Immunogenicity of Augmented Compared With Standard Dose Hepatitis B Vaccine in Pediatric Patients on Dialysis: a Midwest Pediatric Nephrology Consortium Study

Jason M Misurac; Rene G VanDeVoorde; Mahmoud Kallash; Franca M Iorember; Kera E Luckritz; Michelle N Rheault; Jennifer G Jetton; Martin A Turman; Gaurav Kapur; Katherine E Twombley; Shireen Hashmat; Donald J Weaver; Jeffrey D Leiser; Corina Nailescu

doi:10.2215/CJN.04750416

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Immunogenicity of Augmented Compared With Standard Dose Hepatitis B Vaccine in Pediatric Patients on Dialysis: a Midwest Pediatric Nephrology Consortium Study

Journal article

Open access

Immunogenicity of Augmented Compared With Standard Dose Hepatitis B Vaccine in Pediatric Patients on Dialysis: a Midwest Pediatric Nephrology Consortium Study

Jason M Misurac, Rene G VanDeVoorde, Mahmoud Kallash, Franca M Iorember, Kera E Luckritz, Michelle N Rheault, Jennifer G Jetton, Martin A Turman, Gaurav Kapur, Katherine E Twombley, …

Clinical journal of the American Society of Nephrology, Vol.12(5), pp.772-778

05/08/2017

DOI: 10.2215/CJN.04750416

PMCID: PMC5477206

PMID: 28270432

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Abstract

Patients on maintenance dialysis have a higher risk of unresponsiveness to hepatitis B vaccination and loss of hepatitis B immunity. Adult guidelines recommend augmented dosing (40 mcg/dose), resulting in improved response in adults. We sought to determine whether children on dialysis mount a similar antibody response when given standard or augmented dosing of hepatitis B vaccine. This is a retrospective review of patients on dialysis aged <19 years from May 1, 2008 to May 1, 2013 at 12 pediatric dialysis units. Hepatitis B surface antibody (HBsAb) titers ≥10 mIU/ml were defined as protective. A total of 187 out of 417 patients received one or more hepatitis B vaccine boosters. The median age was 13 years; the cohort was 57% boys and 59% white. Booster dose or HBsAb titers were missing in 17 patients. Conversion to protective HBsAb titers was achieved in 135 out of 170 patients (79%) after their first single-dose booster or multidose booster series. In patients receiving a single-dose booster, the response rate was 53% (nine out of 17) after a 10 mcg dose, 86% (65 out of 76) after a 20 mcg dose, and 65% (17 out of 26) after a 40 mcg hepatitis B vaccine dose. In patients receiving a multidose booster series, the response rate was 95% (19 out of 20) after a 10 mcg/dose series, 83% (20 out of 24) after a 20 mcg/dose series, and 71% (five out of seven) after a 40 mcg/dose series. Patients receiving a multidose booster series had a response rate of 86% (44 out of 51), compared with 76% (91 out of 119) in patients receiving a single-dose booster ( =0.21). Twenty-seven patients received more than one single-dose booster or multidose series, and 26 out of 27 (96%) eventually gained immunity after receiving one to three additional single-dose boosters or multidose booster series. There was no clear gradient of increasing seroconversion rate with increasing vaccine dose in this cohort of pediatric patients on dialysis.

Immunogenicity, Vaccine

Age Factors

Humans

Kidney Diseases - diagnosis

Vaccination

Child, Preschool

Male

Hepatitis B - blood

Midwestern United States

Hepatitis B - immunology

Hepatitis B Antibodies - blood

Peritoneal Dialysis - adverse effects

Immunization, Secondary

Time Factors

Female

Retrospective Studies

Child

Hepatitis B Vaccines - administration & dosage

Treatment Outcome

Biomarkers - blood

Seroconversion

Kidney Diseases - immunology

Hepatitis B - diagnosis

Adolescent

Renal Dialysis - adverse effects

Kidney Diseases - therapy

Hepatitis B Vaccines - immunology

Hepatitis B - prevention & control

Details

Title: Subtitle: Immunogenicity of Augmented Compared With Standard Dose Hepatitis B Vaccine in Pediatric Patients on Dialysis: a Midwest Pediatric Nephrology Consortium Study
Creators: Jason M Misurac - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. jason-misurac@uiowa.edu
Rene G VanDeVoorde - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Mahmoud Kallash - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Franca M Iorember - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Kera E Luckritz - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Michelle N Rheault - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Jennifer G Jetton - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Martin A Turman - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Gaurav Kapur - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Katherine E Twombley - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Shireen Hashmat - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Donald J Weaver - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Jeffrey D Leiser - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Corina Nailescu - Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
Resource Type: Journal article
Publication Details: Clinical journal of the American Society of Nephrology, Vol.12(5), pp.772-778
DOI: 10.2215/CJN.04750416
PMID: 28270432
PMCID: PMC5477206
NLM abbreviation: Clin J Am Soc Nephrol
ISSN: 1555-9041
eISSN: 1555-905X
Language: English
Date published: 05/08/2017
Academic Unit: Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
Record Identifier: 9984093219402771

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