Intramuscular vs intradermal route for hepatitis B booster vaccine in celiac children

摘要

AIM:To compare intradermal(ID) and intramuscular(IM) booster doses,which have been used in healthy and high risk subjects,such as healthcare workers,haemodialysis patients,human immunodeficiency virus patients,and renal transplant recipients unresponsive to initial hepatitis B vaccination,in celiac individuals.METHODS:We conducted our study on 58 celiac patients,vaccinated in the first year of life,whose blood analysis had showed the absence of protective hepatitis B virus(HBV) antibodies.All patients had received the last vaccine injection at least one year before study enrolment and they had been on a gluten free diet for at least 1 year.In all patients we randomly performed an HBV vaccine booster dose by ID or IM route.Thirty celiac patients were revaccinated with recombinant hepatitis B vaccine(Engerix B) 2 g by the ID route,while 28 celiac patients were revaccinated with Engerix B 10 g by the IM route.Four weeks after every booster dose,the anti-hepatitis B surface(HBs) antibody titer was measured by an enzyme-linked immuneadsorbent assay.We performed a maximum of three booster doses in patients with no anti-HBs antibodies after the first or the second vaccine dose.The cut off value for a negative anti-HBs antibody titer was 10 IU/L.Patients with values between 10 and 100 IU/L were considered "low responders" while patients with an antibody titer higher than 1000 IU/L were considered "high responders".RESULTS:No significant difference in age,gender,duration of illness,and years of gluten intake was found between the two groups.We found a high percentage of "responders" after the first booster dose(ID = 76.7%,IM = 78.6%) and a greater increase after the third dose(ID = 90%,IM = 96.4%) of vaccine in both groups.Moreover we found a significantly higher number of high responders(with an anti-HBs antibody titer > 1000 IU/L) in the ID(40%) than in the IM(7.1%) group,and this difference was evident after the first booster dose of vaccination(P < 0.01).No side effects were recorded in performing delivery of the vaccine by either the ID or IM route.CONCLUSION:Our study suggests that both ID and IM routes are effective and safe options to administer a booster dose of HBV vaccine in celiac patients.However the ID route seems to achieve a greater number of high responders and to have a better cost/benefit ratio.