Intradermal Inoculation With Heptavax-B
Immune Response and Histologic Evaluation of Injection Sites
- Jessica A. Clarke, MD, PhD;
- F. Blaine Hollinger, MD;
- Ernest Lewis, MD;
- Liisa A. Russell, MD;
- Claramae H. Miller, PhD;
- Art Huntley, MD;
- Neil M. Flynn, MD
- From the Departments of Medicine (Drs Clarke and Flynn), Urology (Dr Lewis), Pathology (Drs Russell and Miller), and Dermatology (Dr Huntley), University of California, Davis, School of Medicine; and the Departments of Virology, Epidemiology, and Medicine, Baylor College of Medicine, Houston, Tex (Dr Hollinger).
Abstract
The high cost of hepatitis B vaccine has limited its widespread use. Low-dose, intradermal injections of vaccine represent one option for reducing the cost. In this study, 92 nonimmune medical students were given three 0.1-mL intradermal injections of Heptavax-B containing 2 μg of hepatitis B surface antigen (HBsAg) at 0,1, and 6 months. By 6 months, 90% of the subjects had developed protective levels of antibody to HBsAg (≥10 mlU/mL). Follow-up at 1 year showed a geometric mean concentration of antibodies to HBsAg of 396 mlU/mL for the group, and 95% had levels of antibody to HBsAg greater than or equal to 10 mlU/mL. A level of antibody to HBsAg of greater than 100 mlU/mL also was observed in more than 75% of subjects. Side effects included induration of the inoculation site in 18% at 6 months, which disappeared by 12 months, and macules that persisted at 1 year in 63%. The administration of hepatitis B vaccine intradermally is an attractive, low-cost alternative in the United States, where universal vaccination of preschool children or adolescents is being contemplated, and where booster doses are being considered.
(JAMA. 1989;262:2567-2571)
Footnotes
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Reprint requests to Department of Internal Medicine, University of California Davis Medical Center, 2221 Stockton Blvd, PCC 4M 3120, Sacramento, CA 95817 (Dr Clarke).
