Hossein Khedmat

Morteza Izadi

Seyed Moayed Alavian

International Journal of Travel Medicine and Global Health

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International Journal of Travel Medicine & Global Health  Infection Diseases Section                                                                                                                                                     Editorial Hepatitis B Virus Vaccination in Hemodialysis Patients: A Necessity for Individualizing of Immunization?  Hossein Khedmat1, Morteza Izadi*2, Seyed Moayed Alavian1     Dear Editor, We read with interest the review article by Houshang Sanadgol [1], on the feasibility of administering Levamizol on enhancing Hepatitis B vaccination in hemodialysis patients. The topic is of utmost importance for at least three reasons: 1. the very high rate of HBV infection in the world population which is supposed to affect up to half a billion people [2]; 2. The higher rate of HBV infection among hemdialysis patients due to the repetitive injections, blood transfusions and cross-contamination through environmental and procedural devices; and 3. the poor response to vaccinations due to the suppressed immune system. Although strict adherence to hygienic precautions has substantially reduced the rate of HBV incidence in hemodialysis patients due to the mentioned risk factors, it still sounds logical and necessary to promote protection through vaccination of this patient population. Several endeavors have been proposed to enhance the effectiveness of vaccination in hemodialysis patients; usage of higher doses of HBV vaccine (40 µg vs. conventional 10-20 µg) in a four (than 3 in the conventional method) shot administration is one of these endeavors that has brought some hopes [3]. Some investigators have proposed to change the timing and method of vaccine administration. Jadoul et al. [4] have proposed that using 20 μg vaccine dosages every month until serum antibody titers reach 100 UI/l, or up to 10 doses to be administered. They reached to 70% protection rate one year after the study commencement. Charest et al. [5] recommended intradermal administration of 5 µg vaccine every 2 weeks for 18 months or when the peak antibody titer reaches to 1000 IU/L. on the other hand, controversial evidence also exist on whether augmentation of vaccine doses can improve immunity responses [6]. The study by Dr. Sanadgol [1] also showed that Levamisole can have 1. Baqiyatallah Research Center for Gastroenterology and Liver Disease; Baqiyatallah University of Medical Sciences; Tehran 2. International Travel Center Medicine Center of Iran; Health Research Center; Baqiyatallah University of Medical Sciences, Tehran, Iran.  * Corresponding Author Dr. Morteza Izadi, Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Email: Dr.izadi.m@gmail.com  Submission: 10 Sep 2013  Keywords: HBV, Hepatitis B Virus, Vaccination, Hemodialysis, Chronic Kidney Disease International Journal of Travel Medicine and Global Health, Volume 1, Issue 2, Summer 2013; 37-38  All rights reserved for official publication of Baqiyatallah university of medical sciences© Khedmat H. et al , HBV Vaccination in Hemodialysis Patients beneficial effects on the bioavailability of anti-HBV antibody titers in a significant number of patients, while it has no beneficial effects in other studies [7].  In the era of therapeutic endeavors, the literature suggests individualization of treatment of patients infected with HCV infection according to the hosts’ genetic individualizations [8]. Considering dissimilar reaction to HBV vaccination in different hemodialysis patients, one may think that the same individual variations might exist in this era, as well. Evidence suggests that several host factors including advanced age, male gender, previous blood transfusions are associated with poor seroconversion rates [9]. But to the best of our knowledge, no major studies have been performed to address the issue that whther it is possible to combine ou current knowledge to individualize HBV vaccination protocol for each hemodialysis patient based on its demographic, medical history and genetic factors. So, we suggest that future research efforts to be directed to address this critical issue.  References 1. Sanadgol H. Levamisole Usage as an Adjuvant to Hepatitis B Vaccine in Hemodialysis Patients, Yes or No? Nephro-Urology Monthly. 2012 December; 5(1): 673-678. 2. Janus N, Vacher LV, Karie S, Ledneva E, Deray G. Vaccination and chronic kidney disease. Nephrol Dial Transplant. 2008 Mar;23(3):800-7. 3. McNulty CA, Bowen JK,Williams AJ. Hepatitis B vaccination in predialysis chronic renal failure patients a comparison of two vaccination schedules. Vaccine 2005; 23: 4142–4147. 4. Jadoul M, Goubau P. Is anti-hepatitis B virus (HBV) immunization successful in elderly hemodialysis (HD) patients? Clin Nephrol 2002;58: 301–304. 5. Charest AF, McDougall J, Goldstein MB. A randomized comparison of intradermal and intramuscular vaccination against hepatitis B virus in incident chronic hemodialysis patients. Am J Kidney Dis 2000; 36:976–982. 6. Ahmadi F, Ramezani M, Razeghi E, Ranjbarnovin N, Khazaeipour Z. A randomized controlled trial of two schedules of hepatitis B vaccination in predialysed chronic renal failure patients. Hepat Mon. 2012 May;12(5):344-8. doi:10.5812/hepatmon.6438. 7. Sali S, Alavian SM, Hajarizadeh B. Effect of levamisole supplementation on hepatitis B virus vaccination response in hemodialysis patients. Nephrology (Carlton). 2008 Oct;13(5):376-9. doi: 10.1111/j.1440-1797.2008.00952.x. 8. Ge D, Fellay J, Thompson AJ, Simon JS, Shianna KV, Urban TJ, Heinzen EL, Qiu P, Bertelsen AH, Muir AJ, Sulkowski M, McHutchison JG, Goldstein DB. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature. 2009 Sep 17;461(7262):399-401. doi: 10.1038/nature08309. 9. Johnson DW, Fleming SJ. The use of vaccines in renal failure. Clin Pharmacokinet 1992; 22: 434–446. 38                               International Journal of Travel Medicine and Global Health, Volume 1, Issue 2, Summer 2013 

Hepatitis B Virus Vaccination in Hemodialysis Patients: A Necessity for Individualizing of Immunization?

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Hepatitis B Virus Vaccination in Hemodialysis Patients: A Necessity for Individualizing of Immunization?

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