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

Published online by Cambridge University Press:  02 January 2015

E. Geoffrey Playford ,
Patrick G. Hogan ,
Amolak S. Bansal ,
Kareena Harrison ,
David Drummond ,
David F. M. Looke  and
Michael Whitby
E. Geoffrey Playford*
Affiliation:
Infection Management Service, Princess Alexandra Hospital and District Health Service, Brisbane, Queensland, Australia
Patrick G. Hogan
Affiliation:
Department of Immunology, Princess Alexandra Hospital and District Health Service, Brisbane, Queensland, Australia
Amolak S. Bansal
Affiliation:
Department of Immunology, Princess Alexandra Hospital and District Health Service, Brisbane, Queensland, Australia
Kareena Harrison
Affiliation:
Infection Management Service, Princess Alexandra Hospital and District Health Service, Brisbane, Queensland, Australia
David Drummond
Affiliation:
Queensland Medical Laboratories, Brisbane, Queensland, Australia
David F. M. Looke
Affiliation:
Infection Management Service, Princess Alexandra Hospital and District Health Service, Brisbane, Queensland, Australia
Michael Whitby
Affiliation:
Infection Management Service, Princess Alexandra Hospital and District Health Service, Brisbane, Queensland, Australia
*
Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW 2145, Australia
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Abstract

Objective:

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.

Design:

An open, prospective, before–after trial.

Setting:

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

Participants:

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

Methods:

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.

Results:

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.

Conclusion:

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 2 , February 2002 , pp. 87 - 90
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

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):1–42.Google Scholar
2.National Health and Medical Research Council. The Australian Immunisation Handbook, 6th ed. Canberra, Australia: Australian Government Publishing Service; 1997.Google Scholar
3.Roome, AJ, Walsh, SJ, Cartter, ML, Hadler, JL. Hepatitis B vaccine responsiveness in Connecticut public safety personnel. JAMA 1993;270:2931–2934.Google Scholar
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;270:2935–2939.CrossRefGoogle ScholarPubMed
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;303:833–841.CrossRefGoogle Scholar
6.Stevens, CE, Alter, HJ, Taylor, PE, et al. Hepatitis B vaccine in patients receiving hemodialysis: immunogenicity and efficacy. N Engl J Med 1984;311:496–501.CrossRefGoogle ScholarPubMed
7.Lindsay, KL, Herbert, DA, Gitnick, GL. Hepatitis B vaccine: low post-vaccination immunity in hospital personnel given gluteal injections. Hepatology 1985;5:1088–1090.Google Scholar
8.Alper, CA, Kruskall, MS, Marcus-Bagley, D, et al. Genetic predisposition of nonresponse to hepatitis B vaccine. N Engl J Med 1989;321:708–712.CrossRefGoogle Scholar
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;260:1734–1738.Google Scholar
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;26:468–470.CrossRefGoogle ScholarPubMed
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;16:88–91.Google Scholar
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.Google Scholar
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;265:2679–2683.CrossRefGoogle ScholarPubMed
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; 1992:1065–1220.Google Scholar
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;40:569–572.Google Scholar
16.West, DJ, Calandra, GB. Vaccine induced immunological memory for hepatitis B surface antigen: implications for policy on booster vaccination. Vaccine 1996;14:1019–1027.Google Scholar
17.Assad, S, Francis, A. Over a decade of experience with a yeast recombinant hepatitis B vaccine. Vaccine 1999;18:57–67.Google Scholar
18.Bryan, JP, Sjogren, MH, Perine, PL, Legters, LJ. Low-dose intradermal and intramuscular vaccination against hepatitis B. Clin Infect Dis 1992;14:697–707.Google Scholar
19.Frazer, IH, Jones, B, Dimitrakakis, M, Mackay, IR. Intramuscular versus low-dose hepatitis B vaccine. Med J Aust 1987;146:242–245.Google Scholar
20.Platt, J, Grant, B, Eddy, A, Michael, A. Immune cell properties in cutaneous delayed-type hypersensitivity. J Exp Med 1983;158:1227–1242.CrossRefGoogle Scholar
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; 1989:95–115.Google Scholar
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;12:1204–1211.Google Scholar