Literature Review
July 1, 2000 2 minutes read
Literature Review
Henderson EA, Louie TJ, Ramotar K, et al. Comparison of higher-dose intradermal hepatitis B vaccination to standard intramuscular vaccination of healthcare workers. Infect Control Hosp Epidemiol 2000; 21:264-269.
Vaccinating health care workers against hepatitis B through an intradermal (ID) route requires one-sixth of the inoculum that is needed for intramuscular (IM) injections and therefore could lead to significant cost savings. Researchers at Calgary General Hospital in Alberta, Canada sought to determine if the intradermal vaccination would be just as effective.
When the 590 employees completing the series of three doses were tested, both the ID and IM routes were "highly effective in producing seroconversion and seropositivity in health care workers," the authors stated. "The results from this study show that HbsAb [hepatitis B surface antibody] titers for both vaccination routes were well in excess of accepted protective titers."
However, health care workers vaccinated intradermally had lower antibody titers. Overall, 73% of those with the ID vaccination remained seropositive after two years compared to 93% for the IM group.
The authors noted that protection against infection may continue despite undetectable levels of antibodies. A single booster injection could return seropositivity.
When given a choice, the health care workers were significantly more likely to select the ID route. Even though minor skin discoloration at the injection site that persisted for at least two years proved to be a major side effect of the ID vaccine, two-thirds of those completing a post-vaccine survey said they would still have chosen the ID route.
More research is needed to establish the long-term efficacy of the ID vaccine against HBV, the researchers concluded. But they expressed hopefulness that the intradermal vaccine could be a cost-effective alternative for HBV vaccination of health care workers.
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