Active immunization against hepatitis B infection of a haemodialysis population

Patients undergoing haemodialysis run a high risk of developing hepatitis B virus infection. We noted high prevalence rates of this infection in our patients despite a policy of using active hepatitis B vaccination. We, therefore, examined the reasons why haemodialysis-associated hepatitis B virus infection was difficult to control.

We analysed retrospectively 131 patients who had undergone haemodialysis for end-stage renal disease at our centre between June 1991 and May 1992. Patients given hepatitis B vaccine prior to starting haemodialysis were included in group A while those vaccinated after starting haemodialysis were placed in group B. The vaccination schedule consisted of 3 doses of recombinant hepatitis B vaccine given at monthly intervals.

Fifteen patients had hepatitis B infection at entry, of whom 12 had had prior blood transfusions. Active immunization with recombinant hepatitis B vaccine was attempted in the remaining 116 patients. There were 16 patients in group A and 100 in group B. Of the 7 patients in group A and 46 in group B who completed the vaccination schedule, protective antibodies and markers of hepatitis B viral infection were noted in 3 and 2 patients respectively in group A and 7 and 14 patients respectively in group B. Vaccination was not completed in 63 patients as 25 discontinued haemodialysis, 22 developed markers of hepatitis B infection and 16 underwent renal transplantation.

Poor seroprotection rates with the standard vaccination schedule, unscreened blood transfusions and an inability to complete the vaccination schedule were the major reasons why active immunization against hepatitis B viral infection in our patients on haemodialysis has been largely unsuccessful.