Efficacy of Intradermal Hepatitis B Vaccination Compared to Intramuscular Vaccination in Hemodialysis Patients
Thawee Chanchairujira MD*, Narumol Chantaphakul MD*, Thaweesak Thanwandee MD**, Leena Ong-Ajyooth MD*
Affiliation : * Renal Division, Department of Medicine, Siriraj Hospital ** Gastrointestinal Division, Department of Medicine, Siriraj Hospital
Background : Hepatitis B virus infection remains an important problem in hemodialysis patients. Only 50 to
60% of the patients develop seroconversion (anti-HBs Ab titer > 10 IU/L) after intramuscular hepatitis B
vaccination. Small dose intradermal inoculation method of hepatitis B vaccine has been reported to be
effective as well as economical, and could provide rapid seroconvesion of immunity. The aim of the present
study was to compare the efficacy of intradermal hepatitis B vaccination with intramuscular vaccination in
hemodialysis patients.
Materials and Methods : Fifty one hemodialysis patients were randomly assigned to two groups, 25 patients
received a total 7 doses of 10 mµg of recombinant hepatitis B vaccine (Engerix B) intradermally every 2 weeks
(ID group), whereas 26 patients received 40 µg intramuscularly at 0, 1, 2 and 6 months (IM group). Anti-HBs
Ab titer was measured at 2, 3, 4 and 7 months after the first vaccination in both groups. Vaccination responses
were classified into 3 subgroups according to anti-HBs Ab titer and these included excellent response (>
1,000 IU/L), good response (10 - 999 IU/L) and non-response (< 10 IU/L).
Results : The seroconversion rates at 2, 3, 4, and 7 months in the ID group were 56%, 76%, 88%, and 92%
compared with 31%, 42%, 65%, and 69% in the IM group, respectively. Only the seroconversion rates at 3
months were significantly higher in the ID group (76% versus 42%, p = 0.03). At 7 months after the first
vaccination, good and excellent responders in the ID group were 72% (18/25) and 20% (5/25) compared with
34.5% (9/26) and 34.5% (9/26), respectively (p > 0.05). Only minor side effects were observed.
Conclusion : Seven doses of 10 mg intradermal vaccination induced a high seroconversion rate and were
comparable with intramuscular regimen. Intradermal vaccination may be helpful for the rapid induction of
protective level of antibodies and may be a cost-saving alternative to intramuscular vaccination in hemodilaysis
patients.
Keywords : Immune response, Intradermal Hepatitis B Vaccination, Hemodialysis
