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首页> 外文期刊>Vaccine >Immunogenicity of hepatitis B vaccine among hemodialysis patients: effect of revaccination of non-responders and duration of protection.
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Immunogenicity of hepatitis B vaccine among hemodialysis patients: effect of revaccination of non-responders and duration of protection.

机译：乙型肝炎疫苗在血液透析患者中​​的免疫原性：无反应者再次接种疫苗的效果和保护期。

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Background: Hepatitis B vaccination is recommended for patients on hemodialysis, however, seroprotection after a primary vaccine series is suboptimum. Limited data are available on the effect of revaccination of non-responders and on persistence of immunity in this population. Methods: Hepatitis B vaccine (40 micro g/dose) was given to 77 susceptible patients on hemodialysis (0, 1, and 6 month schedule). Levels of hepatitis B surface antibody (anti-HBs) were tested >=28 days after the third dose was administered, and non-responders revaccinated with an additional 3-dose series. Vaccine responders (anti-HBs >=10 mIU/mL) were re-tested every 6 months and booster doses given as needed. Kaplan-Meier survival curve was used to estimate the probability of maintaining protective antibody level. Cox-proportional hazards models were used to assess the association between time to loss of protective antibody levels and certain explanatory variables. Results: Overall primary vaccine-induced response was 79.2% (95% CI 68.2%, 87.3%), including 49/77 (63.6%; 95% CI 51.8%, 74.7%) patients who received the initial primary hepatitis B vaccine series and 12/21 (57.1%; 95% CI 34.4%, 77.4%) non-responders who were revaccinated with an additional series. Among weak responders (anti-HBs level 10.0-99.9 mIU/mL), protective antibody levels persisted in 44% for 12 months post-vaccination; whereas among strong responders (anti-HBs level >=100 mIU/mL), protective antibody levels persisted in 92% for 12 months, and 68% for 24 months post-vaccination. A weak post-vaccination response increased the risk of losing protective antibody levels (adjusted hazard ratio, 9.7; 95% confidence interval, 3.5-28.5; p<0.0001). Conclusion: Revaccinating patients undergoing hemodialysis who do not respond to a primary vaccine series substantially increases the pool of protected patients. The threshold for defining hepatitis B vaccine-induced immunity should be revisited in this patient population to maximize the duration of protectionDigital Object Identifier http://dx.doi.org/10.1016/j.vaccine.2011.10.057
机译：背景：建议对血液透析患者进行乙肝疫苗接种，但是，一次主要疫苗接种后的血清保护作用欠佳。关于无应答者再次接种疫苗的效果以及该人群中免疫力持续存在的数据有限。方法：对77名易感患者进行了血液透析（0、1、6个月计划）给予乙肝疫苗（40微克/剂量）。在第三次给药后≥28天，对乙型肝炎表面抗体（抗-HBs）的水平进行了测试，并在无反应者中再接种了3剂系列疫苗。每6个月对疫苗应答者（抗HBs> = 10 mIU / mL）进行重新测试，并根据需要给予加强剂量。 Kaplan-Meier存活曲线用于估计维持保护性抗体水平的可能性。使用Cox比例危害模型评估保护性抗体水平丧失的时间与某些解释变量之间的关联。结果：一级疫苗总体诱导应答率为79.2％（95％CI 68.2％，87.3％），其中包括接受初次乙型肝炎疫苗初次接种的49/77（63.6％; 95％CI 51.8％，74.7％）患者。 12/21（57.1％; 95％CI 34.4％，77.4％）无应答者已接种其他疫苗。在弱反应者中（抗-HBs水平为10.0-99.9 mIU / mL），疫苗接种后的12个月中保护性抗体水平持续44％;而在强应答者中（抗HBs水平> = 100 mIU / mL），保护性抗体水平在接种后持续12个月为92％，在接种后24个月持续为68％。接种后反应较弱会增加失去保护性抗体水平的风险（调整后的危险比为9.7; 95％置信区间为3.5-28.5; p <0.0001）。结论：对血液透析患者进行重新接种而对主要疫苗系列无反应的患者，将大大增加受保护患者的数量。应重新定义该患者人群中定义乙肝疫苗诱导的免疫力的阈值，以最大程度地延长保护时间数字对象标识符http://dx.doi.org/10.1016/j.vaccine.2011.10.057

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