAg titer > 10 mIU/mL at one year after completion of intradermal dosing was considered a successful response.

Results

Twenty-five of 28 (89%) patients unresponsive to two courses of DDIM Engerix-B responded to intradermal dosing with a mean anti-HBsAg titer of 258 mIU/mL at 1 year. Twenty of the 25 patients who seroconverted responded with a titer > 30 mIU/mL. No significant differences in age, race, gender, dialysis access type, comorbidities, nutritional parameters, bone mineral markers, dialysis adequacy, or dialysis vintage were noted between the two groups. There were no reports of adverse events associated with intradermal dosing.

Conclusion

Intradermal dosing of Engerix-B to hemodialysis patients unresponsive to two courses of DDIM vaccination is highly effective in achieving a sustained serologic response. The practice of administering a second DDIM vaccination series to non-responder hemodialysis patients should be abandoned and replaced with an intradermal Engerix-B dosing regimen.