Intradermal versus intramuscular hepatitis B re-vaccination in non-responsive chronic dialysis patients: a prospective randomized study with cost-e ectiveness evaluation

rotection rate was higher in i.d. than in i.m. group (30 vs 0%, P=0.2). At month 20, the median anti-HBs Background. It has been calculated that 30% of chronic uraemic patients fail to produce antibodies to HBsAg titres in i.d. patients were 21 mUI/ml, and GMT (95% CI) were 20.9 (2–54) mUI/ml. No important general antigen after hepatitis B (HB) vaccination. Low-dose intradermal (i.d.) inoculations and supplementary or local side-e ects were observed. The cost of our schedule was $92 US whereas the costs of other intramuscular (i.m.) injections have been reported to improve the response rate in previous non-responder re-vaccination protocols ranged between 138 and $807 US. chronic uraemic patients, but no cost-e ectiveness evaluations have been made about this issue. Conclusions. Our results show that the unresponsiveness to recombinant yeast-derived vaccine may be Methods. We re-vaccinated 50 chronic dialysis patients, who did not have any detectable anti-HBs mostly reversed by repeated low-dose i.d. injections of the same agent. In spite of an equal amount of HBsAg antibody after a reinforced protocol of hepatitis B vaccine given by i.m. route, with hepatitis B recombinreceived, i.d. hepatitis B re-vaccination shows higher immunogenicity compared to i.m. administration over ant DNA yeast vaccine (80 mg) by intradermal (25 patients) or intramuscular (25 patients) administration a 20-month observation period. Cost-e ectiveness analysis demonstrated that the intradermal administration (randomly allocated). We used the same amount of HBsAg in order to exclude the confounding e ect of of HB vaccine is the most clinically e ective re-vaccination strategy; it is also the most unexpensive the dose level administered on the immune response of uraemic patients. We studied, over a 20-month one. We strongly recommend low-dose intradermal inoculations in order to re-vaccinate chronic dialysis follow-up, the persistence of anti-HBs antibodies in our responder vaccinees. We made a comparison patients who fail to respond to hepatitis B vaccination. between the costs of our re-vaccination protocol and the other re-vaccination strategies that have been