Hepatitis b vaccine

It was explained to me at my unit that CMS requires all dialysis patients to be given the hepatitis b vaccine annually due to our compromised immune systems. I took this to mean that a patient can not receive Medicare payments if one does not comply. I have never seen a post on any kidney board re the pros and cons of taking this vaccine, but of course, there are posts all over the net about the down side of this vaccine as with other vaccines. Is it possible to get a religious, or other, exemption as far as protecting, in this case, a dialysis patient’s right not to take the vaccine? I am not advocating one take or not take this vaccine. Would just like to have a better explanation of it before making a decision.

Hepatitis B is transmitted by blood and body fluids. In dialysis there may be blood leakage from needle sites or if a dialyzer or blood line leaks. Staff should disinfect surfaces with bleach between patients and should use bleach to clean up visible blood. In addition, they should be washing hands and changing gloves frequently for infection control. The Hepatitis B virus can live on surfaces for 7 days or longer. I’ve seen pictures of the face of a dialysis machine and other surfaces where there had been blood and staff had thought they’d cleaned those surfaces well enough. Shockingly, luminol showed traces of blood on those surfaces.

Because of the risk of Hepatitis B transmission in dialysis, several years ago the Centers for Disease Control published recommendations for dialysis facilities that were incorporated into Federal dialysis regulations that were published in 2008. According to the regulations, dialysis facilities should know whether a new patient has Hepatitis B upon admission or should do a blood test to determine if the new patient has Hepatitis B immediately upon admission and know the results within a few days. Medicare regulations require facilities to educate patients about the importance of getting vaccinated against Hepatitis B, flu and pneumonia, all vaccinations covered by Medicare.

Although patients always have the right to refuse vaccination, if a patient has or gets Hepatitis B and does in-center dialysis, he/she will need to be dialyzed in an isolation room or area at the dialysis facility. If a clinic doesn’t have an isolation room or area, it may need to transfer the Hepatitis B positive patient to another clinic. Being isolated or transferred can be upsetting to the dialysis patient with Hepatitis B, but is required to protect other dialysis patients who are Hepatitis B negative and susceptible. It is also important to consider taking the vaccine to protect your loved ones who could be exposed if you got Hepatitis B as well.

If someone has enough immunity, he/she only needs to have the blood test for Hepatitis B annually. If someone is does not have enough immunity to Hepatitis B either because he/she didn’t have the vaccine or didn’t respond to it, he/she will have to be tested for Hepatitis B monthly.

Incidentally, patients who have Hepatitis B can do home dialysis (PD or HD). Hepatitis B positive patients need to train in an isolation room with a machine and supplies that are used just for him/her. If the patient requires a partner, the facility staff should encourage the partner to ask his/her doctor for the Hepatitis B vaccine. While helping with dialysis in the home, the partner should wear personal protective equipment (face shield, mask, gloves, and cover garment) to protect himself/herself and others should not be in the room where dialysis is taking place whenever there’s a risk of spurting or splattering of blood or other body fluids.

I’m not sure what risks you’ve seen or heard about, but although some websites claim that the vaccine is linked to MS, results of these studies have been called into question and other studies have dispelled the link.

Here’s the CDC’s website where you can read about Hepatitis B and CDC recommendations for hemodialysis.

Dialysis staff are also vaccinated for Hepatitis B. I received two different types of Hepatitis B vaccine over the years that I worked in dialysis. I had no side effects from the vaccination.