Peces R, Laurés A S
Service of Nephrology, Hospital Central de Asturias, Oviedo, Spain.
Nephron. 2001 Oct;89(2):172-6. doi: 10.1159/000046064.
Hepatitis B (HB) vaccine is effective in producing protection against HB virus infection, but the persistence of immunity remains largely unknown. Seventy-six hemodialysis (HD) patients (60 after primary HB vaccination and 16 with natural immunity) and 46 healthcare workers (32 after primary HB vaccination and 14 with natural immunity) were followed up for 10 years to evaluate the persistence of immunity. Ten years after vaccination, the analysis showed a lower seroconversion rate (38 vs. 75%, p < 0.001) in HD patients as compared with healthcare workers. In the follow-up period, the protective immunity developed through HB virus infection also showed a lower seroconversion rate (44 vs. 86%, p < 0.025) in HD patients as compared with healthcare workers. To assess the status of immunologic memory, we administered a booster dose of HB vaccine 3-12 years (mean 6.7 +/- 0.6 years) after primary vaccination in a selected group of 37 HD patients who presented a decline of their antibodies or were nonresponders. In another group of 12 healthcare workers who had a decline of their antibodies, we also administered a booster dose of HB vaccine 5-8 years (mean 5.8 +/- 0.3 years) after primary vaccination. Nineteen of the 37 HD patients (51%) presented an anamnestic response to the booster dose, and 15 of these (40%) were high responders. All of the healthcare workers responded to the booster dose with a high antibody response. We conclude that patients undergoing HD not only have lower rates of immunization to HB than healthy adults, but also that these are frequently transient. Booster doses after a primary course of vaccine are effective in about the half of HD patients who presented a decline of their antibodies or were nonresponders but whether they are necessary is unclear. The majority of healthcare workers continue to have high levels of protective HBs antibody for at least 10 years and routine boosters are not required.
乙肝（HB）疫苗在预防HB病毒感染方面有效，但免疫持久性在很大程度上仍不清楚。对76例血液透析（HD）患者（60例初次接种乙肝疫苗后，16例有自然免疫力）和46名医护人员（32例初次接种乙肝疫苗后，14例有自然免疫力）进行了10年随访，以评估免疫持久性。接种疫苗10年后的分析显示，与医护人员相比，HD患者的血清转化率较低（38%对75%，p<0.001）。在随访期间，通过HB病毒感染产生的保护性免疫在HD患者中的血清转化率也低于医护人员（44%对86%，p<0.025）。为评估免疫记忆状态，在初次接种疫苗3至12年（平均6.7±0.6年）后，对37例抗体水平下降或无反应的HD患者进行了一组强化剂量乙肝疫苗接种。在另一组12名抗体水平下降的医护人员中，我们也在初次接种疫苗5至8年（平均5.8±0.3年）后给予了强化剂量乙肝疫苗。37例HD患者中有19例（51%）对强化剂量有回忆反应，其中15例（40%）为高反应者。所有医护人员对强化剂量均有高抗体反应。我们得出结论，接受HD治疗的患者不仅对乙肝的免疫接种率低于健康成年人，而且这些免疫反应往往是短暂的。疫苗初次接种后给予强化剂量对约一半抗体水平下降或无反应的HD患者有效，但强化剂量是否必要尚不清楚。大多数医护人员至少10年内持续有高水平的保护性乙肝表面抗体，无需常规强化接种。
