Respuesta a la vacuna contra la hepatitis B en pacientes en hemodiálisis crónica

  • Nelson López Universidad Nacional de Itapúa
  • Raúl Real Hospital Nacional, Itauguá
Palabras clave: enfermedad renal crónica, antiHBsAg, vacuna hepatitis B, hemodiálisis

Resumen

Introducción: la hepatitis B (HB) sigue siendo un importante problema de Salud Pública debido a las consecuencias que acarrea en los pacientes infectados. Entre los grupos de alto riesgo de adquirir este virus se encuentran los pacientes con enfermedad renal crónica (ERC) en tratamiento hemodialítico, por lo que la vacunación constituye un importante método de prevención y protección contra el virus de la hepatitis B (VHB).

Objetivos: determinar el nivel de antiHBsAg y hallar la prevalencia de respuesta inadecuada a la vacuna contra la HB. Detectar los factores de riesgo asociados a la falta de respuesta inmunológica a la vacuna contra HB.

Metodología: estudio observacional, descriptivo, prospectivo, de corte transverso, con componente analítico. Se incluyeron pacientes adultos con ERC en tratamiento hemodialítico trisemanal del Hospital Nacional de Itauguá durante el 2015. A todos se les determinó antiHBsAg.

Resultados: se incluyeron 89 sujetos, de los cuales 47% tuvieron una respuesta inadecuada a la vacuna contra el VHB, con un leve predominio del sexo masculino.

Conclusiones: la frecuencia de respuesta inadecuada a la vacuna es 47%. La edad, el hábito tabáquico, las comorbilidades y el estado de nutrición por IMC resultaron como factores de riesgo no significativos en la respuesta inadecuada a la vacuna contra el VHB, mientras que los años de hemodiálsis y la uremia se relacionaron de manera significativa a esta mala respuesta.

Citas

Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat. 2004 Mar;11(2):97-107.

Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep. 2006 Dec 8;55(RR-16):1-33.

Zampino R, Boemio A, Sagnelli C, Alessio L, Adinolfi LE, Sagnelli E, Coppola N. Hepatitis B virus burden in developing countries. World J Gastroenterol. 2015 Nov 14;21(42):11941-53.

European Best Practice Guidelines Expert Group on Hemodialysis, European Renal Association. Section VI. Haemodialysis-associated infection. Nephrol Dial Transplant. 2002;17 Suppl 7:72-87.

Fehr T, Ambühl PM. Chronic hepatitis virus infections in patients on renal replacement therapy. Nephrol Dial Transplant. 2004 May;19(5):1049-53.

Pin M, Compte MT, Angelet P, Gállego C, Gutiérrez C, Martinez Vea A. Long-term evaluation of immune response to hepatitis B vaccine in 136 patients undergoing hemodialysis. Nefrologia. 2009;29(5):415-20.

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, et al. Evidence-based clinical guidelines for immigrants and refugees. CMAJ. 2011 Sep 6;183(12):E824-925.

Schroth RJ, Hitchon CA, Uhanova J, Noreddin A, Taback SP, Moffatt ME, Zacharias JM. Hepatitis B vaccination for patients with chronic renal failure. Cochrane Database Syst Rev. 2004;(3):CD003775.

Thudi K, Yadav D, Sweeney K, Behari J. Physicians infrequently adhere to hepatitis vaccination guidelines for chronic liver disease. PLoS One. 2013 Jul 26;8(7):e71124.

Annunziata K, Rak A, Del Buono H, DiBonaventura M, Krishnarajah G. Vaccination rates among the general adult population and high-risk groups in the United States. PLoS One. 2012;7(11):e50553.

Launay O, Floret D. Hepatitis B vaccination: a review. Med Sci (Paris). 2015 May;31(5):551-8

Pham H, Geraci SA, Burton MJ; CDC Advisory Committee on Immunization Practices. Adult immunizations: update on recommendations. Am J Med. 2011 Aug;124(8):698-701.

Chen W, Gluud C. Vaccines for preventing hepatitis B in health-care workers. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD000100.

Einollahi B. Immune response to hepatitis B vaccine in patients with chronic kidney disease. Hepat Mon. 2011 Oct;11(10):781-2.

Davison SA, Strasser SI. Ordering and interpreting hepatitis B serology. BMJ. 2014 Apr 17;348:g2522.

García C. Patricia, De La Cerda S. Gabriela, Calvo A. Mario, Godoy G. Rosa, Covarrubias F. Carmen, Potin S. Marcela et al. Inmunogenicidad de una vacuna recombinante anti hepatitis B en personal de salud. Rev. chil. infectol. [Internet]. 2002 [citado 2016 Ene 09] ; 19( 3 ): 133-139. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182002000300001&lng=es.

Pérez-López JA, García-Elorriaga G, Del Rey-Pineda G, Manjarrez-Téllez B. Antibodies against hepatitis B after vaccination in health workers. Salud Publica Mex. 2011 May-Jun;53(3):205-6.

Pereira ZT, Mendoza-Sassi RA. Factors associated with the immune response to hepatitis B vaccine in Brazilian hemodialysis patients. Rev Med Chil. 2012 Jul;140(7):882-8.

Roukens AH, Visser LG. Hepatitis B vaccination strategy in vaccine low and non-responders: a matter of quantity of quality? Hum Vaccin. 2011 Jun;7(6):654-7.

