Immune response to a heat-inactivated hepatitis B vaccine in patients undergoing hemodialysis. Enhancement of the response by increasing the dose of hepatitis B surface antigen from 3 to 27 micrograms.

In a randomized trial, 227 patients undergoing hemodialysis who were seronegative for all markers of hepatitis B virus were immunized at monthly intervals with three doses of either 3 micrograms or 27 micrograms of heat-inactivated hepatitis B HB-vaccine (CLB). Five months after the first injection, 77% of the patients in the 3-micrograms group and 94% in the 27-micrograms group manifested antibodies against hepatitis B surface antigen (anti-HBs). At month 12 the proportions of subjects with anti-HBs in the 3-micrograms and 27-micrograms groups had dropped to 68% and 87%, respectively. At all times, the differences in the anti-HBs conversion rate between the two treatment groups were significant. These results show that the impaired immune reactivity to hepatitis B vaccines of patients undergoing hemodialysis can be overcome by increasing the dose of the vaccine.