Bryan J P, Sjogren M H, Perine P L, Legters L J
Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814.
Clin Infect Dis. 1992 Mar;14(3):697-707. doi: 10.1093/clinids/14.3.697.
Hepatitis B and its sequelae are global problems preventable by immunization. Expense limits the use of hepatitis B vaccines, but low-dose intradermal immunization has been evaluated as a cost-saving strategy in numerous studies. With few exceptions, low-dose intradermal plasma-derived vaccines have elicited protective levels of antibody in 82%-100% of young healthy adults--a proportion similar to that noted with full-dose regimens; peak levels of antibody to hepatitis B surface antigen (HBsAg) are lower with reduced doses, however. Although children respond well to low-dose intradermal immunization, this procedure is technically difficult in neonates and should not be used for those born to HBsAg-positive mothers. For persons at high risk, antibody to HBsAg must be assessed after immunization to determine the need for a booster dose. A fourth dose 1-2 years after the initial series substantially increases antibody concentrations. In low intradermal doses, recombinant vaccine elicits lower rates of seroconversion than plasma-derived vaccine. However, low intramuscular doses of recombinant vaccine give favorable results. In short, low-dose intradermal or intramuscular immunization offers protection against hepatitis B at significant savings and may be useful for mass immunization of populations at high risk.
乙型肝炎及其后遗症是可通过免疫预防的全球性问题。费用限制了乙型肝炎疫苗的使用，但低剂量皮内免疫在众多研究中已被评估为一种节省成本的策略。除少数例外情况外，低剂量皮内血浆源性疫苗在82% - 100%的年轻健康成年人中引发了保护性抗体水平，这一比例与全剂量方案相似；然而，乙型肝炎表面抗原（HBsAg）抗体的峰值水平在剂量降低时较低。虽然儿童对低剂量皮内免疫反应良好，但该方法在新生儿中操作技术上困难，且不应应用于HBsAg阳性母亲所生的婴儿。对于高危人群，免疫后必须评估HBsAg抗体以确定是否需要加强剂量。在初始系列接种后1 - 2年接种第四剂可大幅提高抗体浓度。低皮内剂量时，重组疫苗的血清转化率低于血浆源性疫苗。然而，低肌肉注射剂量的重组疫苗效果良好。简而言之，低剂量皮内或肌肉注射免疫可显著节省成本地提供针对乙型肝炎的保护，可能对高危人群的大规模免疫有用。
