BACKGROUND: Patients undergoing haemodialysis run a high risk of developing hepatitis B virus infection. We noted high prevalence rates of this infection in our patients despite a policy of using active hepatitis B vaccination. We, therefore, examined the reasons why haemodialysis-associated hepatitis B virus infection was difficult to control. METHODS: We analysed retrospectively 131 patients who had undergone haemodialysis for end-stage renal disease at our centre between June 1991 and May 1992. Patients given hepatitis B vaccine prior to starting haemodialysis were included in group A while those vaccinated after starting haemodialysis were placed in group B. The vaccination schedule consisted of 3 doses of recombinant hepatitis B vaccine given at monthly intervals. RESULTS: Fifteen patients had hepatitis B infection at entry, of whom 12 had had prior blood transfusions. Active immunization with recombinant hepatitis B vaccine was attempted in the remaining 116 patients. There were 16 patients in group A and 100 in group B. Of the 7 patients in group A and 46 in group B who completed the vaccination schedule, protective antibodies and markers of hepatitis B viral infection were noted in 3 and 2 patients respectively in group A and 7 and 14 patients respectively in group B. Vaccination was not completed in 63 patients as 25 discontinued haemodialysis, 22 developed markers of hepatitis B infection and 16 underwent renal transplantation. CONCLUSIONS: Poor seroprotection rates with the standard vaccination schedule, unscreened blood transfusions and an inability to complete the vaccination schedule were the major reasons why active immunization against hepatitis B viral infection in our patients on haemodialysis has been largely unsuccessful.
BACKGROUND:Patients undergoing haemodialysis run a high risk of developing hepatitis B virus infection. We noted high prevalence rates of this infection in our patients despite a policy of using active hepatitis B vaccination. We, therefore, examined the reasons why haemodialysis-associated hepatitis B virus infection was difficult to control. METHODS: We analysed retrospectively 131 patients who had undergone haemodialysis for end-stage renal disease at our centre between June 1991 and May 1992. Patients given hepatitis B vaccine prior to starting haemodialysis were included in group A while those vaccinated after starting haemodialysis were placed in group B. The vaccination schedule consisted of 3 doses of recombinant hepatitis B vaccine given at monthly intervals. RESULTS: Fifteen patients had hepatitis B infection at entry, of whom 12 had had prior blood transfusions. Active immunization with recombinant hepatitis B vaccine was attempted in the remaining 116 patients. There were 16 patients in group A and 100 in group B. Of the 7 patients in group A and 46 in group B who completed the vaccination schedule, protective antibodies and markers of hepatitis B viral infection were noted in 3 and 2 patients respectively in group A and 7 and 14 patients respectively in group B. Vaccination was not completed in 63 patients as 25 discontinued haemodialysis, 22 developed markers of hepatitis B infection and 16 underwent renal transplantation. CONCLUSIONS: Poor seroprotection rates with the standard vaccination schedule, unscreened blood transfusions and an inability to complete the vaccination schedule were the major reasons why active immunization against hepatitis B viral infection in our patients on haemodialysis has been largely unsuccessful.