The efficacy and acceptability of yeast-derived recombinant hepatitis B vaccine given by the intradermal route was investigated in 221 health care volunteers. Two hundred and sixteen received a full course of three doses of vaccine. Only one subject was withdrawn because of a significant adverse reaction (psoriasis). The vaccine stimulated an antibody response in 81%. The response to the vaccine was better in women than in men (87% compared with 71%, p = 0·007) and in women below the age of 40 years compared with older women (94% compared with 76%, p = 0·01). For men the response showed a sequential decline with age for each decade (90% responders from age 29 or less, 72% aged 30—39 and 65% aged 40 or more, p = 0·04). Retrospective enquiry showed that over 90% had found the intradermal route acceptable and 59% would prefer vaccine by the intradermal route in preference to intramuscular notwithstanding local reactions. Although the seroconversion rate was of a high order in younger women the antibody titres were not high with only 9 of 215 recipients developing titres >1000 mIU/ml, a level which could be expected to ensure prolonged immunity. A fourth intradermal dose of vaccine given to 60 volunteers who had shown a low response (<38 mIU/ml) or no serological response to a three-dose course stimulated a good booster effect (to 150—600 mIU/ml) in only 5 (8%).
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