title: A low-dose intradermal hepatitis B vaccine programme in health-care workers and students is highly effective and cost saving: a retrospective follow-up survey in the clinical setting.
abstract: OBJECTIVE
  To evaluate compliance, serologic response and the cost-benefit of a low-dose intradermal hepatitis B vaccination programme, followed by intramuscular boosters in non-responders.
  
  
  METHODS
  The study comprised a retrospective survey of 1521 health-care workers and 968 students. Response was defined as hepatitis B antibody titres > or =10 IU/L. Non-response included vaccinees with undetectable antibodies and a hypo-response if antibodies were detectable.
  
  
  RESULTS
  Overall, 2145/2489 (86%) subjects completed the intradermal series, whereof 1840/2489 (74%) complied with the serological check-up. Response was achieved in 1517/1840 (82.5%), whereas 107/1840 (5.8%) had a hypo-response and 216/1840 (11.7%) had an undetectable response. In a logistic regression model, younger age (odds ratio 0.73 (95% CI: 0.65-0.82, p<0.001)) and female gender (odds ratio 2.16 (95% CI: 1.67-2.80; p<0.001)) were predictive of response. In hypo-responders and those with undetectable responses, 43/46 (94%) and 71/136 (52%), respectively, had a response after the first intramuscular booster. Hence, in compliant vaccinees an overall seroprotection rate of 94% was reached after a single intramuscular booster. A cost-benefit analysis indicated a cost reduction exceeding 50% compared to a standard intramuscular vaccine regimen.
  
  
  CONCLUSIONS
  In the clinical setting, a low-dose intradermal hepatitis B vaccination programme, followed by intramuscular boosters to non-responders, is effective and cost saving.
authors: Department of Infectious Diseases, Akademiska University Hospital, Uppsala University, Uppsala, Sweden. per.sangfelt@medsci.uu.se
authors: Per
authors: P
authors: Sangfelt
authors: Ingrid
authors: I
authors: Uhnoo
authors: Olle
authors: O
authors: Reichard
authors: Ola
authors: O
authors: Weiland
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003625:Data Collection; D005260:Female; D006282:Health Personnel; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D017589:Immunization Programs; D007117:Immunization, Secondary; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000191:economics / Q000517:prevention & control*; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D013337:Students, Medical; D014611:Vaccination / Q000191:economics; D014614:Vaccines, Synthetic
chemical_list: C075654:Engerix-B; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic