Dialysis Clinic Inc, Nashville, TN, USA.
Tufts Medical Center, Boston, MA, USA.
Nephrol Dial Transplant. 2023 Feb 13;38(2):447-454. doi: 10.1093/ndt/gfac039.
Vaccination against hepatitis B virus (HBV) is recommended for dialysis patients. Two reports comparing seroprotection (SP) rates following HepB and HepB-CpG in vaccine-naïve patients with chronic kidney disease enrolled few dialysis patients (n = 122 combined). SP rates in a subset of dialysis patients were not reported or not powered to detect statistically significant differences. SP rates in those requiring additional vaccine series or booster doses are not known.
A retrospective cohort analysis including dialysis patients completing HepB or HepB-CpG vaccination between January 2019 and December 2020. Vaccine-naïve patients received a series of HepB or HepB-CpG (Series 1). A repeat series was given to nonresponders (Series 2). A booster regimen consists of one dose of either vaccine. Primary outcome was achieving SP (anti-HBs >10 mIU/mL) at least 60 days after the last HBV vaccine dose for Series 1 and Series 2, and achieving SP at least 3 weeks post-booster.
For Series 1 (n = 3509), SP after HepB vaccination was significantly higher (62.9% versus 50.1% for HepB-CpG; P < 0.0001). Series 2 (n = 1040) and booster (n = 2028) SP rates were similar between vaccines. Patients that received up to four HepB-CpG doses had higher SP rates compared with four doses of HepB (82.0% versus 62.9%, respectively; P < 0.0001).
SP rates in hepatitis B vaccine-naïve dialysis patients administered a recommended four doses of HepB were higher than those recommended two doses of HepB-CpG. SP rates were higher and achieved sooner if HepB-CpG was utilized initially and, if needed, for Series 2. Optimal HepB-CpG dosing deserves further study.
乙型肝炎病毒 (HBV) 疫苗接种被推荐用于透析患者。有两份报告比较了在接受慢性肾脏病治疗的初免患者中，乙型肝炎疫苗 (HepB) 和 HepB-CpG 的血清保护 (SP) 率，其中纳入的透析患者人数较少 (共 122 例)。也未报告或未进行统计学上的显著差异检测来报告透析患者亚组的 SP 率。尚不清楚需要额外疫苗系列或加强剂量的患者的 SP 率。
这是一项回顾性队列分析，纳入了 2019 年 1 月至 2020 年 12 月期间完成 HepB 或 HepB-CpG 疫苗接种的透析患者。初免患者接受 HepB 或 HepB-CpG 系列 1 疫苗接种。对无应答者给予重复系列疫苗接种 (系列 2)。加强方案由一剂两种疫苗中的任意一种组成。主要结局是在接受系列 1 和系列 2 的最后一剂 HBV 疫苗后至少 60 天和在接受加强剂后至少 3 周时达到 SP（抗-HBs >10 mIU/mL）。
对于系列 1（n = 3509），HepB 疫苗接种后的 SP 率显著更高（HepB-CpG 为 50.1%；P < 0.0001）。在系列 2（n = 1040）和加强剂（n = 2028）中，两种疫苗的 SP 率相似。与接受 4 剂 HepB 相比，接受最多 4 剂 HepB-CpG 的患者 SP 率更高（分别为 82.0%和 62.9%；P < 0.0001）。
在接受推荐剂量的 4 剂 HepB 的初免透析患者中，HBV 疫苗接种的 SP 率高于推荐剂量的 2 剂 HepB-CpG。如果最初使用 HepB-CpG 并在需要时进行系列 2 接种，SP 率更高，且更早达到。HepB-CpG 的最佳剂量值得进一步研究。
