Hemodialysis and Viral Hepatitis
Hepatitis B Vaccination and Testing
Since the initiation of strict infection-control practices and hepatitis B vaccination, the rate of hepatitis B virus (HBV) infection among patients undergoing hemodialysis has declined approximately 95%. Nonetheless, repeated outbreaks of HBV infection among unvaccinated patients underscore the continued risk for infection in this population. In addition, primary HBV infections become chronic more frequently in immunosuppressed persons, including hemodialysis patients.
The
Advisory Committee on Immunization Practices recommends universal vaccination
of persons with end-stage renal disease, including predialysis, hemodialysis,
peritoneal dialysis, and home dialysis patients. Other recommendations specific
to this population are as follows:
- Hepatitis B vaccination is recommended for pre-end-stage renal disease patients before they become dialysis dependent and for peritoneal and home dialysis patients because they might require in-center hemodialysis.
- Higher hepatitis B vaccine doses are recommended for adult dialysis patients and other immunocompromised persons. Compared with immunocompetent adults, hemodialysis patients are less likely to have protective levels of antibody after vaccination with standard vaccine dosages.
- Serologic testing of hemodialysis patients and other immunocompromised persons is recommended 1–2 months after administration of the final dose of the primary vaccine series to determine the need for revaccination.
- For hemodialysis patients, the need for hepatitis B vaccine booster doses should be assessed by annual testing for antibody to hepatitis B surface antigen (anti-HBs). A booster dose should be administered when anti-HBs levels decline to <10 mIU/mL.
Hepatitis C Testing
Guidelines and Recommendations
Infection Control Requirements for Dialysis Facilities and Clarification Regarding Guidance on Parenteral Medication Vials
MMWR 2008; 57(32):875-876
Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection
MMWR 2008;57(RR-8)
Hepatitis B Vaccination Recommendations for Adults; Appendix
A,
B,
C
PDF
version (with appendices)
MMWR 2006;55(RR-16)
Recommendations
for Preventing Transmission of Infections Among Chronic Hemodialysis Patients
MMWR 2001;50(RR-5)
Guidelines for Vaccinating Kidney Dialysis Patients and Patients with Chronic
Kidney Disease
Summary of ACIP recommendations, June 2006
Recommendations
for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related
Chronic Disease
MMWR 1998;47(RR-19)
Related Pages
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CDC
-
Federal
National Institute of Diabetes & Digestive & Kidney Diseases
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Other
Page last modified: October 1, 2008
Content source:
Division of Viral Hepatitis
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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