Intradermal inoculation with Heptavax-B: immune response and histologic evaluation of infection sites
Article Abstract:
The vaccine that is currently used against hepatitis B infections is effective, but its use is limited because of its high cost. This study investigated the feasibility of substituting an intradermal (injected under the skin rather than into muscle) vaccine containing lower dosages of the surface antigen, hepatitis B surface antigen, (HBsAg). (Antigen stimulates the production of specific antibodies; in this case an immunized individual would have antibodies against hepatitis B.) Medical students are one of the groups at increased risk for contracting the hepatitis B virus (HBV) and were used as the subjects of this study. Ninety-two healthy young students volunteered for the study and were screened for previous exposure to the virus. The subjects were given a low-dose intradermal injection of Heptavax-B, containing the active ingredient HBsAg, which was followed up with additional injections at one month and at six months. Measurement of HBsAg antibody levels were also taken at these intervals and again after one year had elapsed. Some minor abnormalities were observed in the tissue area surrounding the injection site. At the six-month interval, 18 percent of the students had a hardening of the tissue at the injection site, but this disappeared by the end of one year. Another side effect which persisted in 63 percent of the subjects for over a year was a discoloration of the skin. Tests made at six months indicated levels of antibodies at greater than or equal to 10mlU per ml for HBsAG. At the end of one year 95 percent of the subjects showed antibody levels greater than or equal to 10mlU per ml and 75 percent actually had levels exceeding 100mlU per ml. It was concluded that Heptavax-B is a safe and economic means of providing immunization to large groups of people. The authors believe that the value of this technique is significant because universal vaccination is being considered for children in this country and Heptavax-B may provide the best method.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1989
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Reversal of nonresponders and postexposure prophylaxis by intradermal hepatitis B vaccination in Japanese medical personnel
Article Abstract:
Hepatitis B is the ninth leading cause of death worldwide. The virus is spread by exposure to contaminated blood, sexual contact with an infected person, or by infected mothers who pass the virus to their babies at birth. Health care workers are at high risk for infection because of contact with needles and the blood of infected patients. Although the hepatitis B vaccine is effective, it is expensive, takes a long time to provide immunity, and provides incomplete protection after exposure to the virus. The duration of immunity is unpredictable, and some people fail to develop immunity. Injection of the vaccine under the skin (intradermal injection) provides good results at a lower cost than injection into the muscle (intramuscular injection). Another advantage of the intradermal vaccine is the formation of delayed type hypersensitivity (DTH) skin reaction, which indicates whether the vaccine was effective. In addition, intradermal injection reverses nonresponsiveness to the vaccine among individuals who did not benefit from intramuscular injection. Thirty-one Japanese health care workers who did not respond to injections of the conventional vaccine were given the intradermal vaccine. Nonresponsiveness was reversed in 94 percent, and long-lasting immunity resulted. Women required fewer revaccinations, and older people responded less well than their younger counterparts. Intradermal hepatitis B vaccine is useful for vaccinating nonresponders at high risk for exposure and for preventive vaccination after exposure. This method may be useful against other viruses with long incubation periods, including rabies, hepatitis C, and human immunodeficiency virus. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1991
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Intrafamilial transmission of hepatitis C virus among the population of an endemic area of Japan
Article Abstract:
Hepatitis C virus (HCV) transmission does not appear to occur frequently between family members in Japan. Researchers tested 1,122 residents of a village on Iki Island for HCV. Overall, 14% of the population was infected with HCV. All of the cases occurred in people over the age of 20. Women and men were equally infected. HCV type II and IV were responsible for 97.5% of the infections. Thirty-eight percent of those who had received a blood transfusion were infected, compared to 17.4% of those who had surgery. Only 9% of those who had neither surgery or a transfusion were infected. Only three of 53 children of HCV-positive women were infected but two were older than 20 and had had surgery. The other child was infected with a different HCV type than the mother. Of 11 couples who were both infected, five had different HCV types. The high rates of HCV infection in this island may be due to the use of unsterilized surgical instruments by doctors making house calls.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1995
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