Response of Hepatitis B Vaccination in Children on Hemodialysis

ABSTRACT
Background: Following hepatitis B vaccination, dialysis patients show lower production and more rapid decline of protective antibodies compared to healthy individuals. Higher doses of vaccine are therefore recommended for adults with end stage renal disease. The issue has been less well studied in children. Objective: To assess the efficacy of hepatitis B vaccine in Egyptian children on regular hemodialysis for end stage renal disease (ESRD). Methods: Three intramuscular doses of hepatitis B vaccine; 20 μg hepatitis B surface antigen each, was investigated in 30 Egyptian children (age 5-13 years) on regular hemodialysis for end stage renal disease (ESRD). Antibody response was assess after the third dose and antibodies to hepatitis B surface antigen (HBsAB) levels were measured one and three years thereafter. Results: Initial response with positive HBsAB occurred in 26 patients (87%). Protective antibodies (≥10Miu/Ml) were present in 83% of cases after one year and 65% after three years. Antibodies response was maintained for three years in all patients who had HBsAB levels of 100Miu/Ml or higher at one year. There was no significant  relation between the response to the vaccine and either gender, age, weight, serum albumin, hemoglobin or hepatitis C infection. Conclusions: A series of three 20 μg doses of hepatitis B vaccine is effective in inducing an appropriate antibody response in most children with ESRD on hemodialysis.