Comparison of the response to the recombinant vaccine against hepatitis B virus in dialyzed and nondialyzed children with CRF using different doses and routes of administration.

In patients with chronic renal failure (CRF), parenteral transmission of the hepatitis B virus (HBV) is common. The response to the recombinant vaccine is 50%-80% of seroprotection. Therefore, to improve seroprotection, different strategies such as dose augmentation, vaccination at the predialysis stage, subcutaneous application, and using interleukin were tried, with unsatisfactory results. In children, there are no studies demonstrating the efficacy of the vaccine. The aim of this study was to evaluate the efficacy of the recombinant vaccine in children with CRF, in late as well as early phases, through the quantification of antibodies against the surface antigen in response to different doses of the vaccine against HBV. There were 103 patients who were assigned to three groups: (1) 25 patients with CRF in the early phase (undergoing pharmacological treatment only); (2) 67 patients with CRF in the late phase (treatment with peritoneal dialysis or hemodialysis); (3) 11 patients with CRF in the early phase (undergoing low-dose pharmacological treatment only). The antibodies against the serum antigen (HBsAg) were measured by the aEIA method. Urea, creatinine, and creatinine clearance were measured at 0, 2, and 12 months. In our seroprotection results we observed that group 1 and 3 developed earlier seroconversion (50% first month). In patients undergoing dialysis the seroconversion happened in 91% at month 13, but with lower concentration than group 1 and/or group 3 (p < 0.05). In conclusion, there is a better response in predialysis patients. The levels of antibodies are similar in groups 1 and 3 (with small doses), which are similar to the complete doses for an efficient immunity in children with chronic renal failure.