The results of vaccine prophylaxis of hepatitis B and predictors of its efficiency in HD-patients

The results of vaccine prophylaxis of hepatitis B in 175 patients (96 males and 79 females, aged 46,1 ± 14,8 years) treated with haemodialysis were analysed. In 3 month after beginning of vaccination 75% of patients had anti-HBs level between 10 and 100 mME/ml and 51% of patients had anti-HBs level above 100 mME/ml. 7 month after the immunization these levels were detected in 84% and 67% patients, respectively. To reveal predictors of low efficiency of immunization, log-transformed titres of antibodies after 3 months (intermediate response) and 7 months (final response) were correlated with clinical, biochemical and immunological parameters before vaccination. A strong correlation of the intermediate response was found with the number of lymphocytes (p < 0,000005), IgM concentration (p < 0,019), inhibition of leucocyte migration (p < 0,019), interleukine concentration (p < 0,014) and transferrine blood level (р < 0,019). Average value of Кt/V, the numbers of B- and T-lymphocytes in blood (including T-helpers), concentrations of IgM, IL-1 and IL-2 in blood was significantly lower in patients with negative or weak intermediate response. Alternatively, all these parameters were increased in patients with a good response to vaccination. In the group of patients with negative or weak final response to immunization, the IgM and IL-2 concentrations were significantly lower than in the group with good response. Blood level of IgM below 0,95 g/l and concentration of B-lymphocytes below 0,37 × 109/l are the predictors of low efficiency of immunization after 3 month. IgM level below <0,85 g/l and IL-2 concentration under 12,1 pM predict low final efficiency of immunization. Any of these two predictors can be used. Coexistence of both predictors makes the unfavourable prognosis more specific.

гепатит В, вакцинопрофилактика, гемодиализ

1. Зубкин М.Л., Селиванов Н.А., Стаханова В.М. и др. Распространенность и особенности инфицирования вирусами гепатитов В и С в условиях лечения гемодиализом. Вопр. вирусол. 2000; 1: 10-14.

2. Зубкин М.Л., Селькова Е.П., Стаханова В.М. и др. Гепатит В в центрах гемодиализа Москвы: клинико-эпидемиологическая характеристика. Нефрология и диализ 2001; 4: 442-446.

3. Зубкин М.Л. Динамика титра протективных антител после вакцинопрофилактики гепатита В у больных с терминальной стадией хронической почечной недостаточности, получающих лечение программным гемодиализом. Нефрология и диализ 2003; 3: 295.

4. Ивашкин В.Т., Калинин А.В., Ивлев А.С. и др. Российский журнал гастроэнтерологии, гепатологии 1993; 2: 34-38.

5. Костерева Е.М., Васильев А.Н., Михайлов А.А. и др. Проблемы вакцинации больных с хронической почечной недостаточностью, получающих лечение гемодиализом. Нефрология 2003; 1: 102-105.

6. Мартынов С.И. и др. Инфекция вирусов гепатита среди гемодиализных пациентов в Якутии. XXXVI Congress of the European Renal Association European Dialysis and Transplant Association. Madrid, Spain 1999; 216.

7. Михайлов М.И., Шахгильдян И.В., Есаулкова А.Ю. и др. Гепатит В - предварительный скрининг. Уральское медицинское обозрение. Тематическое приложение. 1998; 1: 19-21.

8. Онищенко Г.Г., Шахгильдян И.В. Актуальные вопросы эпидемиологии и профилактики вирусных гепатитов В и С в Российской Федерации. Журнал микробиологии, эпидемиологии и иммунологии 2000; 1: 50-54.

9. Савин Е.А., Кузин С.Н., Вашкевич А.И. и др. Предварительные результаты применения вакцины ENGERIX B в группах высокого риска инфицирования вирусом гепатита В - медицинских работников и больных отделений гемодиализа. Актуальные вопросы медицинской биотехнологии: Материалы науч. конф., посвященной 85-летию Томского НИИ вакцин и сывороток. Томск 1991; 1: 42-43.

10. Савин Е.А., Кузин С.Н., Блинов В.Н. и др. Исследование значимости фактора гемотрансфузий в эпидемическом процессе гепатита С у пациентов отделений хронического гемодиализа с помощью имитационной компьютерной модели. Вопросы вирусологии 1993; 3: 135-137.

11. Савин Е.А., Кузин С.Н., Васильев А.Н. и др. Особенности профилактики НВ-вирусной инфекции в отделениях гемодиализа. Терапевтический архив 1995; 2: 47-51.

12. Самоходская Л.М., Акимкин В.Г., Гранкин В.И. и др. Частота выявления маркеров инфицирования вирусами гепатитов В и С в крови пациентов отделения гемодиализа в зависимости от количества проведенных диализов. III Научно-практическая конференция «Внепочечные методы очищения крови в специализированной медицинской помощи». Москва 1997; 51-53.

13. Сычев А.В., Михайлов М.И. Инфицирование вирусом гепатита С медицинских работников и пациентов гемодиализных отделений Москвы. Вопросы вирусологии 1993; 3: 105-107.

