The Impact of Simultaneous Td and HB Vaccination on HBS Antibody Titer in Dialysis Patients

Antibody production in patients with end-stage kidney disease impairs due to several mechanisms. There are different ways to improve response rate to Hepatitis B (HB) vaccine. In this study we evaluated the effect of Tetanus-diphtheria toxoid (Td) vaccine on HBS Antibody (Ab) level while being given simultaneously with HB vaccine. We recruited 43 hemodialysis and 20 peritoneal dialysis patients who had HBS Ab titer less than 10 IU/L after first schedule of HB vaccination. The patients were divided into two groups: A (30 patients) and B (33 patients). Both received 3 dose HB vaccination schedule of 40 µg intramuscularly in the left deltoid muscle at 0, 1 and 6 months while group A, received Td vaccine intramuscularly simultaneous with first dose of HB vaccine, too. HBS Ab was measured in periods of 1 and 6 months after completion of vaccination. Group A had better but not significant response rate than group B in one month (96% vs. 83.9%) (P = 0.07) and six months (87.5% vs 83.3%) (P = 0.34) after completion of vaccination. Patients with HCV infection had lower response rate than the ones who did not have HCV infection (33.3% vs. 92.5%) (P= 0.02). Response rate was better in younger patients (r= 0.339 and P= 0.005). The use of Td vaccine simultaneous with HB vaccination does not have any role in the persistence of immune response. Age and HCV infection negatively affect the response to HB vaccination in dialysis patients.