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PAPERS: Sunanda Ray, Terry Samuel, Jeremy Hawker, and Steve Smith Hepatitis B immunisation in renal units in the United Kingdom: questionnaire study BMJ 2002; 324: 877-878 [Full text]

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Not a bed of roses

Shailendra Goswami   (13 April 2002)

Not a bed of roses 13 April 2002
Shailendra Goswami, DNB trainee, General Medicine. Lisie Hospital, Ernakulam, Kerala, India. 682018 Send response to journal: Re: Not a bed of roses	Dear Sir, The paper ‘Hepatitis B immunization in renal units in the United Kingdom: questionnaire study’ [1] conveys a message which deserves special attention. It is very disappointing that despite knowing the benefits of Hepatitis B vaccination on dialysis patients, some dialysis centers are not giving full and proper vaccination coverage for their patients. Are these dialysis centers justified in their approach? To fortify the argument that Hepatitis B vaccine is beneficial for dialysis patients, mention may be made of a study published in American journal of kidney diseases. The study found that the risk of hepatitis B infection was 70% lower in patients who received Hepatitis B vaccination [2]. I think giving this amount of protection to hemodialysis patients is highly desirable. If still in doubt, the dialysis units should explain the benefits of Hepatitis B vaccination to their patients, mentioning clearly that the vaccination reduces the risk of Hepatitis B infection by about 70%, and let the patients choose and decide their fate. The Centers for disease control and prevention (CDC) has recommended Hepatitis B vaccination to hemodialysis patients since 1982. Department of health and the renal association also recommend this prophylaxis. These recommendations should be followed as they are in the interest of the dialysis patients. Dialysis patients’ life is not a bed of roses. They have to face incessant battle of life and death. They have to face the increased risk of various infections like HIV, Hepatitis C, Hepatitis B, vascular access infections, in addition to the various other problems like uraemia, anaemia, hyperkalaemia and their associated complications, which frequently land them in emergency units. When their life is turmoil, won’t it be wise to give them prophylaxis against preventable diseases like Hepatitis B? If I were a dialysis patient, I would never have said ‘No’ to Hepatitis B vaccination. References: 1. Sunanda Ray, Terry Samuel, Jeremy Hawker, Steve Smith: Hepatitis B immunisation in renal units in the United Kingdom: questionnaire study. BMJ 2002;324:877-878 ( 13 April ). 2. Elaine R. Miller, Miriam J. Alter, Jerome I. Tokars: Protective effect of hepatitis B vaccine in chronic hemo patients. American Journal of Kidney Diseases: February 1999 • Volume 33 • Number 2.