Sex: U
Vaccine: HEP
Symptoms: Decreased immune responsiveness, Therapy non-responder
Clinical narrative: This literature report has been received from the author of a published literature article, titled as stated above. Abstract Background and objectives: 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. Design, setting, participants and measurements: This was a retrospective review of patients on dialysis aged <19 years from 01-MAY-2008 to 01-MAY-2013 at 12 pediatric dialysis units. Hepatitis B surface antibody (HBsAb) titers >= 10 mIU /ml were defined as protective. Results: 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 (The hepatitis B vaccine was given as a single-dose or multi-dose booster series in 187 patients, of which 170 patients had data suitable for analysis). Conversion to protective HBsAb titers was achieved in 135 out of 170 patients (79 %) after their first single-dose booster or multi-dose 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 multi-dose booster series, the response rate was 95 %  (19 out of 20) after a 10 mcg/ dose series, 83 %  (20 out of 24) after a 20mcg/ dose series, and 71 %  (five out of seven) after a 40 mcg/ dose series.  Patients receiving a multi dose 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 (P=0.21). 27 patients received more than one single-dose booster or multi-dose series, and 26 out of 27 (96 % ) eventually gained immunity after receiving one to three additional single-dose boosters or multi-dose booster series. During the study period, 27 of the 170 patients mentioned above received one or more additional hepatitis B boosters, either because they failed to obtain immunity after the first booster or because they responded but then lost immunity. Of these 27 patients, 96 % (26 out of 27) eventually responded to vaccination: 20 out of 27 (74 %) after one more booster or multi-dose booster series, 4 out of 27 after two more boosters or multi-dose series, and 2 out of 27 after three more boosters or multi-dose series. This case refers to a patient of unspecified age and gender. On an unknown date, the patient received hepatitis b vaccine (recombinant) (manufacturer unknown) for prophylaxis. On an unknown date, the patient received one or more additional hepatitis b vaccine (recombinant), either because they failed to obtain immunity after the first booster or because they responded but then lost immunity. The outcome of the event was unknown. Sender's Comments: GB-009507513-1707USA005257: GB-009507513-1707USA004564: GB-009507513-1707USA005256.