[Results of vaccination with the hepatitis B vaccine in patients and personnel at the Hemodialysis Center in Karlovac].

Hepatitis B remains a significant risk to patients and staff members of hemodialysis unit. Prior to immunization, 38 hemodialysis patients and 24 staff members were screened for HBs antigen, HBc antibodies and HBs antibodies using ELISA method (Abbott). Of 18 (47%) patients, five were chronic carriers of HBsAg and 13 had anti-HBs and anti-HBc while anti-HBs and anti-HBc were found in four (17%) members of medical staff. A total of 20 (53%) susceptible patients (mean 51.2 years) and 19 (79%) susceptible staff members (mean 28.1 years) received hepatitis B vaccine (H-B-VAX, Merck, Sharp and Dohme). Between patients were four (20%) non-responders and seven (35%) low-responders while among medical staff were two (10.5%) non-responders and one (5.2%) low responder only. The geometric mean titer of anti-HBs was 724 IU/L in patients and 3407 IU/L in staff members. Non-responders (5 of 6) who were given a fourth vaccine dose also failed to mount an antibody response. In none of vaccinated patients antibody to human immunodeficiency virus (HIV-1) occurred in their sera three and six months after complete vaccination. Consideration should be given to a prevaccinal screening of presumptive vaccinees between patients and staff members of hemodialysis units because of high level of preexisting HBV infection among them. The data suggest a high non-responder and low-responder rate in vaccinated hemodialysis patients and serial surveillance for anti-HBs is warranted especially in persons aged over 40 years. Additional booster dose or some doses of HB vaccine should be given to low-responders and they should be retested thereafter. Non-responders still remain the unresolved problem.