Efficacy and side effects of intradermal hepatitis B vaccination in CAPD patients: a comparison with the intramuscular vaccination

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Am J Kidney Dis. 2004 May;43(5):910-7.

Efficacy and side effects of intradermal hepatitis B vaccination in CAPD

patients: a comparison with the intramuscular vaccination.

Chau KF, Cheng YL, Tsang DN, Choi KS, Wong KM, Chak WL, Chan YH, Li CS.

Department of Medicine, Queen Hospital, Hong Kong, China People's

Republic of China.

BACKGROUND: This prospective randomized study aims to assess the

effectiveness of intradermal (ID) hepatitis B virus (HBV) vaccination in

patients on continuous ambulatory peritoneal dialysis (CAPD) therapy.

METHODS: Sixty patients were randomly divided into 2 groups. The ID group

was treated with 5 microg of recombinant HBV vaccine intradermally every

week for a total of 10 doses, and the intramuscular (IM) group, with 20

microg intramuscularly at 0, 1, and 6 months. RESULTS: ID HBV vaccination

was associated with a greater seroconversion rate (81.5% versus 62.1%),

although the difference did not reach statistical significance (P = 0.14).

The cumulative seroconversion rate was significantly greater with ID

vaccination by 6 months after the first vaccine dose (P = 0.03). There was

no difference between the 2 groups in time required to convert, peak

antibody to HBV surface antigen (anti-HBs), and proportion of patients with

anti-HBs levels maintained at greater than 10 mIU/mL or 100 mIU/mL in the

2-year observation period. Although the ID group achieved a peak anti-HBs

titer significantly earlier than the IM group (P = 0.001), we found a

significant trend for the ID group to achieve a lower peak anti-HBs titer

(chi-square test for trend, P = 0.005). The incidence of local reactions was

significantly greater with ID immunization; however, reactions were mild and

transient. CONCLUSION: ID HBV vaccination is associated with significant

improvement in seroconversion rate in CAPD patients at 6 months, but this

difference diminishes at 2 years. Larger studies are warranted to confirm

this finding.

PMID: 15112182 [PubMed]