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Reversal of Nonresponders and Postexposure Prophylaxis by Intradermal Hepatitis B Vaccination in Japanese Medical Personnel
Seiho Nagafuchi, MD;
Seizaburo Kashiwagi, MD;
Kenji Okada, MD;
Keizo Anzai, MD;
Minoru Nakamura, MD;
Yasuharu Nishimura, MD;
Takehiko Sasazuki, MD;
Yoshiyuki Niho, MD
JAMA. 1991;265(20):2679-2683.
Abstract
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Thirty-one Japanese nonresponders to subcutaneous hepatitis B vaccination and 15 medical personnel who were accidentally exposed to specimens positive for hepatitis B e antigen and were given hepatitis B immunoglobulin were intradermally immunized with 5 µg of plasma-derived hepatitis B vaccine every 2 weeks until delayed type hypersensitivity skin reaction to hepatitis B surface antigen became positive. Thirty (97%) of the 31 nonresponders developed delayed type hypersensitivity skin reactions to hepatitis B surface antigen after 2.3 ±1.2 (mean±SD) revaccinations. Twenty-nine (94%) of the 31 nonresponders had anti—hepatitis B surface antigen antibody levels greater than 10 IU/L. The immunoglobulin subclass of the antibody to hepatitis B surface antigen was mainly IgG1. After 1 year, 23 (74%) of the 31 nonresponders continued to have anti—hepatitis B surface antigen antibody levels greater than 10 IU/L. Persons accidentally exposed to specimens positive for hepatitis B e antigen developed delayed type hypersensitivity skin reactions to hepatitis B surface antigen following 3.1 ±1.1 revaccinations. None developed clinical hepatitis. There was no production of anti—hepatitis B core antigen antibody 1 year after exposure, indicating that protection was 100%. Intradermal hepatitis B vaccination is useful in reversing nonresponsiveness to hepatitis B surface antigen and for prophylaxis after exposure.
(JAMA. 1991;265:2679-2683)
Author Affiliations
From the First Department of Internal Medicine (Drs Nagafuchi, Anzai, Nakamura, and Niho), the Department of General Medicine (Dr Kashiwagi), and the Department of Pediatrics (Dr Okada), Faculty of Medicine, and the Department of Genetics, Medical Institute of Bioregulation (Drs Nishimura and Sasazuki), Kyushu University, Fukuoka, Japan.
Footnotes
Reprint requests to the First Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, 812 Japan (Dr Nagafuchi).
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