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Duration of Immunity After Hepatitis B Vaccination: Efficacy of Low-Dose Booster Vaccine

MARY M. HOROWITZ, M.D.; WILLIAM B. ERSHLER, M.D.; W. PAUL MCKINNEY, M.D.; and RICHARD J. BATTIOLA, M.D.
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▸Requests for reprints should be addressed to Mary M. Horowitz, M.D.; Medical College of Wisconsin—IBMTR, P.O. Box 26509; Milwaukee, WI 53226.


Milwaukee and Madison, Wisconsin


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;108(2):185-189. doi:10.7326/0003-4819-108-2-185
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Although the efficacy of hepatitis vaccine is well documented, the duration of immunity of healthy adults after vaccination is unknown. We studied 245 hospital employees 3 years after primary vaccination with hepatitis B vaccine to determine the prevalence of immunity indicated by levels of antibody to hepatitis B surface antigen of 10 mlU/mL or greater; and to compare the immunogenicity of low-dose intradermal vaccine with standard-dose intramuscular vaccine in persons found to be seronegative. Thirty-eight percent of employees studied had antibody levels less than 10 mlU/mL. Low levels were associated with smoking, older age, and higher body-mass index. Seventy-eight percent of persons with low antibody levels responded to a single booster vaccine. Two micrograms of intradermal vaccine was as effective as 20 µg of intramuscular vaccine in inducing an antibody response; however, intradermal vaccine was associated with more local reactions (42% compared with 17%). Many healthy adults will need periodic boosters of hepatitis B vaccine to maintain production of antibody to hepatitis B surface antigen; low-dose intradermal booster schedules may be feasible.

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