FA16 Immunization Module’s Updates

Vaccine non-responders and Hepatits B

I became interested in the area of vaccine non-responders after a comment one of my nurses had made when I was completing my vaccine requirements for medical school. Some of my titers had returned negative, and I was receiving several series again. She had told me, “You might end up being one of the ‘lucky ones’ that just don’t respond.” In my readings, I stumbled onto this article from the World Journal of Hepatology detailing options for non-responders of the Hep B vaccine specifically.

To put some perspective to this, Hepatitis B is a virus that is responsible for nearly 1 million deaths yearly worldwide. It is found abundantly in body fluids. The vaccine is usually administered as an intramuscular dose in three doses of 0, 1, and 6 months at 10 mg. This vaccine produces a positive response for 95 percent of immune-competent individuals, leaving 5 percent of individuals that do not respond.

The article details that individuals who “do not respond to the standard regimen as well as the additional booster or repeated course regimen are labeled as true non-responders.” The article further indicates that there may be a genetic predisposition in which subjects may have a defect in the antigen presentation or the stimulation of T-helper cells. A non-responder should prevent exposure to blood and body fluids, which would prove difficult for those of us in health care, so what other options are there?

The following were a few strategies that are being explored and could potentially be considered for those who do not respond to the standard vaccine:

  1. Increased dosage or increased frequency of the vaccine, which appeared to help individuals at high-risk.
  2. Intradermal injection instead of intramuscular injection of the vaccine. However, intradermal injection tends to be more difficult to perform effectively. Other routes of administration are also being looked into.
  3. Use of other adjuvants (substances used to help the immune response) in conjunction with aluminum.
  4. Both nasal and oral vaccines are being considered and tested.

These were not the only strategies outlined, but a few that I found interesting. What I found more interesting though was that I could find very few credible articles containing helpful information for individuals who did not respond to other vaccinations aside from Hep B. Has anyone found any information on this in their own research? If not, non-responders of vaccines could certainly benefit from “herd immunity” idea presented in the Immunization Basics PowerPoint. 

WJH-7-2503(1).pdf

 

  • Richard Tapping
  • Brooke Dean
  • Daniel Cibich
  • Nadia Churchill-Gilstrap