Intradermal hepatitis B vaccination in non-responders after topical application of imiquimod (Aldara).
BACKGROUND
Five to ten percent of immunocompetent persons fail to develop a protective immune response to hepatitis B vaccination, and are defined non-responders (NR). We investigated the immune response to intradermal hepatitis B vaccination after pre-treatment of the skin with the TLR7 agonist imiquimod.


METHODS
Twenty-one non-responders (anti-HBs <10 IU/l after at least 6 intramuscular hepatitis B vaccinations) were randomly assigned to the control group (N=11) or the experimental group (N=10). Participants in both groups received 3 intradermal (ID) vaccinations with 5 microg HBsAg (0.125 mL) at 0, 1 and 6 months. In the experimental group, the dermal site of injection was pre-treated with 250 mg imiquimod ointment. Anti-HBs antibodies were determined at 0, 1, 2, 6 and 7 months.


RESULTS
In both study groups, 70% of the participants developed a protective immune response (anti-HBs >or=10 IU/l), after the 3rd intradermal vaccination.


CONCLUSIONS
The application of imiquimod on the skin prior to intradermal vaccination did not enhance the humoral response to hepatitis B vaccine. However, irrespective of imiquimod application, 70% of the NR who had not responded to 6 previous intramuscular vaccinations, developed a protective immune response with high affinity antibodies after 3 ID hepatitis B vaccinations with 5 microg HBsAg.
Roukens
Anna H
AH
Department of Infectious Diseases, Leiden University Medical Center, The Netherlands. a.h.e.roukens@lumc.nl
Vossen
Ann C
AC
Boland
Greet J
GJ
Verduyn
Willem
W
van Dissel
Jaap T
JT
Visser
Leo G
LG
D000279:Administration, Cutaneous; D000328:Adult; D000634:Aminoquinolines / Q000008:administration & dosage*; D000915:Antibody Affinity; D000917:Antibody Formation; D005260:Female; D006680:HLA Antigens / Q000235:genetics; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000008:administration & dosage / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D000077271:Imiquimod; D056724:Immunity, Humoral; D007117:Immunization, Secondary; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D000634:Aminoquinolines; D006680:HLA Antigens; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D000077271:Imiquimod