Skip to main content Accessibility help

Intradermal Recombinant Hepatitis B Vaccine for Healthcare Workers Who Fail to Respond to Intramuscular Vaccine

  • E. Geoffrey Playford (a1), Patrick G. Hogan (a2), Amolak S. Bansal (a2), Kareena Harrison (a1), David Drummond (a3), David F. M. Looke (a1) and Michael Whitby (a1)...



To study the humoral immune responses, safety, and tolerability of intradermal recombinant hepatitis B vaccination in healthcare workers (HCWs) nonresponsive to previous repeated intramuscular vaccination.


An open, prospective, before–after trial.


A tertiary referral hospital and surrounding district health service in Queensland, Australia.


Hospital and community HCWs nonresponsive to previous intramuscular hepatitis B vaccination.


Intradermal recombinant hepatitis B vaccine was administered every second week for a maximum of 4 doses. Hepatitis B surface antibody (anti-HBs) responses were assessed 2 weeks after each dose.


Protective anti-HBs levels developed in 17 (94%) of 18 study subjects. Three doses resulted in seroconversion of all responding subjects and the highest geometric mean antibody concentration. The vaccine was well tolerated.


More than 90% of previously nonresponsive HCWs responded to intradermal recombinant hepatitis B vaccine with protective anti-HBs levels.


Corresponding author

Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia


Hide All
1.Centers for Disease Control and Prevention. Immunization of healthcare workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Advisory Committee (HICPAC). MMWR 1997;46(RR-18):142.
2.National Health and Medical Research Council. The Australian Immunisation Handbook, 6th ed. Canberra, Australia: Australian Government Publishing Service; 1997.
3.Roome, AJ, Walsh, SJ, Cartter, ML, Hadler, JL. Hepatitis B vaccine responsiveness in Connecticut public safety personnel. JAMA 1993;270:29312934.
4.Wood, RC, MacDonald, KL, White, KE, Hedberg, CW, Hanson, M, Osterholm, MT. Risk factors for lack of detectable antibody following hepatitis B vaccination of Minnesota health care workers. JAMA 1993;270:29352939.
5.Szmuness, W, Stevens, CE, Harley, EJ, et al. Hepatitis B vaccine: demonstration of efficacy in a controlled clinical trial in a high-risk population in the United States. N Engl J Med 1980;303:833841.
6.Stevens, CE, Alter, HJ, Taylor, PE, et al. Hepatitis B vaccine in patients receiving hemodialysis: immunogenicity and efficacy. N Engl J Med 1984;311:496501.
7.Lindsay, KL, Herbert, DA, Gitnick, GL. Hepatitis B vaccine: low post-vaccination immunity in hospital personnel given gluteal injections. Hepatology 1985;5:10881090.
8.Alper, CA, Kruskall, MS, Marcus-Bagley, D, et al. Genetic predisposition of nonresponse to hepatitis B vaccine. N Engl J Med 1989;321:708712.
9.Weissman, JY, Tsuchiyose, MM, Tong, MJ, et al. Lack of response to recombinant hepatitis B vaccine in nonresponders to the plasma vaccine. JAMA 1988;260:17341738.
10.Struve, J, Aronsson, B, Frenning, B, et al. Seroconversion after additional vaccine doses to non-responders to three doses of intradermally or intramuscularly administered recombinant hepatitis B vaccine. Scand J Infect Dis 1994;26:468470.
11.Levitz, RE, Cooper, BW, Regan, HC. Immunization with high dose intradermal recombinant hepatitis B vaccine in healthcare workers who fail to respond to intramuscular vaccination. Infect Control Hosp Epidemiol 1995;16:8891.
12.Lutwick, LI. The development and duration of an antibody response to intradermal hepatitis B virus vaccination in poor responders to intramuscular route: a five year follow-up. Presented at the Annual Meeting of the Society for Hospital Epidemiology of America; April 18-20, 1999; San Francisco, CA. Abstract.
13.Nagafuchi, S, Kashiwagi, S, Okada, K, et al. Reversal of nonresponders and postexposure prophylaxis by intradermal hepatitis B vaccination in Japanese medical personnel. JAMA 1991;265:26792683.
14.Tsuyi, K, Aizawa, M, Sasazuki, T, eds. HLA 1991: Proceedings of the 11th International Histocompatibility Workshop and Conference, vol. 1. Oxford, UK: Oxford University Press; 1992:10651220.
15.Centers for Disease Control and Prevention. Epidemiologic notes and reports: inadequate immune response among public safety workers receiving intradermal vaccination against hepatitis B—United States, 1990-1991. MMWR 1991;40:569572.
16.West, DJ, Calandra, GB. Vaccine induced immunological memory for hepatitis B surface antigen: implications for policy on booster vaccination. Vaccine 1996;14:10191027.
17.Assad, S, Francis, A. Over a decade of experience with a yeast recombinant hepatitis B vaccine. Vaccine 1999;18:5767.
18.Bryan, JP, Sjogren, MH, Perine, PL, Legters, LJ. Low-dose intradermal and intramuscular vaccination against hepatitis B. Clin Infect Dis 1992;14:697707.
19.Frazer, IH, Jones, B, Dimitrakakis, M, Mackay, IR. Intramuscular versus low-dose hepatitis B vaccine. Med J Aust 1987;146:242245.
20.Platt, J, Grant, B, Eddy, A, Michael, A. Immune cell properties in cutaneous delayed-type hypersensitivity. J Exp Med 1983;158:12271242.
21.Unanue, ER. Macrophages, antigen-presenting cells, and the phenomena of antigen handling and presentation. In: Paul, WE, ed. Fundamental Immunology. New York: Raven Press; 1989:95115.
22.Fabrizi, F, Andrulli, S, Bacchini, G, Corti, M, Locatelli, F. Intradermal versus intramuscular hepatitis B re-vaccination in non-responsive chronic dialysis patients: a prospective randomized study with cost-effectiveness evaluation. Nephrol Dial Transplant 1997;12:12041211.

Intradermal Recombinant Hepatitis B Vaccine for Healthcare Workers Who Fail to Respond to Intramuscular Vaccine

  • E. Geoffrey Playford (a1), Patrick G. Hogan (a2), Amolak S. Bansal (a2), Kareena Harrison (a1), David Drummond (a3), David F. M. Looke (a1) and Michael Whitby (a1)...


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