Epidemiology and Infection

Research Article

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

C. A. Morrisa1, P. R. Olivera1, F. Reynoldsa1 and J. B. Selkona2

a1 Public Health Laboratory, Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, Shropshire, SY3 8XH

a2 Public Health Laboratory, John Radcliffe Infirmary, Headington, Oxford, 0X3 9DU

Abstract

The efficacy and acceptability of yeast-derived recombinant hepatitis B vaccine given by the intradermal route was investigated in 221 health 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 Only one subject was withdrawn because of a significant adverse reaction (psoriasis).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 60 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%).

(Accepted May 31 1989)

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