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

Research output: Contribution to journalArticle

3 Citations (Scopus)

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, & measurements 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. 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. 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 ratewas 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 20mcg/dose series, and 71%(five out of seven) after a 40mcg/dose series. Patients receiving amultidose 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). 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. Conclusions There was no clear gradient of increasing seroconversion rate with increasing vaccine dose in this cohort of pediatric patients on dialysis.

Original languageEnglish (US)
Pages (from-to)772-778
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume12
Issue number5
DOIs
StatePublished - 2017

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Hepatitis B Vaccines
Nephrology
Dialysis
Pediatrics
Hepatitis B Antibodies
Hepatitis B
Immunity
Antibody Formation
Vaccination
Vaccines
Maintenance
Guidelines

Keywords

  • Adolescent
  • Adult
  • Antibody Formation
  • Child
  • Hemodialysis
  • Hepatitis B
  • Hepatitis B Antibodies
  • Hepatitis B Vaccines
  • Humans
  • Male
  • Nephrology
  • Peritoneal dialysis
  • Renal dialysis
  • Retrospective Studies
  • Seroconversion
  • Vaccination

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Immunogenicity of augmented compared with standard dose hepatitis B vaccine in pediatric patients on dialysis : A midwest pediatric nephrology consortium study. / Misurac, Jason M.; Vandevoorde, Rene G.; Kallash, Mahmoud; Iorember, Franca M.; Luckritz, Kera E.; Rheault, Michelle N.; Jetton, Jennifer G.; Turman, Martin A.; Kapur, Gaurav; Twombley, Katherine E.; Hashmat, Shireen; Weaver, Donald J.; Leiser, Jeffrey D.; Nailescu, Corina.

In: Clinical Journal of the American Society of Nephrology, Vol. 12, No. 5, 2017, p. 772-778.

Research output: Contribution to journalArticle

Misurac, JM, Vandevoorde, RG, Kallash, M, Iorember, FM, Luckritz, KE, Rheault, MN, Jetton, JG, Turman, MA, Kapur, G, Twombley, KE, Hashmat, S, Weaver, DJ, Leiser, JD & Nailescu, C 2017, 'Immunogenicity of augmented compared with standard dose hepatitis B vaccine in pediatric patients on dialysis: A midwest pediatric nephrology consortium study', Clinical Journal of the American Society of Nephrology, vol. 12, no. 5, pp. 772-778. https://doi.org/10.2215/CJN.04750416
Misurac, Jason M. ; Vandevoorde, Rene G. ; Kallash, Mahmoud ; Iorember, Franca M. ; Luckritz, Kera E. ; Rheault, Michelle N. ; Jetton, Jennifer G. ; Turman, Martin A. ; Kapur, Gaurav ; Twombley, Katherine E. ; Hashmat, Shireen ; Weaver, Donald J. ; Leiser, Jeffrey D. ; Nailescu, Corina. / Immunogenicity of augmented compared with standard dose hepatitis B vaccine in pediatric patients on dialysis : A midwest pediatric nephrology consortium study. In: Clinical Journal of the American Society of Nephrology. 2017 ; Vol. 12, No. 5. pp. 772-778.
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title = "Immunogenicity of augmented compared with standard dose hepatitis B vaccine in pediatric patients on dialysis: A midwest pediatric nephrology consortium study",
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, & measurements 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. 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. 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 ratewas 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 20mcg/dose series, and 71{\%}(five out of seven) after a 40mcg/dose series. Patients receiving amultidose 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). 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. Conclusions There was no clear gradient of increasing seroconversion rate with increasing vaccine dose in this cohort of pediatric patients on dialysis.",
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author = "Misurac, {Jason M.} and Vandevoorde, {Rene G.} and Mahmoud Kallash and Iorember, {Franca M.} and Luckritz, {Kera E.} and Rheault, {Michelle N.} and Jetton, {Jennifer G.} and Turman, {Martin A.} and Gaurav Kapur and Twombley, {Katherine E.} and Shireen Hashmat and Weaver, {Donald J.} and Leiser, {Jeffrey D.} and Corina Nailescu",
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T1 - Immunogenicity of augmented compared with standard dose hepatitis B vaccine in pediatric patients on dialysis

T2 - A midwest pediatric nephrology consortium study

AU - Misurac, Jason M.

AU - Vandevoorde, Rene G.

AU - Kallash, Mahmoud

AU - Iorember, Franca M.

AU - Luckritz, Kera E.

AU - Rheault, Michelle N.

AU - Jetton, Jennifer G.

AU - Turman, Martin A.

AU - Kapur, Gaurav

AU - Twombley, Katherine E.

AU - Hashmat, Shireen

AU - Weaver, Donald J.

AU - Leiser, Jeffrey D.

AU - Nailescu, Corina

PY - 2017

Y1 - 2017

N2 - 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, & measurements 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. 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. 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 ratewas 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 20mcg/dose series, and 71%(five out of seven) after a 40mcg/dose series. Patients receiving amultidose 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). 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. Conclusions There was no clear gradient of increasing seroconversion rate with increasing vaccine dose in this cohort of pediatric patients on dialysis.

AB - 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, & measurements 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. 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. 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 ratewas 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 20mcg/dose series, and 71%(five out of seven) after a 40mcg/dose series. Patients receiving amultidose 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). 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. Conclusions There was no clear gradient of increasing seroconversion rate with increasing vaccine dose in this cohort of pediatric patients on dialysis.

KW - Adolescent

KW - Adult

KW - Antibody Formation

KW - Child

KW - Hemodialysis

KW - Hepatitis B

KW - Hepatitis B Antibodies

KW - Hepatitis B Vaccines

KW - Humans

KW - Male

KW - Nephrology

KW - Peritoneal dialysis

KW - Renal dialysis

KW - Retrospective Studies

KW - Seroconversion

KW - Vaccination

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