Intradermal recombinant hepatitis B vaccination (IDRV) for non-responsive healthcare workers (HCWs)

This was an observational study of non-responsive HCWs who were referred to Stockport Specialist Immunisation Clinic (SSIC) between 1st January 2003 and 31st May 2006. Anti- HBs titres were determined 4 - 6 weeks after each intradermal recombinant vaccine ( IDRV). Median anti- HBs titres were compared using the exact Wilcoxon rank sum test. In total, 23 eligible non- responding HCWs were identified. Protective anti- HBs titres (= 10 mIU/ ml) were induced in the majority of non- responders [ 21/ 23 ( 91.3%)] following two doses of IDRVs. HCWs who responded to the 1st IDRV with anti- HBs levels = 10 mIU/ ml were significantly younger and received their 1st IDRV more than six months after the last IM dose. Two HCWs ( 41 and 45 year old females) anti- HBs titres remained below 10 mIU/ ml even after a 3rd dose. Anti- HBs titres were available for 40% ( 9/ 23) of the HCWs six or more months after the last maximum anti- HBs titres were achieved. None of the nine HCWs anti- HBs titres declined to less than 10 mIU/ ml six or more months after the last maximum anti- HBs titres were achieved. However, a larger study with longterm follow- up is needed to determine the duration of protection following IDRV. HCWs with anti- HBs titres < 10 mIU/ ml after two full courses of intramuscular recombinant vaccine ( IMRV) should be offered two doses of IDRVs followed by assessment of anti- HBs titres one to four months after the second dose in order to identify persistent non- responders. No significant adverse events were noted with IDRV being well tolerated and acceptable to HCWs.