Hep B - Intradermal Vaaccination

[Growler]

Over the last 23 years I've been immunized (full course of 3 shots each time) against Hep B on 3 separate occasions....the last in 2009 finally took (antibody level 23mlU/ml).

During my most recent checkup the Hep B antibody level was measured and the result was 1mlU/ml, meaning no immunity  

I appreciate that Hep B vaccination in poz people can be less likely to take, but a little research has brought up the idea of Hep B intradermal vaccination. I'm wondering if anyone has come across any research on the success or otherwise of intradermal vaccination in poz people who have failed the intramuscular route?

Growler

[tednlou2]

I'm on my 2nd vaccination series.  The first, I got the Twinrix with the A and B.  They messed up the schedule giving me the first shot again a second time, when I was suppose to get the 2nd shot in the series.  So, that may have caused an issue.  I developed antibodies to A, but not B.

This time, they are doing an experiment by giving people a 4th shot instead of the normal 3 to see if that helps to create immunity.  We will see.  They did tell me that a few docs and nurses there who are HIV Neg cannot create immunity either.  On a side note, I've been hearing on the news how people over 65 should get the "higher-powered" flu vaccine, as they have a hard time creating a response sometimes as well.  I wondered why don't they just give that to everyone.  I didn't know there was a more powerful flu vaccine.  And, it got me thinking whether there are studies showing HIV poz folks should get higher doses of vaccines as well and whether that would be safe, etc, etc.   

Anyway, I'll be interested to hear any info others have to your main question.

[Growler]

Thanks for the response and my sympathies about having to through a second round of shots...those buggers  bloody  sting!

On Friday i received a surprise call from an immunologist who consults for the HIV clinic I attend. While I had his ear I asked about the hep B vaccination situation and his reply was as follows.....if you've previously achieved a protective antibody level after undergoing the full course of the Hep B vaccinations then you will remain protected into the future. Antidody levels drop over time but the background level that remains is adequate  to respond in  the event of infection.

GROWLER

[elf]

Hi Growler.
We've talked about hepB here, maybe you find it useful:


http://forums.poz.com/index.php?topic=37413.0

My hepB response was low 6 months after the vaccination (3rd shot),
but 1 year later, antibodies appeared. : 550 of them, and apparently everything over 200 is ''good response''; <10 is not protective).

Brazilian immunologists found an effective scheme for HIVpositive people:
4 double doses of vaccine (4x2) taken at  0, 1, 2 and 6 months:
http://www.ncbi.nlm.nih.gov/pubmed/19995540

I think the best for you would be just one single double-dose shot.  
Full re-vaccination is needed only for those who have never achieved >10 mlU/ml.

[surf18]

if you already had hep b are you immune from it forever?thanks

[Growler]

Thanks elf for the info.....I agree, definitely worth checking out that booster shot.

I checked out the advice of the immunologist and generally his advice is correct according to the CDC

http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm#general

quote
"How long does protection from Hepatitis B vaccine last?

Studies indicate that immunologic memory remains intact for at least 20 years among healthy vaccinated individuals who initiated Hepatitis B vaccination >6 months of age. The vaccine confers long-term protection against clinical illness and chronic Hepatitis B virus infection. Cellular immunity appears to persist even though antibody levels might become low or decline below detectable levels."

But as you suggest the situation for HIV infected individuals isn't so clear

quote
"For other immunocompromised persons (e.g., HIV-infected persons, hematopoietic stem-cell transplant recipients, and persons receiving chemotherapy), the need for booster doses has not been determined. When anti-HBs levels decline to <10 mIU/mL, annual anti-HBs testing and booster doses should be considered for those with an ongoing risk for exposure. "

As surf18's question concerning life-long immunity after hep b infection

http://www.cdc.gov/hepatitis/b/bfaq.htm

quote"If I had Hepatitis B in the past, can I get it again?

No, once you recover from Hepatitis B, you develop antibodies that protect you from the virus for life. An antibody is a substance found in the blood that the body produces in response to a virus. Antibodies protect the body from disease by attaching to the virus and destroying it. However, some people, especially those infected during early childhood, remain infected for life because they never clear the virus from their bodies."

That said having HIV may change this situation so it might be worth checking with your HIV specialist.

GROWLER