The duration of hepatitis B vaccine immunity in pediatric dialysis patients

• Published in: Pediatric nephrology (Berlin, West) Vol. 29; no. 10; pp. 2029 - 2037
• Main Authors: Sheth, Rita D., Peskin, Melissa F., Du, Xianglin L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2014; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Adults; Antibodies; Antibodies, Viral - blood; Care and treatment; Child; Child, Preschool; Complications and side effects; Data collection; Development and progression; Female; Health aspects; Health care; Hemodialysis; Hemodialysis patients; Hepatitis A Vaccines - administration & dosage; Hepatitis A Vaccines - immunology; Hepatitis B; Hepatitis B - prevention & control; Hepatitis B Antibodies - blood; Hepatitis B Vaccines - administration & dosage; Hepatitis B Vaccines - immunology; Hepatitis B virus; Humans; Infant; Infections; Kaplan-Meier Estimate; Kidney diseases; Liver diseases; Male; Medicine; Medicine & Public Health; Nephrology; Original Article; Patient outcomes; Patients; Pediatrics; Proportional Hazards Models; Renal Dialysis - mortality; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Risk factors; Survival analysis; Transplants & implants; Urology; Vaccination - methods; Vaccines; Vaccines, Combined - administration & dosage; Vaccines, Combined - immunology; Viral infections; Young Adult; United States; United States > US; Loma Linda California; CKD patient vaccines; Childhood immunization; Pediatric dialysis patients; Hepatitis B immunity
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-014-2822-7

Background Dialysis patients are at risk for hepatitis B infection, a serious but preventable disease. Long-term hepatitis B protection has not been defined in pediatric patients with chronic kidney disease stage 5 on dialysis (CKD 5D) who were vaccinated as infants or children. Methods Annual hepatitis B antibody surveillance data were collected retrospectively on a cohort of pediatric CKD 5D patients ( n  = 202) at a single institution and analyzed by survival analysis to assess hepatitis B immunity duration. Results Median duration of immunity by Kaplan–Meier analysis since primary vaccination was 106.3 [95 % confidence interval (CI) 93.9, 124.4] months. After the initiation of dialysis, the median duration of hepatitis B immunity was 37.1 (95 % CI 24.2, 72.3) months. Multivariate adjusted analysis showed that there was a significant difference in the duration of hepatitis immunity based on the timing of hepatitis B vaccination ( p  < 0.001). Patients immunized after starting dialysis had a hazard ratio of 6.13 (95 % CI 2.87, 13.08) for hepatitis B immunity loss compared to patients immunized as infants ( p  < 0.001). Conclusions After dialysis initiation, protective hepatitis B antibody levels wane rapidly, with a shortened duration of immunity. In our cohort of pediatric patients with CKD 5D, this decline was more pronounced in children who were immunized after starting dialysis than in those who received hepatitis B immunizations during childhood. Both groups of patients should be monitored with serial antibody titers.