Intradermal hepatitis B immunization with yeast-derived vaccine: serological response by sex and age

Abstract

SUMMARYThe efficacy and acceptability of yeast-derived recombinant hepatitis B vaccine given by the intradermal route was investigated in 221 healthl care volunteers. Two hundred and sixteen received a full course of three doses of vaccine. Only one subject was withdrawn because of a significant adverse reaction (psoriasis). The vaccine stimulated an antibody response in 81 %. The response to the vaccine was better in women than in men (87 % compared with 71 %, p = 0 007) and in women below the age of 40 years compared with older women (94 % compared with 76 %, p = 0-01). For men the response showed a sequential decline with age for each decade (90 % responders from age 29 or less, 72 % aged 30-39 and 65 % aged 40 or more, p = 0 04). Retrospective enquiry showed that over 90% had found the intradermal route acceptable and 59 % would prefer vaccine by the intradermal route in preference to intramuscular notwithstanding local reactions. Although the seroconversion rate was of a high order in younger women the antibody titres were not high with only 9 of 215 recipients developing titres > 1000 mIU/ml, a level which could be expected to ensure prolonged immunity. A fourth intradermal dose of vaccine given to 00 volunteers who had shown a low response (< 38 mIU/ml) or no serological response to a three-dose course stimulated a good booster effect (to 150-600 mIU/ml) in only 5 (8%).

Responsiveness to Hepatitis B Vaccine in Immunocompromised Patients by Doubling the Dose Scheduling

“…Many authors have used the intradermal route with variable responses [21][22][23][24], Gonzales et al [25] compared the intradermal and intramuscular routes of hepatitis B vacci nation. They noted a 78.1% seroconversion rate in a three-dose schedule (0, 1 and 6 months), while Morris et al [26] obtained a slightly higher seroconversion rate.…”

Meta‐analysis: the effect of age on immunological response to hepatitis B vaccine in end‐stage renal disease

“…The conclusions of this meta‐analysis appear to confirm the results of HBV vaccination in patients with normal renal function. The relationship between age and response to hepatitis B vaccine in the general population had been addressed by several authors with conflicting results; 10, 11 however, a recent review 12 noted a consistent association between older age and risk of non‐response to HB vaccine. This finding is biologically plausible, as numerous changes in cellular and humoral immune responses have been described in older individuals 8, 9 …”

“…It has been suggested that age‐associated changes in humoral and cellular immune function may decrease vaccine effectiveness in older individuals, compared with children or young adults 8, 9 . However, recent research related to this topic has yielded contradictory findings in the general population 10–12 . This issue is of practical importance, as the different efficacy of the vaccine in different age groups could change the optimal vaccination policy.…”

Factors influencing immunologic response to hepatitis B vaccine in adults

“…A previous meta-analysis in 2002 observed many factors influencing response to hepatitis B vaccine, especially a decrease response to recombinant HBV vaccine at higher ages11, which suggested that earlier vaccination should be prioritized for prevention at the population level. However, in the last decade, numerous emerging reports, which focused on the seroprotection rate of hepatitis B vaccine in adults12131415161718192021222324252627282930313233343536373839404142434445464748, are still inconclusive to immunize what adults are the most appropriate in order to increase the seroprotection rate. Factors influencing immunologic response to hepatitis B vaccine in adults have been inconsistently examined in existing studies.…”