Hepatitis B vaccination for those on dialysis: What you need to know

Hepatitis B is a liver disease caused by the transmission of the Hepatitis B Virus into the blood stream of an individual. Hemodialysis patients are at a greater risk of getting infected by this virus because of their blood being passed through external circuits for Hemodialysis. Further, reprocessing of dialyzers and bloodlines increases this risk because the inner circuits are exposed further during the reprocessing procedure.

There is no guaranteed cure for Hepatitis B today and patients often require to take some form of anti-viral treatment for the rest of their lives to reduce the impact of the virus on the liver.

The best news is that there is a vaccine for Hepatitis B. So, if you are on dialysis or likely to start dialysis in the near future, you should check with your doctor about getting vaccinated for Hepatitis B.

Here are a few things to note in this regard:

1. Dialysis patients need double the normal dose of the vaccine:

In India, Hepatitis B vaccines are usually available in vials of 1 ml. Dialysis patients need to take 2 ml each time.

2. You need to take 4 doses over a period of time:

You need to take double the dose (i.e., 2 ml) 4 times to complete your vaccination schedule. You need to take a 2 ml injection on Day 0, Month 1, Month 2 and Month 6. This means that if you took thre first dose of 2 ml today, you need to take another 2 ml dose after a month, another 2 ml dose after one more month and finally the last 2 ml dose after 4 more months of the last dose. Sample dates could be 

First dose - 1st January 2018
Second dose - 1st February 2018
Third dose - 1st March 2018
Fourth dose - 1st July 2018

3. Getting tested if you are protected against the Hepatitis B Virus:

Once you’ve taken 4 doses of the vaccine, you need to check if you have been protected adequately against the virus two months after the last dose. In the above example,  this test would be done on 1st September. This is checked by performing a test called the Anti Hepatitis B Surface Antibody Titre.  If the Titre value is greater than 10 IU/ml, then you have been adequately protected.

If the titre value is less than 10 IU/ml, then you should repeat the entire vaccination schedule again (4 doses of 2 ml each with the gaps as outlined above). Then again check your titre. If it is greater than 10 IU/ml, then you are now adequately protected. However, if your titre is still less than 10 IU/ml, then you are classified as a non-responder and it is unlikely that the vaccine is going to work for you. Read the section on Non Responders below.

4. Follow-up testing annually:

With the Hepatitis B vaccine different people get different levels of protection and this protection lasts for different durations. The protocol is to get tested annually for the same Anti Hepatitis B Surface Antibody Titre. If your titre value is less than 10 IU/ml, then you should get a booster dose (one dose of 2 ml of vaccine). If your titre is greater than 10 IU/ml then you do not need a booster for another year. If your titre is 100 IU/ml or greater then you do not need to test for the titre or get a booster ever in your entire life.

Annual Anti Hepatitis B Surface Antibody Titre < 10 IU/ml - Booster dose of 2 ml
Titre > 10 IU/ml but < 100 IU/ml - No need for booster for one more year
Titre > 100 IU/ml - No need to check your titre ever again and no need to get a booster for your entire life

5. Non Responders: 

Some people do not respond to the Hepatitis B vaccine. Despite getting the entire vaccination schedule (even twice) their titre value is still less than 10 IU/ml. This means that they are not adequately protected against the Hepatitis B virus. They should take adequate precautions to avoid getting infected. Things like avoiding blood transfusions unless absolutely necessary, not dialysing on a machine that has been used to dialyze a Hepatitis B positive patient, not dialysing at a station close to one that has been used to dialyse a Hepatitis B positive patient and so on should be adopted.

Dialysis patients have a tough life. The last thing someone would want is to get burdened with another disease like Hepatitis B. When there is a vaccine available, getting vaccinated is the most prudent thing to do. Yet, many dialysis patients take this easy and delay or avoid taking the vaccine. Prevention, obviously and more so in this case, is better than cure.