Long-standing infection control procedures and HB vaccination have strongly reduced the spread of HBV in dialysis units of US and Western Europe; however, continued implementation of these measures is needed for complete eradication of HBV among patients and staff. In developing countries the incidence and prevalence rates of HBV infection are still high; it is expected that HBV spread will decline in these countries after full implementation of the same measures. The prognosis of HBV infection in dialysis patients appears rather benign; however, in developing countries HBV-related liver disease may play a significant role in morbidity and mortality. Active immunization is an important piece of the mosaic for preventing HBV diffusion; the low response rate of dialysis patients to HB vaccine may be mostly reversed by repeated low-dose of vaccine by intradermal route. Booster vaccination is needed whenever the anti-HBs titers fall below 10 mlU/ml in dialysis patients. Although the initial vaccination is costly, this cost is offset by reductions in the cost of frequent serologic screening for patients and staff in dialysis centers. Only limited and incontrolled data concerning the treatment of hepatitis B among HD patients are available.
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