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 vac¬cination 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 4 patients of unspecified age and genders. On unknown dates, the patients received hepatitis b vaccine (recombinant) (manufacturer unknown) for prophylaxis. On unknown dates, the patient was required to repeat vaccination of hepatitis b vaccine (recombinant) either because they failed to respond to the initial vaccination or because they responded and subsequently lost immunity once more. Eventually the patients responded to the vaccination after two additional dose of hepatitis b vaccine (recombinant) (manufacturer unknown). Sender's Comments: GB-009507513-1707USA005257: GB-009507513-1707USA005258: GB-009507513-1707USA004564.