Skip to main content Accessibility help
×
Home

Comparison of Higher-Dose Intradermal Hepatitis B Vaccination to Standard Intramuscular Vaccination of Healthcare Workers

  • Elizabeth A. Henderson (a1) (a2), Thomas J. Louie (a1) (a3) (a4), Karam Ramotar (a1) (a4), Donna Ledgerwood (a1), Karen Myrthu Hope (a1) and Agnes Kennedy (a1)...

Abstract

Objective.

To compare the immunogenicity of hepatitis B vaccine administered via intradermal (ID) versus intramuscular (IM) route.

Methods:

Subjects chose either to specify the route of immunization or to undergo random allocation to vaccination by the ID (0.15 mL) or the IM (1.0 mL) route. Yeast-derived recombinant hepatitis B vaccine was given at 0, 30, and 180 days. Hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) were measured by microparticle enzyme immunoassay.

Results:

763 subjects were enrolled. Baseline screening identified 65 subjects (8%) who were positive for HBsAb or HBcAb. Vaccination was completed by 590 (85%) of 698 enrollees (370 ID, 220 IM). Seroconversion rates (geometric mean titers [GMT]>0 IU/mL HBsAb) for those vaccinated ID were 99% and 96% for screening at 9 months and 1 year post-vaccination, respectively; subjects vaccinated intramuscularly had similar rates of 95% and 96%. Seropositivity rates (GMT ≥ 10 IU/mL HBsAb) showed a similar pattern, with 95%, 92%, and 73% at 9 months and 1 and 2 years, respectively, for those vaccinated ID, and 94%, 93%, and 81% for those having IM vaccination. GMT for HBsAb was significantly higher for individuals vaccinated IM than for those vaccinated ID (P<.0001). The GMT ratio for the IM and ID routes decreased over time, being 9.3 at 9 months, 7.8 at 1 year, and 5.9 at 2 years. An unanticipated side effect of intradermal vaccination was skin discoloration at injection sites, which persisted for at least 2 years postvaccination. Two thirds (112/166) of respondents reported that they would have selected the ID route despite the discoloration.

Conclusions:

Higher-dose ID vaccination (3 vs 1 μg per injection) uses one sixth of the dose required for standard IM vaccination. It is a cost-effective way to vaccinate populations against hepatitis B virus, but the long-term efficacy of the ID route must still be investigated.

Copyright

Corresponding author

Infection Prevention and Control, Peter Lougheed Center of the Calgary General Hospital, 3500—26 Ave NE, Calgary, Alberta T1Y6J4, Canada

References

Hide All
1.Bryan, J, Iqbal, M, Sjogren, M, et al. Low-dose intradermal recombinant hepatitis B vaccine. ICAAC. Houston, TX; September 1989;133. Abstract 196.
2.Lancaster, D, Elam, S, Kaiser, AB. Immunogenicity of the intradermal route of hepatitis B vaccination with the use of recombinant hepatitis B vaccine. Am J Infect Control 1989;17:126129.
3.Bryan, JP, Sjogren, M, Iqbal, M, Khattak, AR, Nabi, S, Ahmed, A, et al. Comparative trial of low-dose, intradermal, recombinant- and plasma-based hepatitis B vaccines. J Infect Dis 1990;162:789793.
4.Heijtink, RA, Breukers, AA, den Hartigh, G, Schepman, RW, Schmitz, I, Schalm, SW, et al. Low-dose intradermal vaccination against hepatitis B in mentally retarded patients. Vaccine 1988;6:5961.
5.McMaster, KR III, Roper, JK, Carter, JB. Intradermal hepatitis B vaccination in a 300-bed primary care hospital: experience with a recombinant vaccine in a four-dose schedule. Am J Infect Control 1993;21:283288.
6.Parish, DC, Muecke, HW, Joiner, TA, Pope, WT, Haider, SC. Immunogenicity of low-dose intradermal recombinant DNA hepatitis B vaccine. Southern Medical Journal 1991;84:426430.
7.Wistrom, J, Settergren, B, Gustafsson, A, Juto, P, Norrby, RS. Intradermal versus intramuscular hepatitis B vaccination. JAMA 1990;264:181182.
8.Redfield, RR, Innis, BL, Scott, RM, Cannon, HG, Bancroft, WH. Clinical evaluation of low-dose intradermally administered hepatitis B virus vaccine: a cost strategy. JAMA 1985;254:32033206.
9.Prasetya, E, Linggadjaja, W, Syambali, R, Kusumo, S, Dharmesetyawan, DF, Rahardja, U. Intradermal vaccination against hepatitis B in Immanuel Hospital personnel—a preliminary report. Ann Academic Medicine 1986;15:153157.
10.Halsey, NA, Reppert, EJ, Margolis, HS, Francis, DP, Fields, HA. Intradermal hepatitis B vaccination in an abbreviated schedule. Vaccine 1986;4:228232.
11.Wahl, M, Hermodsson, S. Intradermal, subcutaneous or intramuscular administration of hepatitis B vaccine: side effects and antibody response. Scandinavian Journal of Infectious Diseases 1987;19:617621.
12.Gonzalez, ML, Usandizaga, M, Alomar, P, Salva, F, Martin, F, Erroz, MJ, et al. Intradermal and intramuscular route for vaccination against hepatitis B. Vaccine 1990;8:402404.
13.Bryan, JP, Sjogren, MH, Perine, PL, Legters, LJ. Low-dose intradermal and intramuscular vaccination against hepatitis B. Clin Infect Dis 1991;14:697707.
14.Hadler, SC, Francis, DP, Maynard, JE, Thompson, SE, Judson, FN, Echenberg, DF, et al. Long-term immunogenicity and efficacy of hepatitis B vaccine in homosexual men. N Engl J Med 1986;315: 209214.
15.Barnes, GP, Hanacik, LJ. Hepatitis B Vaccine: persistence of antibody following immunization. Infect Control Hosp Epidemiol 1988;9:147150.
16.McKinney, WP, Horowitz, M, Battiola, R, Russler, S. Duration of response to intramuscular versus low-dose intradermal hepatitis B booster vaccination. ICAAC. Houston, TX; September 1989;17:131. Abstract 181.
17.West, DJ. Clinical experience with hepatitis B vaccine. Am J Infect Control 1989;17:172180.
18.Centers for Disease Control. Update on hepatitis B prevention. MMWR 1987;36:353366.
19.Szmuness, W, Stevens, CE, Harley, EJ. Hepatitis B vaccine in medical staff of hemodialysis units: efficacy and subtype cross-protection. N Engl J Med 1982;307:14811486.
20.Szmuness, W, Stevens, CE, Zang, EA, Harley, EJ, Kellner, A. A controlled clinical trial of the efficacy of the hepatitis B vaccine (Heptovax B): a final report. Hepatology 1981;1:377385.
21.Krugman, S, Davidson, M. Hepatitis B vaccine: prospects for duration of immunity. Yale Journal of Biological Medicine 1987;60:333338.

Comparison of Higher-Dose Intradermal Hepatitis B Vaccination to Standard Intramuscular Vaccination of Healthcare Workers

  • Elizabeth A. Henderson (a1) (a2), Thomas J. Louie (a1) (a3) (a4), Karam Ramotar (a1) (a4), Donna Ledgerwood (a1), Karen Myrthu Hope (a1) and Agnes Kennedy (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed