A variety of
factors can impair the immunogenicity of the hepatitis B vaccine,
including gluteal or intradermal administration, increased age, higher
body mass index, and genetics, such as human leukocyte antigen-DR3,
which is present in about 95% of people with type 1 diabetes.
Unpublished data from the Centers for Disease
Control and Prevention suggest that diabetes patients experience a
similar drop in seroprotection with age (80% at 41-59 years, 65% at
60-69 years, and less than 40% at 70 years and older), he noted.
For patients who fail to respond to the first or
second series of vaccinations, based on postimmunization serologic
testing, using a higher 40 mcg-dose or four doses at 0, 1, 2, and 6
months has been shown to improve immunologic responses. There is no
need, however, to restart a series if it was interrupted, regardless of
the duration between vaccinations, Dr. Parenti said.
Labels: HBV vaccine response, immunogenicity of HBV vaccine, re-vaccination, vaccine administration