14. Тареев Е.М., Ермоленко В.М., Ананьев В.А. и др. Вирусные гепатиты у больных, находящихся на поддерживающем ГД. Особенности клиники. Вопросы эпидемиологии 1979; 4: 20-26.

15. Шахгильдян И.В., Михайлов М.И., Хухлович П.А. и др. Вакцинопрофилактика гепатита В в России - достижения, проблемы, перспективы. Журнал микробиологии, эпидемиологии и иммунологии 2000; 2: 44-49.

16. Abbas N. et al. The Department of Health recommendations for hepatitis B vaccinations is not effective in patients with chronic renal failure. XXXVI Congress of the European Renal Association European Dialysis and Transplant Association. Madrid, Spain 1999; 188.

17. Bergia R., Pellerey M., Berto I. et al. Hepatitis B Vaccination in Uremic Patients: Comparison between Recombinant and Plasma-Derived Vaccine. Nephron 1992; 61: 328.

18. Bock H.L., Kruppenbaher J., Sanger R. et al. Иммуногенность рекомбинантной вакцины против гепатита В при вакцинации взрослых людей. JAMA, Россия 1996; 3: 37-43.

19. Boes M., Esau C., Fischer M.B. et al. Enhanced B-l cell development, but impaired IgG antibody responses in mice deficient in secreted IgM. J Immunol 1998; 160: 4776-4787.

20. Bruguera M., Cremada M., Rodicio J.L. et al. Immunogenecity of a yeast-derived hepatitis B vaccine in hemodialysis patients. Am J Med 1989; 87: 30-32.

21. Craven D.E., Awdeh Z.L., Kunches L.M. et al. Non-responsiveness to hepatitis B vaccine in health care workers. Am Intern Med 1986; 105: 356-360.

22. Crosnier J., Degos F., Jungers P. Dialysis associated hepatitis. In: Replacement of renal function by dialysis (ed. J.F. Maher) Dordrecht: Kluwer Academic, 1989: 881-903.

23. Crovari P., Cuneo-Crovari P., Icardi Q.C. et al. Immunization of young adults with two yeast-derived hepatitis B vaccines. In: Zuckerman A.J., ed. Viral hepatitis and liver disease. New York: Alan R Liss Inc. 1988: 1071-1073.

24. Descamps-Latscha B. Infection and immunity in end-stage renal disease. In: Dialysis (ed. W.L. Henrich). Baltimore, Philadelphia, Hong Kong: Williams & Wilkins, 1994: 209-224.

25. Deutsch T., Carson E., Ludwig E. Dealing with Medical Knowledge. Plenum Press. N.Y. and London 1994.

26. Dienstag J.L., Werner B.G., Polk B.F. et al. Hepatitis B vaccine in health care personnel: safety, immunogenecity, and indicators of efficacy. Am Intern Med 1984; 101: 34-40.

27. Ehrenstein M.R., O’Keefe T.L., Davies S.L. et al. Targeted gene disruption reveals a role for natural secretory IgM in the maturation of the primary immune response. Proc. Natl. Acad. Sci. USA 1998; 95: 10089-10093.

28. Fanelli V., Sanna G., Soliiias A. Expectation of Impaired Response to Recombinant Hepatitis В Vaccination. Nephron 1992; 61: 293-295.

29. Fernandez E., Betrro M.A, Gomez R. et al. Response to the hepatitis В virus vaccine in haemodialysis patients: influence of malnutrition and its importance as a risk factor for morbidity and mortality. Nephrol Dial Transplant 1996; 11: 1559-1563.

30. Girndt M., Kohler H. Hepatitis B Virus Infection Hemodialysis Patients. Seminars in Nephrology 2002; 4: 340-350.

31. Harnett J.D., Zeldis J.B., Parfrey P.S. et al. Hepatitis B disease in dialysis and transplant patients. Transplantation 1987; 44: 369-376.

32. Haubitz M., Ehlerding G., Beigel A. et al. Clinical experience with a new recombinant hepatitis-B vaccine in previous non-responders with chronic renal insufficiency. Clin Nephrol 1996; 45: 180-182.

33. Hess G., Kreiter F., Kosters W. et al. The effect of granulocyte-macrophage colony-stimulating factor (GM-CSF) on hepatitis B vaccination in haemodialysis patients. J Vir Hepat 1996; 3: 149-153.

34. Jungers P., Devillier P., Salomon H. et al. Randomised placebo-controlled trial of recombinant interleukin-2 in chronic uremic patients who are non-responders to hepatitis B vaccine. Lancet 1994; 344: 856-857.

35. Kapoor D., Aggarwal S.R., Singh N.P. et al. Granulocyte-macrophage colony-stimulating factor enhances the efficacy of hepatitis B virus vaccine in previously unvaccinated hemodialysis patients.J Viral Hepat 1999; 6: 405-409.

