Elsevier

Vaccine

Volume 7, Issue 5, October 1989, Pages 425-430
Vaccine

Paper
Effect of anatomic injection site, age and smoking on the immune response to hepatitis B vaccination

https://doi.org/10.1016/0264-410X(89)90157-6Get rights and content

Abstract

Soon after the plasma-derived hepatitis B vaccine became available in the US, the Centers for Disease Control and the manufacturer received over 100 reports of vaccinated groups with unexpectedly low levels of vaccine-induced antibody. To confirm previous retrospective surveys relating these failures to buttock injection and to evaluate the effect of other host factors on vaccine-induced antibody responses, we conducted a clinical trial in healthy health-care workers. Participants were randomly assigned to one of three treatment groups: 1-Ar, 1-inch needle injection in the arm; 1-Bu, 1-inch needle injection in the buttock; 2-Bu, 2-inch needle injection in the buttock. All participants were administered vaccine according to the standard vaccine dosage schedule of 20 μg at 0, 1 and 6 months. Antibody response rates (antibody to hepatitis B surface antigen ⩾10 sample ratio units by radioimmunoassay) and geometric mean titres of antibody two months after the third vaccine dose were 93% and 1454 mIU ml−1 for group 1-Ar, 72% and 85 mIU ml−1 for group I-Bu, and 83% and 387 mIU ml−1 for group 2-Bu. Seroconversion rates and titres of antibody in the three groups were significantly different from each other statistically. Increasing age, increasing total skinfold thickness and cigarette smoking were independently associated with lower antibody responses in persons receiving buttock injections but not in persons receiving arm injections. These results support previous findings that buttock injection was the cause of reported low vaccine-induced antibody responses to hepatitis B vaccination before April 1985, the date when arm injection was specified as the recommended injection site. Furthermore, they imply that the anatomic site of administration may be more important than previously thought as a determinant of the bioavailability of any intramuscularly-injected vaccine, biologic or drug.

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  • Cited by (0)

    Present affiliation: Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA

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