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Immunogenicity of hepatitis B vaccine (HEVAC B) in children with advanced renal failure
G Pillion1, M Chiesa, A Maisin
1Service de Néphrologie Pédiatrique, Hôpital Robert Debré, Paris, France.
Insights
Hepatitis B (HB) vaccine HEVAC B safely protects over 90% of children with advanced renal failure. A reinforced vaccination schedule ensured sustained protection, with no HB infections reported.
Area of Science:
- Immunology
- Vaccinology
- Pediatric Nephrology
Background:
- Children with advanced renal failure often have an impaired immune response.
- Hepatitis B (HB) infection poses a significant risk to patients with renal failure.
Purpose of the Study:
- To evaluate the immunogenicity and safety of the HEVAC B vaccine in children with advanced renal failure.
- To determine the sustained protection levels and identify predictors of antibody decline.
Main Methods:
- 33 children with advanced renal failure received three initial HB vaccine doses and a booster.
- Antibody titres to HB surface antigen (anti-HBs) were measured to define responders (>10 mIU/ml) and protected patients (>50 mIU/ml).
- Patients received additional injections if protection waned.
Main Results:
- 91% of children were responders and 91% were protected 2 months post-third dose.
- 100% response and protection were achieved after the booster dose, sustained for at least 26 months.
- 25% of patients required additional injections to maintain protection.
Conclusions:
- HEVAC B vaccine is safe and effective in achieving sustained protection in most children with advanced renal failure.
- Early anti-HBs titres post-vaccination can predict antibody decline, guiding the need for further immunizations.
- A reinforced vaccination schedule is effective in maintaining long-term immunity against Hepatitis B in this vulnerable population.
Abstract:
The immune response after hepatitis B (HB) vaccine HEVAC B was studied in 33 children (mean age 10 +/- 4 years) with advanced renal failure. Responders and protected patients were defined by antibody titres to HB surface antigen (anti-HBs) of greater than 10 and 50 mIU/ml, respectively. All received the initial recommended three injections at monthly intervals, and 23 received a booster injection (IB) 11 +/- 1 months after the third injection (I3). Loss of protection after I3 led to additional injections in 8 patients (25%). Vaccine was well tolerated and no HB infection occurred during the follow-up period (19 +/- 10 months). The percentage of responders was 91% 2 +/- 1 months after I3, and 100% 1 month, 13 +/- 1 months and 26 +/- 2 months after IB. The percentages of protected patients at these dates were 91%, 95%, 100% and 100%. Anti-HBs titres 1-3 months after I3 were useful for indicating those patients likely to have a rapid decline in anti-HBs titres, thus requiring serial anti-HBs determinations and additional injections to prevent a loss of protection. We conclude that at the expense of a reinforced vaccination schedule in 25% of patients, HEV AC B vaccine can safely achieve a sustained protection in more than 90% of uraemic children.