Hepatitis B, prevalentie en resultaten van preventieve maatregelen in dialysecentra

– In the past hepatitis B was a serious complication in patients undergoing chronic intermittent haemodialysis. The medical staff also was at risk. Introduction of some hygienic measures, fewer HBsAg negative blood transfusions and the possibility of separate treatment of HBsAg negative and HBsAg positive patients have reduced the frequency of this problem. Further reduction was obtained by vaccination. In all, the results are for HBsAg positive patients a decrease from 23 (1974) to 1.8) (1985) with an increase of anti-HBs from 8.8 (1978) to 32.2 (1985) while the medical staff went from 1 (1978) to 0 (1985) and from 9.6 (1978) to 50 (1985), respectively.

As known from the literature the two vaccines used (MSD vaccine, prepared by Merck, Sharp & Dohme, West Point, Pasadena, and CLB-vaccine, prepared by the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service in Amsterdam) gave a good immune response for the medical staff (85-95). The immune response after vaccination is less go in dialysis patients (60-64).

In the future this problem can perhaps be solved by booster injections, higher dosages or more immunogenic vaccines (2nd generation vaccines).