Hepatitis B virus vaccination in children with steroid sensitive nephrotic syndrome: Immunogenicity and safety?

• HBV vaccination is found to be effective (87.8%) in children with steroid sensitive nephrotic syndrome.
• Steroid therapy is susbtantially related with suboptimal response to HBVac and low antibody titer.
• Seroconversion was significantly lower in full dose steroid users than the controls.
• Steroid therapy may delay but does not prevent the antibody response to the HBVac.
• Hepatitis B vaccination may trigger relapse in some patients.

We investigated the efficacy and safety of Hepatitis B vaccine (HBVac) in steroid sensitive nephrotic syndrome (SSNS) children.41 patients with SSNS and 30 controls were vaccinated with HBVac(Engerix B®). Patients were divided into 3 subgroups:full dose steroid users, alternate-day steroid users and steroid non-users. Seroconversion rate was lower in steroid users than non-users at the 6th(p = 0.015) and 12th(p = 0.036) months. Antibody to Hepatitis B surface antigen(HBsAb) titers were significantly different between subgroups and controls at the 15th month. However, HBsAb and response rates were not different between subgroups at the 12th and 15th months (p > 0.05). Five patients were unresponsive to HBVac. Relapse rates after the vaccination were higher than those in the prevaccination period (p = 0.002).HBVac is less effective in producing immune response in SSNS children with steroid therapy. HBVac may trigger relapse in some patients. We recommend HBVac to SSNS children with low dose steroid therapy or after steroids are discontinued.