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World J Gastroenterol. Aug 14, 2014; 20(30): 10383-10394
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10383
Hepatitis B vaccine by intradermal route in non responder patients: An update
Martina Filippelli, Elena Lionetti, Alessia Gennaro, Angela Lanzafame, Teresa Arrigo, Carmelo Salpietro, Mario La Rosa, Salvatore Leonardi
Martina Filippelli, Elena Lionetti, Alessia Gennaro, Angela Lanzafame, Mario La Rosa, Salvatore Leonardi, Department of Medical and Pediatric Science, University of Catania, 95100 Catania, Italy
Teresa Arrigo, Carmelo Salpietro, Department of Pediatric Sciences, University of Messina, 98100 Messina, Italy
Author contributions: Filippelli M and Leonardi S participated in the conception and design of the review, manuscript writing and revision; Lionetti E, Gennaro A, Lanzafame A, Arrigo T, Salpietro C and La Rosa M participated manuscript writing; all authors read and approved the final manuscript.
Correspondence to: Salvatore Leonardi, Professor, Department of Medical and Pediatric Science, University of Catania, Via S Sofia 78, 95100 Catania, Italy. leonardi@unict.it
Telephone: +39-9-53782764 Fax: +39-9-53782895
Received: November 29, 2013
Revised: March 12, 2014
Accepted: April 27, 2014
Published online: August 14, 2014
Processing time: 261 Days and 21.1 Hours
Abstract

Vaccination is the main prophylactic measure to reduce the mortality caused by hepatitis B virus (HBV) infection in healthy subjects since the immune response to hepatitis B recombinant vaccination occurs in over 90% of general population. Individuals who develop an anti-HBs titer less than 10 mIU/mL after primary vaccination cycle are defined “no responders”. Many factors could cause a non response to the HBV vaccination, such as administration of the vaccine in buttocks, impaired vaccine storage conditions, drug abuse, smoking, infections and obesity. Moreover there are some diseases, like chronic kidney disease, human immunodeficiency virus infection, chronic liver disease, celiac disease, thalassaemia, type I diabetes mellitus, down’s syndrome and other forms of mental retardation that are characterized by a poorer response to HBV vaccination than healthy subjects. To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection. Recent studies seem to indicate that the administration of HBV recombinant vaccine by the intradermal route is very effective and could represent a more useful strategy than intramuscular route. This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients. A comprehensive review of the literature using PubMed database, with appropriate terms, was undertaken for articles in English published since 1983. The literature search was undertaken in September 2013.

Keywords: Hepatitis B virus; Vaccine; Intradermal route; Non responders; Update

Core tip: Vaccination is the principal strategy to reduce the morbidity and mortality caused by hepatitis B virus. Vaccinated subjects with an hepatitis B surface antibody titer less than 10 mIU/mL after primary vaccine series are considered “no responders”. There are chronic conditions that are characterized by a poorer response to hepatitis B virus vaccination than healthy subjects. To date it is still unclear how to treat this group of patients at high risk of hepatitis B infection. This review focuses on the use of anti hepatitis B vaccine by intradermal route as alternative to conventional intramuscular vaccine in all non responder patients.