Nagafuchi S, Kashiwagi S, Okada K, Anzai K, Nakamura M, Nishimura Y, Sasazuki T, Niho Y
First Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
JAMA. 1991;265(20):2679-83.
Thirty-one Japanese nonresponders to subcutaneous hepatitis B vaccination and 15 medical personnel who were accidentally exposed to specimens positive for hepatitis B e antigen and were given hepatitis B immunoglobulin were intradermally immunized with 5 micrograms of plasma-derived hepatitis B vaccine every 2 weeks until delayed type hypersensitivity skin reaction to hepatitis B surface antigen became positive. Thirty (97%) of the 31 nonresponders developed delayed type hypersensitivity skin reactions to hepatitis B surface antigen after 2.3 +/- 1.2 (mean +/- SD) revaccinations. Twenty-nine (94%) of the 31 nonresponders had anti-hepatitis B surface antigen antibody levels greater than 10 IU/L. The immunoglobulin subclass of the antibody to hepatitis B surface antigen was mainly IgG1. After 1 year, 23 (74%) of the 31 nonresponders continued to have anti-hepatitis B surface antigen antibody levels greater than 10 IU/L. Persons accidentally exposed to specimens positive for hepatitis B e antigen developed delayed type hypersensitivity skin reactions to hepatitis B surface antigen following 3.1 +/- 1.1 revaccinations. None developed clinical hepatitis. There was no production of anti-hepatitis B core antigen antibody 1 year after exposure, indicating that protection was 100%. Intradermal hepatitis B vaccination is useful in reversing nonresponsiveness to hepatitis B surface antigen and for prophylaxis after exposure.
31名对皮下注射乙肝疫苗无反应的日本人和15名意外接触乙肝e抗原阳性标本并接受乙肝免疫球蛋白治疗的医务人员，每2周接受5微克血浆源性乙肝疫苗皮内免疫，直至对乙肝表面抗原的迟发型超敏皮肤反应呈阳性。31名无反应者中，30名（97%）在2.3±1.2次（平均±标准差）再接种后出现了对乙肝表面抗原的迟发型超敏皮肤反应。31名无反应者中有29名（94%）的抗乙肝表面抗原抗体水平大于10 IU/L。乙肝表面抗原抗体的免疫球蛋白亚类主要为IgG1。1年后，31名无反应者中有23名（74%）的抗乙肝表面抗原抗体水平持续大于10 IU/L。意外接触乙肝e抗原阳性标本的人在3.1±1.1次再接种后出现了对乙肝表面抗原的迟发型超敏皮肤反应。无人发生临床肝炎。接触后1年未产生抗乙肝核心抗原抗体，表明保护率为100%。皮内乙肝疫苗接种对于逆转对乙肝表面抗原的无反应性以及接触后的预防是有用的。
