Meta-analysis: intradermal vs. intramuscular vaccination against hepatitis B virus in patients with chronic kidney disease

Authors


Dr F. Fabrizi, Divisione di Nefrologia e Dialisi, Ospedale Maggiore, IRCCS, Pad. Croff, via Commenda 15, 20122 Milano, Italy.
E-mail: fabrizi@policlinico.mi.it

Abstract

Summary

Background

Dialysis patients have suboptimal response towards hepatitis B virus (HBV) vaccine and intradermal hepatitis B virus vaccination has been used to improve the response rate; however, its efficacy remains unclear.

Design

Meta-analysis of controlled trials comparing intradermal vs. intramuscular vaccine against HBV among chronic kidney disease patients.

Identification

Twelve studies involving 640 unique patients were included if they had controlled design, intervention and control group patients received intradermal or intramuscular vaccine against HBV, respectively. Patients were followed for a minimum of 7 months after the first vaccine dose.

Main outcome measures

The odds ratio of failure to respond to HBV vaccine among patients who received vaccine by intradermal vs. intramuscular route was the end point of interest. It was calculated at completion of HBV vaccination and over follow-up.

Results

Pooling of study results demonstrated a decreased risk of failure to respond to HBV vaccine among patients who were vaccinated by intradermal vs. intramuscular route (pooled odds ratio at completion of vaccine protocol: 0.36; 95% CI: 0.21–0.62; test of study heterogeneity, P =0.089). This difference did not occur over follow-up (6–60 months after completing vaccine schedule; pooled odds ratio: 1.1; 95% CI: 0.47–2.5).

Conclusions

Dialysis patients show higher seroprotection after intradermal than intramuscular vaccination schedules; this was not apparent over follow-up. Further studies are warranted to assess if the higher seroprotection rates obtained by intradermal route translates into reduced incidence of de novo HBV virus among chronic kidney disease patients.

Ancillary