Reversal of nonresponders and postexposure prophylaxis by intradermal hepatitis B vaccination in Japanese medical personnel
S. Nagafuchi, S. Kashiwagi, K. Okada, K. Anzai, M. Nakamura, Y. Nishimura, T. Sasazuki and Y. Niho
First Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
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 micrograms 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.
