A randomized comparison of intradermal and intramuscular vaccination against hepatitis B virus in incident chronic hemodialysis patients

Hepatitis B virus (HBV) remains a threat to hemodialysis patients. Nevertheless, the vaccination rate against this virus is low, perhaps because of the low conversion rate. Although intradermal (ID) Vaccination has been proven to be effective (even in patients nonresponsive to intramuscular [IM] vaccination), the duration of immunity was short. The impact of vaccination route and a greater peak antibody (Ab) titer on conversion rate and duration of immunity after ID or IM Vaccination was compared in incident hemodialysis patients. Forty-nine patients were randomly assigned to treatment with 5 mug of recombinant hepatitis B vaccine (Engerix B; Smith Kline Beecham Pharma inc, Oakville, ON, Canada) ID every 2 weeks up to either a peak Ab titer of 1,000 IU/L or greater or 52 doses, whereas 48 patients were administered 40 mug IM at 0, 1, 2, and 6 months. Group demographics were similar, Conversion was achieved in 97.6% of the ID group and 90.5% of the IM group (P = 0.16). There was no difference between ID end IM groups in time required to convert, peak Ab titer reached, and proportion of patients with a peak Ab titer of 1,000 IU/L or greater. Overall, the duration of immunity was not different after ID or IM vaccination (P = 0.683), and patients in the IM group with a peak Ab titer of 1,000 IU/L or greater had a longer duration of immunity (P = 0.001). In conclusion, a high conversion rate and long duration of immunity against HBV can be achieved cost-effectively in the end-stage renal disease population using the ID or IM route and aiming for an Ab titer exceeding 1,000 IU/L. Based on these data, we provide recommendations for vaccination and surveillance in this population. (C) 2000 by the National Kidney Foundation, Inc.