36. Kayatas M., Akalin L., Ozdemir F.N. et al. Levamisole treatment enhances protective antibody response to hepatitis В virus vaccination (HBVV). XXXIV Congress of the European Renal Association European Dialysis and Transplant Association. Geneva, Switzerland 1997; 173.

37. Khan A.N., Bernardini J., Rault R.M. et al. Low seroconversion with hepatitis B vaccination in peritoneal dialysis patients. Perit Dial Int 1996; 16: 370-373.

38. Krugman S. The newly licensed hepatitis B vaccine. J Am med Ass 1982; 247: 2012-2015.

39. Miller E.R., Alter M.J., Tocars J.I. Protective effect of hepatitis B vaccine in chronic hemodialysis patients. Am J Kidney Dis 1999; 33: 356-360.

40. Lombardi M., Pizzarelli F., Righi M. Hepatitis В Vaccination in Dialysis Patients and Nutritional Status. Nephron 1992; 61: 266-268.

41. Morgan D.R. (ed.) for the British Medical Association Board of Science and Education. A code of practice for implementation of the UK hepatitis B immunization guidelines for the protection of patients and staff. London, British Medical Association, 1995.

42. Navarro J.F., Teruel J.L., Mateos M.L. et al. Antibody level after hepatitis B vaccination in hemodialysis patients: influence of hepatitis C virus infection. Am J Nephrol 1996; 16: 95-97.

43. Neto M.C., Draibe S.A., Silva A.E.B. et al. Incidence of and risk factors for hepatitis B virus and hepatitis C virus infection among hemodialysis and CAPD patients: evidence for environmental transmission. Nephrol Dial Transplant 1995; 10: 240-246.

44. Norusis M.J. SPSS_x Advanced Statistics Guide. N.Y. McGrow-Hill, 1985.

45. Ono K., Kashiwagi S. Complete seroconversion by low-dose intradermal injection of recombinant hepatitis B vaccine in haemodialysis patients. Nephron 1991; 58: 47-51.

46. Parfrey P.S., Farge D., Forbes R.D.C. et al. Chronic hepatitis in end-stage renal disease: Comparison of HBsAg-negative and HBsAg-positive patients. Kidney Int 1985; 28: 959-967.

47. Peces R., de la Torre M., Alcazar R. et al. Prospective analysis of the factors influencing the antibody response to hepatitis B vaccine in haemodialysis patients. Am J Kidney Dis 1997; 29: 239-245.

48. Pereversev-Orlov В.С., Stenina I.I., Trunov V.G. Syndrome Analysis of Data. Pattern Recognition and Image Analysis 1993; 3: 500-505.

49. Propst T., Propst A., Lhotta K. et al. Reinforced intradermal hepatitis B vaccination in hemodialysis patients is superior in antibody response to intramuscular or subcutaneous vaccination. Am J Kidney Dis 1998; 32: 1041-1045.

50. Rao V.K, Ma J. Chronic viral hepatitis enhances the risk of infection but not acute rejection in renal transplant recipients. Transplantation 1996; 62: 1765-1769.

51. Sezer S., Ozdemir F.N., Guz G. et al. Factors Influencing Response to Hepatitis В Virus Vaccination in Hemodialysis Patients. Transplantation Proceedings 2000; 32: 607-608.

52. Sherlock S., Dooley J. Diseases of the liver and biliary system. Oxford, London, Edinburgh, Malden: Blackwell Science Ltd, 1997: 274-286.

53. Stachowski J., Pollok M., Barth С. Non-responsiveness to hepatitis В vaccination in haemodialysis patients: association with impaired TCR/CD3 antigen receptor expression regulating co-stimulatory processes in antigen presentation and recognition. Nephrol Dial Transplant 1994; 9: 144-152.

54. Sunder-Plassmann G., Heinz G., Wagner L. T-cell selection and T-cell receptor variable beta-chain usage in chronic hemodialysis patients. Clin Nephrol 1992; 37: 252-259.

55. Vlassopoulos D., Arvanitis D., Lilis D. et al. Complete success of intradermal vaccination against hepatitis B in advanced chronic renal failure and hemodialysis patients. Ren Fail 1997; 19: 455-460.

56. West D.J., Calandra G.B., Ellis R.W. Vaccination of infants and children against hepatitis B. Pediatr Clin North Am 1990; 37: 185-601.

57. Westmoreland D., Player V., Heap D.C. et al. Immunization against hepatitis B - what can we expect? Epidemiol Infect 1990; 104: 499-509.

58. Wood R.C., MacDonald K.L., White K.E. et al. Risk factors for lack of detectable antibody following hepatitis B vaccination of Minnesota health care workers. JAMA. 1993; 270: 2935-2939.

59. Younossi M.Z., Braun E.W., Protiva A.D. et al. Chronic viral hepatitis in renal transplant recipients with allografts functioning fore more than 20 years. Transplantation 1999; 67: 272-275.

60. Zuckerman J.N. Hepatitis В third generation vaccines: improved response and conventional vaccine non-response - third generation pre-S/S vaccines overcome non-response. Journal of Viral Hepatitis 1998; 5: 13-15.