title: Intradermal recombinant hepatitis B vaccination (IDRV) for non-responsive healthcare workers (HCWs).
abstract: This was an observational study of non-responsive HCWs who were referred to Stockport Specialist Immunisation Clinic (SSIC) between 1(st) January 2003 and 31(st) May 2006. Anti-HBs titres were determined 4-6 weeks after each intradermal recombinant vaccine (IDRV). Median anti-HBs titres were compared using the exact Wilcoxon rank sum test. In total, 23 eligible non-responding HCWs were identified. Protective anti-HBs titres (> or =10 mlU/ml) were induced in the majority of non-responders [21/23 (91.3%)] following two doses of IDRVs. HCWs who responded to the 1(st) IDRV with anti-HBs levels > or =10 mlU/ml were significantly younger and received their 1(st) IDRV more than six months after the last IM dose. Two HCWs (41 and 45 year old females) anti-HBs titres remained below 10 mlU/ml even after a 3(rd) dose. Anti-HBs titres were available for 40% (9/23) of the HCWs six or more months after the last maximum anti-HBs titres were achieved. None of the nine HCWs anti-HBs titres declined to less than 10 mlU/ml six or more months after the last maximum anti-HBs titres were achieved. However, a larger study with long-term follow-up is needed to determine the duration of protection following IDRV. HCWs with anti-HBs titres <10 mlU/ml after two full courses of intramuscular recombinant vaccine (IMRV) should be offered two doses of IDRVs followed by assessment of anti-HBs titres one to four months after the second dose in order to identify persistent non-responders. No significant adverse events were noted with IDRV being well tolerated and acceptable to HCWs.
authors.affiliation: HPU Immunisation Lead, Cheshire and Merseyside Health Protection Unit, Chester Microbiology Laboratory, Countess of Chester Health Park, Chester, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Ghebrehewet
authors.forename: David
authors.initials: D
authors.lastname: Baxter
authors.forename: Michelle
authors.initials: M
authors.lastname: Falconer
authors.forename: Keith
authors.initials: K
authors.lastname: Paver
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D006509:Hepatitis B / Q000097:blood / Q000276:immunology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology*; D006801:Humans; D007115:Immunization Schedule; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000276:immunology / Q000517:prevention & control*; D006113:United Kingdom; D014611:Vaccination; D014614:Vaccines, Synthetic / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic