It is estimated that>2 billion people worldwide have been infected with HBV. Of these, approximately 360 million individuals are chronically infected and at-risk of serious illness and death, mainly from liver cirrhosis and hepatocellular carcinoma (HCC). Algeria is situated in areas of intermediate endemicity (prevalences of endemicity of HBsAg 2–7%). Patients suffering from chronic kidney disease (CKD) are at particular risk of infection with HBV, they are associated with reduced immunogenicity following vaccine administration. Because of that, these patients have been offered schedules containing more than 3 doses and larger doses of the vaccine (schedule containing 4 double doses of standard hepatitis B vaccine). Those found to have anti-HBs concentrations<10 mIU/mL after the primary vaccine series, should be revaccinated (3 additional double doses).

Determine the efficacy of the four double doses schedule of hepatitis B vaccine in preventing infection up postvaccination of chronic renal failure patients.

It is a retrospective descriptive study including 209 chronic kidney disease patients. All patients had received hepatitis B vaccine with follow-up at epidemiology service of Oran university hospital (EHUO), during a period 2011–2012. Patients have been offered immunization schedule containing double doses (40μg) of monovalant recombinant hepatitis B vaccine. The primary immunization series consists of 4 doses of vaccine (at 0, 1, 2, 6 month) followed by anti-HBs testing. People who do not respond (anti-HBs antibody titres<10 mIU/mL) to primary vaccine series were revaccinated (3 additional Doses) followed by anti-HBs test (testing 1–2 months after the third dose).

The average age of patients is 61.2±1.1 years old with a sex ratio of 1.1. Non-dialyzed CKD patients accounted for 78.9%. Vaccine seroprotection was obtained in 82% of non-hemodialysis CKD patients and in 76% of CKD hemodialysis patients after primary vaccination. Nevertheless, 12% of non-hemodialysis CKD patients and 12.5% of CKD hemodialysis patients are low responders (10 ≤ AC-HBS<100 IU/L). Low responder patients are at-risk of declining immunity, hence the value of rigorous annual monitoring.

The four doses of 40μg vaccine schedule has proven its effectiveness with good seroprotection in chronic kidney disease patients. The vaccination against hepatitis B represents a considerable advance in the prophylaxis of this disease but unfortunately no regulatory text governs this vaccination in CKD patients in our country. Early vaccination (before dialysis) is recommended.