WJV  Vol.3 No.1 , February 2013
High-Dose Intra-Dermal Hepatitis B Vaccine in a Liver Transplant Patient Who Failed Prior Intramuscular Vaccination: A Brief Case Report
Abstract: Hepatitis B virus (HBV) chronic infection represents a significant cause of morbidity and mortality worldwide. While traditional intramuscular (IM) HBV vaccination is an excellent method for robust and sustained seroconversion in healthy individuals, its efficacy in chronic liver disease is sub-optimal and scant data exists in the post-liver transplant state. Importantly, HBV complications are even more severe in these same immunocompromised populations. Intra-dermal (ID) vaccination has shown initial promise as a successful alternative to achieving HBV seroconversion in patients refractory to standard vaccination protocols. Herein is a case report of a 61 year-old female who underwent liver transplantation for chronic HBV infection and achieved HBsAg seroconversion with a robust HSsAb titer with ID vaccination after having failed both standard and double dose IM vaccination.
Cite this paper: S. Dhillon, K. Sampath, C. Moore, A. Dosanjh and D. Thiel, "High-Dose Intra-Dermal Hepatitis B Vaccine in a Liver Transplant Patient Who Failed Prior Intramuscular Vaccination: A Brief Case Report," World Journal of Vaccines, Vol. 3 No. 1, 2013, pp. 16-18. doi: 10.4236/wjv.2013.31003.

[1]   C. W. Shepard, E. P. Simard, L. Finelli, A. E. Fiore and B. P. Bell, “Hepatitis B Virus Infection: Epidemiology and Vaccination,” Epidemiologic Reviews, Vol. 28, No. 1, 2006, pp. 112-125. doi:10.1093/epirev/mxj009

[2]   A. R. Zanetti, P. Van Damme and D. S. Vaccine, “The Global Impact of Vaccination against Hepatitis B: A Historical Overview,” Vaccine, Vol. 26, No. 49, 2008, pp. 6266-6273. doi:10.1016/j.vaccine.2008.09.056

[3]   N. A. Terrault and T. L. Wright, “Hepatitis B Virus Infection and Liver Transplantation,” Gut, Vol. 40, No. 5, 1997, pp. 568-571.

[4]   J. P. Lerut, M. Donataccio, O. Ciccarelli, et al., “Liver Transplantation and HBsAg-Positive Postnecrotic Cirrhosis: Adequate Immunoprophylaxis and Delta Virus Co-Infection as the Significant Determinants of Long-Term Prognosis,” Journal of Hepatology, Vol. 30, No. 4, 1999, pp. 706-714. doi:10.1016/S0168-8278(99)80203-7

[5]   M. Wiedmann, U. G. Liebert, U. Oesen, H. Porst, M. Wiese, S. Schroeder, U. Halm, J. Mossner and F. Berr, “Decreased Immunogenicity of Recombinant Hepatitis B Vaccine in Chronic Hepatitis C. Hepatology,” Vol. 31, No. 1, 2000, pp. 230-234. doi:10.1002/hep.510310134

[6]   U. Bienzle, M. Günther, R. Neuhaus, P. Vandepapeliere, J. Vollmar, A. Lun and P. Neuhaus, “Immunization with an Adjuvant Hepatitis B Vaccine after Liver Transplantation for Hepatitis B-Related Disease,” Hepatology, Vol. 38, No. 4, 2003, pp. 811-819.

[7]   M. Arslan, R. H. Wiesner, C. Sievers, K. Egan, N. N. Zein, “Double-Dose Accelerated Hepatitis B Vaccine in Patients with End-Stage Liver Disease,” Liver Transplantation, Vol. 7, No. 4, 2001, pp. 314-320. doi:10.1053/jlts.2001.23069

[8]   C. M. Lo, C. L. Liu, S. C. Chan, G. K. Lau and S. T. Fan, “Failure of Hepatitis B Vaccination in Patients Receiving Lamivudine Prophylaxis after Liver Transplantation for Chronic Hepatitis B,” Journal of Hepatology, Vol. 43, No. 2, 2005, pp. 283-287. doi:10.1016/j.jhep.2005.03.013

[9]   F. Fabrizi, V. Dixit, P. Messa and P. Martin, “Intradermal vs Intramuscular Vaccine against Hepatitis B Infection in Dialysis Patients: A Meta-Analysis of Randomized Trials,” Journal of Viral Hepatitis, Vol. 18, No. 10, 2010, pp. 730-737.

