Hepatitis B vaccination in pediatric chronic kidney disease and hemodialysis pediatric patients

Hepatitis B vaccination is recommended for all chronic kidney disease (CKD) pediatric patients. Despite adults, no specific recommendations have been made for higher doses for pediatric hemodialysis patients. However, despite the lack a specific recommendation, some authors believe that the dose of hepatitis B vaccine should be increased for these patients as adults. Anyhow, it should be considered that the response of the immune system in patients with CKD to the vaccines is impaired over time and with aggravation of renal failure .So the patients with progressive kidney disease and patients who are expected to be candidates of the renal transplantation in the future should be vaccinated as soon as possible.In immunocompetent persons without any risk factor, routine post immunization testing of serum anti-HBs Ab is not necessary ,but serum anti-HBs Ab level should be checked in hemodialysis patients 1-2 months after completion of the primary hepatitis B vaccine series , and if the level is less than 10 mIU / ml, then Hbs Ag should first be checked, and if negative, then the patient should again receive a full series of hepatitis B vaccine, and if the level of anti-HBs Ab is still less than 10 mIU / ml at the end of the second series of the vaccination, the person is considered a non-responder.Generally, administration of a complete series of hepatitis B vaccine will produce at least two decades of immunity, and it is believed that even if the level of anti-HBs Ab reaches to less than 10 mIU / ml or non-detectable, there is no need to administer a booster dose of vaccine to a healthy person, but serum anti-HBs Ab level of hemodialysis patients should be checked annually, and if it is less than 10 mIU / ml, then administration of a booster dose is indicated