General Nephrology - Protocol For Hepatitis B Vaccination

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia

CSN-Canada

Ad Hoc Committee Recommendations

Blood Borne Infections
2005

 - Patients with chronic kidney disease (CKD) should be vaccinated against HBV as early in the course of their disease as possible, assuming they are susceptible and there are no contra-indications.  This practice will increase the probability of successful immunization, compared to vaccination at the time of initiation of hemodialysis.  Nephrology programs should develop local databases to track the HBV status of patients with CKD, and should have policies and procedures in place regarding revaccination, and follow-up of immune status.

Recommendations to prevent the transmission of hepatitis B virus in hemodialysis patients.
Page #10 of 17

EBPG-Europe
November 2002

 - Patients should be vaccinated preferably before they start on HD. (Level B)
 - HD patients who have not been previously immunized against HBV should be vaccinated. (Level A)
 - Anti-HBs testing 1-2 months after the primary series, then 6-12 months later depending on the incidence at the local centre. (Level C)
 - Additional doses in patients who do not develop protective antibody titres. A booster dose is recommended if titre is less than 10 IU/ml.
 - Subsequent routine testing every 6 months

VI.6 Prevention and management of HBV HCV HIV in HD patients

Early vaccination should be preferred. Three double doses or four single doses induce more responders.

KDOQI-US

UK-Renal Association

Module 1: CKD
2007

 - Patients who are Hepatitis B surface antigen and Hepatitis B surface antibody negative should be immunised and their antibody levels measured post vaccination (Evidence).

Preparation for dialysis