Intradermal recombinant hepatitis B vaccination (IDRV) for non-responsive healthcare workers (HCWs)

Sam Ghebrehewet, David Baxter, Michelle Falconer and Keith Paver

volume 4 | issue 4

july/august 2008
Pages: 280 - 285

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This was an observational study of non-responsive HCWs who were referred to Stockport Specialist Immunisation Clinic (SSIC) between 1st January 2003 and 31st 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 (≥10mIU/ml) were induced in the majority of non-responders [21/23 (91.3%)] following two doses of IDRVs. HCWs who responded to the 1st IDRV with anti-HBs levels ≥10mIU/ml were significantly younger and received their 1st IDRV more than six months after the last IM dose. Two HCWs (41 and 45 year old females) anti-HBs titres remained below 10mIU/ml even after a 3rd 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 10mIU/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 <10mIU/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

Sam Ghebrehewet

Cheshire and Merseyside Health Protection Unit; Chester Microbiology Laboratory; Chester, United Kingdom

David Baxter

Greater Manchester Health Protection Unit; Manchester, United Kingdom

Michelle Falconer