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The Immunoglobulin G Subclass Response to Hepatitis B Vaccine and the Antibody Response to Pneumococcal Polysaccharides in Dialysis Patients
Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences.
Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Transfusion Medicine and Clinical Immunology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
Department of Clinical Bacteriology, Sahlgren´s University Hospital/Göteborg University.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

We examined the response to hepatitis B vaccination in dialysis patients, and evaluated our vaccination program to hepatitis B virus. No new cases of hepatitis B occurred during the study period, i.e. from 1980 and onwards. Sera were analyzed for anti-HBs in 25 dialysis patients vaccinated at least three times against hepatitis B and 53 health care staff vaccinated three times. The IgG subclass distribution of antibodies to hepatitis B surface antigen (anti-HBs) was determined in 11 dialysis patients and in 45 healthy controls. The antibody response to pneumococci was determined in 29 vaccinated patients.

Results: Ten of 25 (40%) of the dialysis patients had anti-HBs when both tests after the third and/or fourth injections were considered. In four patients a fourth injection was cancelled due to transplantation or bad health, while such data were lacking in 8 cases. In staff 49/53 (93%) of the persons responded with anti-HBs production. In anti-HBs positive patients and controls a significant difference in the response of healthy adults was observed in anti-HBs IgG 1 (p<0.001) vs all other IgG subclasses. Dialysis patients had low levels, or negative findings, in all cases, with lgGI as the highest proportion found (3/11 patients). An antibody response to pneumococcal vaccination was registred in 25 out of 29 dialysis patients (in all 86 %).Dialysis patients respond poorly to hepatitis B vaccine. An anti-HBs subclass response mainly restricted to IgG I was observed in healthy adults, while dialysis patients had low or negative test results affecting all subclasses.

The findings suggest a general deficit in the ability to produce anti-HBs rather than a deficit in the production of a specific subclass of this antibody. Moreover, RBV-vaccination schedules in renal transplant recipients should be started early, as some patients otherwise, due to transplantation or bad health, may not receive a fourth injection.

The antibody response to pneumococcal vaccination indicates that the antigen involved is important in vaccination responses in dialysis patients.

Keyword [en]
Antibodies, dialysis, hepatitis B virus, Immunoglobulin G, pneumococci, vaccination.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-79909OAI: diva2:544572
Available from: 2012-08-15 Created: 2012-08-15 Last updated: 2012-08-15Bibliographically approved
In thesis
1. Immunoglobulins, immunoglobulin subclass-distributions and serologic markers in some renal and systemic disorders
Open this publication in new window or tab >>Immunoglobulins, immunoglobulin subclass-distributions and serologic markers in some renal and systemic disorders
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In this study we evaluated pathogenetic factors and possible mediators of renal and systemic disorders where immunologic mechanisms might be of importance.

An abberant immunoglobulin and IgG-subclass distribution was detected in 103 patients with primary and secondary glomerulonephritis as well as in 38 patients with the systemic disease primary Sjögren 's syndrome or purpura hypergammaglobulinemica (elevated IgG1 and low IgG2 ).

The drug hydralazine, an anti-hypertensive, was considered to cause renal disease on an immunologic base in 17 patients, with autoantibody production (mainly ANA and antibodies to myeloperoxidase).

Dialysis-patients showed adequate antibody responses to vaccination against pneumococci but low responses against hepatitis B, while the IgG-subclass response of the hepatitis B antibody (anti-HBs) was low, but not shown to be significantly different from that of healthy adults.

A therapeutical removal of igG-antibodies with immunoadsorption or plasmapheresis was considered to have a possible adjuvant effect to medical immunosuppressive treatment alone in 44 patients with rapidly progressive glomerulonephritis.

Hepatitis C virus (HCV) is common in dialysis patients and renal transplant recipients. In 20 anti-HCV positive sera from 1988-91 recombinant immunoblott assay (RIBA) was positive in 8 cases and indeterminate in 7, while HCV RNA was present in 13/20 tested sera. In October 1991 17% of our hemodialysis patients were verified or suspected carriers while 11% were verified or suspected carriers in January 1997. Genotype 2b was found in 13/24 tested cases and in 7 amplifiable 2b sequences a strong phylogenetic relationship occurred. In 8 out of 12 RIBA-3 indeterminate sera HCV-RNA was still positive. Awareness and preventive measures limited transmission between patients.

Indeterminate RlBA-results should, also with modem assays, be regarded with caution due to the relative immunodeficiency of uremic patients.

In conclusion renal and systemic diseases may affect the serum immunoglobulins and immunoglobulin G-subclasses, while a study of the specific antibody subclass distributions (anti-HBs) showed no difference in renal (dialysis) patients and healthy adults. Medication (hydralazine) and infection may be triggering factors of various forms of glomerulonephritis. Uremia affects the antibody responses to hepatitis C in dialysis patients. The extent of renal disease as well as the possibility of therapeutic removal of antibodies is also important for the immunologic responses of such disorders.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 87 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 646
Immunoglobulins, immunoglobulin-subclass distribution, hydralazine, ANCA, anti-:MPO, primary SjOgren's syndrome, hepatitis B vaccination, anti-HBssubclasses, immunoadsorption, plasmapheresis, antibodies, hepatitis C virus, transmission, recombinant immunoblot assay, hepatitis C genotype
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-27455 (URN)12108 (Local ID)91-7219-747-1 (ISBN)12108 (Archive number)12108 (OAI)
Public defence
2000-12-15, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-15Bibliographically approved

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Almroth, GabrielEkermo, Bengt
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NephrologyFaculty of Health SciencesDepartment of Transfusion Medicine and Clinical ImmunologyInfectious Diseases
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