Low-Dose Intradermal and Intramuscular Vaccination against Hepatitis B

Joe P. Bryan*, Maria H. Sjogren, Peter L. Perine, Llewellyn J. Legters

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

73 Scopus citations


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 plasmaderived 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.

Original languageEnglish
Pages (from-to)697-707
Number of pages11
JournalClinical Infectious Diseases
Issue number3
StatePublished - 1 Mar 1992
Externally publishedYes


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