Soroprevalência da hepatite B e avaliação da resposta imunológica à vacinação contra a hepatite B por via intramuscular e intradérmica em profissionais de um laboratório de saúde pública / Hepatitis B seroprevalence and evaluation of immune response to hepatitis B vaccination using intramuscular and intradermal routes in public health laboratory employees

OBJETIVOS: Determinar a prevalência dos marcadores da hepatite B (HBsAg e anti-HBs) e avaliar a resposta à vacinação contra hepatite B por via intradérmica (ID) em profissionais de saúde que não responderam à vacinação por via intramuscular (IM). MÉTODO: Todos os funcionários do Instituto Adolfo Lutz (IAL) foram convidados a participar do estudo. Amostras de soro foram colhidas no momento da administração da primeira dose de vacina (Engerix® B) e o HBsAg e o anti-HBs foram pesquisados, utilizando-se kits comerciais (Laboratórios Abbott®). Aos funcionários que não responderam à vacinação convencional (três doses por via IM) foram oferecidas doses de 5µg da mesma vacina por via ID. RESULTADOS: Foram envolvidos nesse estudo 404 funcionários do IAL, dos quais dois (0,5 por cento) eram HBsAg e 42 (10,5 por cento), anti-HBs reagentes. Dos 360 voluntários com sorologia negativa, 316 (87,8 por cento) receberam três doses de vacina (IM) e, desses, 259 colheram soros para avaliação pós-vacinal. Do total, 242 (93,4 por cento) apresentaram anticorpos acima de 10 UI/L após completarem o esquema inicial. Foram administradas duas doses de reforço, porém sete funcionários permaneceram sem resposta imunológica. A vacinação intradérmica foi realizada em cinco voluntários, e todos produziram anticorpos após a utilização dessa via de administração. CONCLUSÕES: A prevalência da hepatite B não foi maior nessa população do que na população geral. A vacinação por via intradérmica pode ser uma boa alternativa na imunização de pessoas que não respondem ao esquema convencional.

OBJECTIVES: To determine the prevalence of HBsAg and anti-HBs and to evaluate the response of intradermal hepatitis vaccination in healthcare workers non-responsive to previous repeated intramuscular vaccination. MATERIAL AND METHOD: All of the employees from Instituto Adolfo Lutz were invited to participate on this study. Serum samples were obtained and HBsAg and anti-HBs were detected using commercial kits (Abbott® Laboratories). Employees were submitted to the conventional three-dose vaccination by intramuscular route. To those employees who did not respond to intramuscular vaccination, 5 µg doses of Engerix® B were then administered by intradermal route up to nine doses. RESULTS: Four hundred and four healthcare workers were enrolled in this study. Initially, two (0.5 percent) and 42 (10.4 percent) were HBsAg and anti-HBs reagent, respectively. Among the 360 negative volunteers, 316 (87.8 percent) received three vaccine doses and in 259 of them, serum samples were collected to evaluate vaccine efficacy. Among them, 242 (93.4 percent) showed antibodies titer higher than 10 UI/l. Intradermal vaccination was carried out in five volunteers and all of them responded to this vaccine administration route. CONCLUSION: The prevalence of hepatitis B was not higher than in general population. Intradermal vaccine administration could be a good alternative in people that did not respond to previous intramuscular route.

Neutralizing antibody response after intradermal vaccination with PCEC multisite at same area.

An inactivated tissue culture rabies vaccine is high immunogenicity for rabies prophylaxis. Because of the high cost of tissue culture vaccine, small doses of intradermal vaccination with tissue culture vaccine have been studied. Neutralizing antibody response after vaccination with PCEC small doses multisided intradermally at same area as abbreviate 4:2:2 scheme were studied at Buriram Provincial Hospital. Forty patients received PCEC 0.1 ml intradermal 4 sites at left deltoid on day 0;2, sites at right deltoid on day 7;2 sites at left deltoid on day 21 and 1 site at left deltoid for booster dose after a year. Blood specimens were collected on days 0, 7, 21, 42, 365 and 425. The patients were aged 3 to 39 years (median 25 years). Two patients had history of previous simple vaccination whereas 38 patients (19 males and 19 females) had no history of previous rabies vaccination. One vial of vaccine per patient was studied. The reconstituted vaccine was kept in refrigerator for 21 days. The NT antibody levels were detected on day 21 and reached their peaks on day 42. After one year, NT antibody level remained and increased rapidly to a significant level on day 425 after booster. The GMT of NT antibody on day 7, 21, 42 and 365 were 0.028, 1.51, 2.98 and 0.57 IU/ml. The GMT of NT antibody at day 425 after booster was 3.13 IU/ml. Two patients had low NT antibody on day 0, anamestic response were demonstrated on day 7. Both of them had NT antibody higher than 10 IU/ml. on day 21 and 42. Adverse reactions were mild and self-limited.