Division of Hepato-gastroenterology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Division of Nephrology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Pan Afr Med J. 2019 Oct 31;34:122. doi: 10.11604/pamj.2019.34.122.19603. eCollection 2019.
Because of the cost, in the hemodialysis centers of Kinshasa, the double dose of hepatitis B (HBV) vaccine is administered only to HIV infected patients while other patients receive a single dose. This study aimed to evaluate the single-dose vaccination Protocol and identify determinants of seroconversion's lack of anti-HBs after vaccination schedule.
56 non-HIV chronic hemodialysis patients serologically negative for HBs Ag, anti-HBs and anti-HBc were selected between January 2014 and December 2016. The recombinant DNA vaccine (Euvax B20 μg) was administered intramuscularly in the deltoid muscle at days 0, 30, 60 and 180. Serum anti-HBs titer was assayed at day 240. The endpoint was seroconversion, defined as anti-HBs titer ≥ 10 IU/l (10-99 IU/l = low protective vaccine response; ≥ 100 IU/l = highly protective vaccine response). Anti-HBs titer < 10 IU/l defined a lack of seroconversion. A Logistic regression model was used to identify factors associated with the lack of seroconversion.
In the study group (mean age 55.6± 15.1 years; 73 % men, 36% diabetic and 86% hypertensive), low and highly protective vaccine responses were seen in 32% and 50% respectively versus 18% of patient had a lack of seroconversion. CRP > 6 mg/L (aOR: 8.96), hypoalbuminemia (aOR: 6.50) and KT/V < 1.2 (aOR: 3.70) were associated with the lack of seroconversion.
Half of the patients in the study had either a lack or low protective vaccine response. Patient-related factors and hemodialysis parameters were the main factors associated with the lack of anti-HbS seroconversion. These results highlight the need to maximize doses of vaccine in all patients.
由于成本原因，金沙萨的血液透析中心仅为感染 HIV 的患者接种乙肝（HBV）疫苗的双倍剂量，而其他患者则接种单剂量。本研究旨在评估单剂量疫苗接种方案，并确定接种方案后抗-HBs 缺乏血清转化率的决定因素。
2014 年 1 月至 2016 年 12 月期间，选择了 56 例血清学 HBsAg、抗-HBs 和抗-HBc 均为阴性的非 HIV 慢性血液透析患者。重组 DNA 疫苗（Euvax B20 μg）在三角肌内肌内注射，分别于第 0、30、60 和 180 天。在第 240 天检测血清抗-HBs 滴度。终点是血清转化率，定义为抗-HBs 滴度≥10 IU/L（10-99 IU/L=低保护性疫苗反应；≥100 IU/L=高保护性疫苗反应）。抗-HBs 滴度<10 IU/L 定义为血清转化率低。采用 Logistic 回归模型来确定与血清转化率低相关的因素。
在研究组（平均年龄 55.6±15.1 岁；73%为男性，36%为糖尿病患者，86%为高血压患者）中，低保护性和高保护性疫苗反应分别为 32%和 50%，而 18%的患者血清转化率低。CRP>6 mg/L（优势比：8.96）、低白蛋白血症（优势比：6.50）和 KT/V<1.2（优势比：3.70）与血清转化率低相关。
研究组中一半的患者要么缺乏或低保护性疫苗反应。与抗-HBs 血清转化率低相关的主要因素是患者相关因素和血液透析参数。这些结果强调了需要为所有患者最大限度地接种疫苗剂量。