[10]   A. Aziz, S. Aziz, D. S. Li, L. Murphy, N. Leone, M. Kennedy, S. Dhillon and D. H. Van Thiel, “Efficacy of Repeated High-Dose Hepatitis B Vaccine (80 μg) in Patients with Chronic Liver Disease,” Journal of Viral Hepatitis, Vol. 13, No. 4, 2006, pp. 217-221. doi:10.1111/j.1365-2893.2005.00674.x

[11]   L. Sangaré, L. Manhart, D. Zehrung and C. C. Wang, “Intradermal Hepatitis B Vaccination: A Systematic Review and Meta-Analysis,” Vaccine, Vol. 27, No. 12, 2009, pp. 1777-1786. doi:10.1016/j.vaccine.2009.01.043

[12]   R. P. Perrillo, M. Kruger, T. Sievers and J. R. Lake, “Posttransplantation: Emerging and Future Therapies,” Seminars in Liver Disease, Vol. 20, No. S1, 2000, PP. 13-17.

[13]   F. Bihl, S. Russmann, V. Gurtner, L. Di Giammarino, L. Pizzi-Bosman, M. Michel, A. Cerny, A. Hadengue, P. Majno, E. Giostra, D. Castelli and G. Mentha, “Hyperimmune Anti-HBs Plasma as Alternative to Commercial Immunoglobulins for Prevention of HBV Recurrence after Liver Transplantation,” BMC Gastroenterology, Vol. 4, No. 71, 2010. doi:10.1186/1471-230X-10-71

[14]   E. A. Arbizu, R. B. Marugán, J. Y. Grijalba, P. L.Serrano and L. G. Grande and S. D. C. Terrón, “Intramuscular versus Intradermal Administration of Anti-Hepatitis B Vaccine in Non-Cirrhotic Hepatitis C Patients,” Vaccine, Vol. 21, No. 21-22, 2003, pp. 2747-2750. doi:10.1016/S0264-410X(03)00221-4

[15]   S. Dhillon, C. Moore, S. D. Li, A. Aziz, A. Kakar, A. Dosanjh, A. Beesla, L. Murphy and D. H. Van Thiel, “Efficacy of High-Dose Intra-Dermal Hepatitis B Virus Vaccine in Previous Vaccination Non-Responders with Chronic Liver Disease,” Digestive Diseases and Sciences, Vol. 57, No. 1, 2012, pp. 215-220. doi:10.1007/s10620-011-1996-0

[16]   R. B. Belshe, F. K. Newman, J. Cannon, C. Duane, J. Treanor, C. Van Hoecke, B. J. Howe and G. Dubin, “Serum Antibody Responses after Intradermal Vaccination against Influenza,” The New England Journal of Medicine, No. 351, No. 22, 2004, pp. 2286-2294. doi:10.1056/NEJMoa043555

[17]   B. Y. Choy, J. S. Peiris, T. M. Chan, S. K. Lo, S. L. Lui and K. N. Lai, “Immunogenicity of Intradermal Hepatitis B Vaccination in Renal Transplant Recipients,” American Journal of Transplantation, Vol. 2, No. 10, 2002, pp. 965-969. doi:10.1034/j.1600-6143.2002.21014.x

[18]   M. Angelico, D. Di Paolo, M. O. Trinito, A. Pterolati, A. Araco, S. Zazza, R. Lionetti, C. U. Casciani and G. Tisone, “Failure of a Reinforced Triple Course of Hepatitis B Vaccination in Patients Transplanted for HBV-Related Cirrhosis,” Hepatology, Vol. 35, No. 1, 2002, pp. 176-181.