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Previous Volume 351:2286-2294 November 25, 2004 Number 22 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by La Montagne, J. R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background If found to be safe and immunogenic, reduced doses of influenza vaccine given by the intradermal route could increase the number of available doses of vaccine.

Methods In an open-label study, we randomly assigned 119 subjects to receive an intradermal injection of trivalent inactivated influenza vaccine, containing 6 µg of hemagglutinin for each antigen (40 percent of the usual dose), and 119 to receive an intramuscular injection of the standard dose of 15 µg of hemagglutinin for each antigen. The two groups were subdivided according to age (18 to 60 years and older than 60 years).

Results Among subjects who were 18 to 60 years of age, serum antibody responses were vigorous and did not differ significantly between the intradermal and intramuscular groups, and all subjects had hemagglutination-inhibition (HAI) titers of at least 1:40. Although the subjects who were older than 60 years of age also had a vigorous antibody response, there was a trend toward a better response in the intramuscular route, but this finding was significant only for antigen to the H3N2 strain. Nevertheless, 100 percent of older subjects in the intramuscular group and 93 percent of such subjects in the intradermal group had an HAI antibody titer to the H3N2 strain of more than 1:40, and 100 percent in each group had a titer of this level for both the H1N1 and B strains. Local pain was significantly more common in the intramuscular group than in the intradermal group among subjects who were 18 to 60 years of age but not among subjects who were over 60 years old. Signs of local inflammation were significantly more common among subjects in the intradermal group than among those in the intramuscular group, in both age groups.

Conclusions As compared with an intramuscular injection of full-dose influenza vaccine, an intradermal injection of a reduced dose resulted in similarly vigorous antibody responses among persons 18 to 60 years of age but not among those over the age of 60 years.

Source Information

From the Department of Internal Medicine, Division of Infectious Diseases and Immunology, Saint Louis University, St. Louis (R.B.B., F.K.N., J.C., C.D.); the Department of Internal Medicine, Division of Infectious Diseases, University of Rochester, Rochester, N.Y. (J.T.); GlaxoSmithKline Biologicals, Rixensart, Belgium (C.V.H.); and GlaxoSmithKline, King of Prussia, Pa. (B.J.H., G.D.).

This article was published at www.nejm.org on November 4, 2004.

Address reprint requests to Dr. Belshe at the Division of Infectious Diseases and Immunology, Saint Louis University, 3635 Vista Ave. (FDT-8N), St. Louis, MO 63110, or at belsherb{at}slu.edu.

Full Text of this Article

Related Letters:

Intradermal Vaccination against Influenza
Weller T. H., Kilbourne E. D., Manian F. A., Belshe R. B., Treanor J., Dubin G., Glenn G. M., Kenney R. T.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:1044-1046, Mar 10, 2005. Correspondence

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