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 journalArticlepeer-review

3 Scopus citations


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
Issue number5
StatePublished - 2017

Bibliographical note

Publisher Copyright:
© 2017 by the American Society of Nephrology.


  • 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


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