Hepatitis B vaccination: addressing a drug-related problem in hemodialysis outpatients with a collaborative initiative. (Research Brief)

The CDC recommends that all hemodialysis (HD) patients be vaccinated against hepatitis B virus (HBV). In 1999, only 39 of our 134 (29%) HD patients had received HBV vaccine. Since the vaccine is indicated for all HD patients, this presented a drug-related problem (DRP): indication without treatment. In response, nurses and pharmacists initiated a proactive HBV vaccination program. Methods: An immunization protocol based on then current CDC recommendations was developed. HBV vaccine (40 mcg IM; at 0, 1 and 6 months) was administered to consenting HD patients. Anti-hepatitis B surface antibody (anti-HBs) titers were monitored and booster doses were given per the protocol. Results: By August 2001, all consenting HD patients (n = 110) had received ≥ 1 dose of HBV vaccine and 90 (81.8%) had either received a full course (≥ 3 doses) or had received ≥ 1 dose and developed a positive anti-HBs titer (≥ 10 mIU/mL). Of these 90 patients, 52 (58%) developed a positive anti-HBs titer, 33 (37%) responded to ≤ 3 doses, and 19 (21%) following a booster. The DRP was significantly improved. Conclusion: Given CDC guidelines, HBV vaccine should be offered to all HD patients. This initiative demonstrates that with concerted effort all consenting HD patients can receive HBV vaccination, thereby addressing an important DRP.
In 1974, the incidence of hepatitis B virus (HBV) infection was 6.2% among hemodialysis (HD) patients and 5.2% among HD staff in the United States (Snydman, Bregman, & Bryan, 1977). [...]