Prabhat Singh, Mohamed Hamdy Yassin and Maureen Lawlor
Aim: This was a quality improvement study to evaluate immune status for Hepatitis B virus (HBV) in patients on Hemodialysis (HD) and to improve vaccination rates in these patients. Methods: A prospective quality control study aimed at assuring adequate immunity for HBV in HD patients. Fifty-nine patients on HD were included during two-month study period. The inclusion criteria are all in patients with renal failure requiring HD. The following serologies were checked: HBs Ag, HBs Ab titer, and HBc Ab total. Serum samples were tested using Enzyme linked immunosorbent assay (ELISA) methods. Vaccination was offered to all patients with no evidence of protective Hepatitis B antibody (HBsAb titer) that is titer<10. Results: Out of 59 patients selected in the study, 48 had prior or current vaccination. Among the vaccinated patients, only 29 patients (60.4%) had HBs Ab titers in protective range (titers>10). We also found 6 patients with Hepatitis C virus antibody (HCV Ab) positive. Conclusion: HBV is the leading cause of blood-borne transmission particularly in inpatient HD units. Monitoring HBV serology (HBs Ag, HBs Ab, HBc Ab) on a routine basis is essential to prevent HBV outbreaks within HD units. Monitoring HBs Ag alone is insufficient and should be coupled with additional serology to ensure adequate protection for this particularly vulnerable population. Initiation of early vaccination in patients with DM, chronic kidney disease (CKD), especially in inpatient facilities will ensure better protection.