Yen YH, Chen CH, Wang JH, Lee CM, Changchien CS, Lu SN. Study of hepatitis B (HB) vaccine non-responsiveness among health care workers from an endemic area (Taiwan). Liver Int. 2005 Dec;25(6):1162-8.

Lin CS, Xie SB, Liu J, Zhao ZX, Chong YT, Gao ZL. Effect of revaccination using different schemes among adults with low or undetectable anti-HBs titers after hepatitis B virus vaccination. Clin Vaccine Immunol. 2010 Oct;17(10):1548-51.

Odinsen O, Owusu-Ofori S, Dompreh A, Sarkodie F, Opare-Sem O, Parker D, Allain JP. Antibody detection and kinetics of antibody production during early stages of immunization with hepatitis B virus vaccine. Clin Vaccine Immunol 2007 Dec;14(12): 1623-8.

Torres Sánchez MJ, Peña Ortega M, Ramírez Gómez M, Pérez Marfil A, Morales A, Balaguer Alberti G, Osuna Ortega A. La vacuna frente al virus de la hepatitis B ¿cuál es la mejor pauta en los pacientes en hemodiálisis? Dial Traspl. 2015;36(2):57-57.

Peces R. Inmunización frente a la hepatitis B y persistencia de memoria inmunológica. Nefrología 2002;22(6):503-506

Dinits-Pensy M, Forrest GN, Cross AS, Hise MK. The use of vaccines in adult patients with renal disease. Am J Kidney Dis 2005;46(6):997-1011

Zhang L, Liu J, Lu J, Yan B, Song L, Li L, Cui F, Zhang G, Wang F, Liang X, Xu A. Antibody response to revaccination among adult non-responders to primary Hepatitis B vaccination in China. Hum Vaccin Immunother. 2015 Nov 2;11(11):2716-22.

Lopes MH, Sartori AM, Souza TV, Mascheretti M, Chaves Tdo S. Hepatitis B revaccination for healthcare workers who are anti-HBs-negative after receiving a primary vaccination series. Rev Soc Bras Med Trop. 2012 Oct;45(5):639-42.

McMahon BJ, Dentinger CM, Bruden D, Zanis C, Peters H, Hurlburt D,et al. Antibody levels and protection after hepatitis B vaccine: results of a 22-year follow-up study and response to a booster dose. J Infect Dis. 2009 Nov 1;200(9):1390-6.

Spradling PR, Xing J, Williams R, Masunu-Faleafaga Y, Dulski T, Mahamud A, et al. Immunity to hepatitis B virus (HBV) infection two decades after implementation of universal infant HBV vaccination: association of detectable residual antibodies and response to a single HBV challenge dose. Clin Vaccine Immunol. 2013 Apr;20(4):559-61.

Wang L, Wang K, Zou ZQ. Crosstalk between innate and adaptive immunity in hepatitis B virus infection. World J Hepatol. 2015 Dec 28;7(30):2980-91.

Mathew RO, Mason DL, Song R, Tryniszewski T, Kennedy JS. Role of T-regulatory cells in the response to hepatitis B vaccine in hemodialysis patients. Hemodial Int. 2015 Jun 23.

Hashemi B, Mahdavi-Mazdeh M, Abbasi M, Hosseini-Moghaddam SM, Zinat NH, Ahmadi F. Efficacy of HBV vaccination in various stages of chronic kidney disease: is earlier better? Hepat Mon. 2011 Oct;11(10):816-20.

Santa Cruz F, Cabrera W, Barreto S, Mayor MM, Báez D. Kidney disease in Paraguay. Kidney Int Suppl. 2005 Aug;(97):S120-5.

Finelli L, Millar JT, Tokars JI, Alter MJ, Arduino MJ. Nacional Surveillance of dialysis-associated diseases in the United Status, 2002. Semin Dial. 2005 Jan-Feb;18(1):52-61.

Fabrizi F, Bunnapradis S, Martin P. HBV infection in patients with end-stage renal disease. Semin Liver Dis 2004;24 Suppl 1:63-70.

Tang S, Lai KN. Chronic viral hepatitis in hemodialysis patients. Hemodial Int. 2005 Apr;9(2):169-79.

Tong NK, Beran J, Kee SA, Miguel JL, Sánchez C, Bayas JM, et al. Immunogenicity and safety of an adjuvanted hepatitis B vaccine in pre-hemodialysis and hemodialysis patients. Kidney Int. 2005 Nov;68(5):2298-303.

Janus N, Vacher LV, Karie S, Ledneva E, Deray G. Vaccination and chronic kidney disease. Nephrol Dial Transplant. 2008 Mar;23(3):800-7.

Walayat S, Ahmed Z, Daniel Martin, Puli S, Cashman M, Dhillon S. Recent advances in vaccination of non-responders to standard dose hepatitis B virus vaccine. World J Hepatol 2015; 7(24): 2503-2509.

Bonazzi PR, Bacchella T, Freitas AC, Osaki KT, Lopes MH, Freire MP, Machado MC, Abdala E. Double-dose hepatitis B vaccination in cirrhotic patients on a liver transplant waiting list. Braz J Infect Dis. 2008 Aug;12(4):306-9.

Publicado
2016-03-01
Sección
ARTICULOS ORIGINALES