E-DRUG: hep B vaccine-dose (4)
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This is my reply to the first enquiry about the dose of hepatitis B:
You wrote:
I am confused about the dose of recombinant hepatitis b vaccine. In
Pakistan we have 10mcg and 20mcg Engerix. I hear that in some countries
a 10mcg is all they have and same strength is used for adult
immunization as well. Please help.
This is indeed confusing! In the UK there are two proprietary brands. Here
are the details from the current British National Formulary:
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BNF Copyright material
<PoM> HB-Vax<Reg> II (Pasteur M�rieux)
A suspension of hepatitis B surface antigen (prepared from yeast cells by
recombinant DNA technique) 10 micrograms/mL adsorbed onto aluminium
hydroxide. Net price 1-mL prefilled syringe = �12.70; 1-mL vial = �11.95
Dose: by intramuscular injection (see note below) 3 doses of 1 mL (10
micrograms), the second 1 month and the third 6 months after the first dose;
more rapid (e.g. for travellers), third dose 2 months after first dose with
booster at 12 months; CHILD birth to 15 years 3 doses of 0.5 mL (5
micrograms); INFANTS born to HBsAg-positive mothers (see also above), 3
doses of 0.5 mL (5 micrograms), first dose at birth with hepatitis B
immunoglobulin injection (separate site)
Note. Deltoid muscle is preferred site of injection in adults; anterolateral
thigh is preferred site in infants and children; not to be injected into the
buttock (vaccine efficacy reduced); subcutaneous route used for patients
with haemophilia.
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<PoM> Engerix B<Reg> (SmithKline Beecham)
A suspension of hepatitis B surface antigen (rby, prepared from yeast cells
by recombinant DNA technique) 20 micrograms/mL adsorbed onto aluminium
hydroxide. Net price 0.5 mL (paediatric) vial = �9.85; 1-mL vial = �13.27;
1-mL prefilled syringe = �13.97
Dose: by intramuscular injection (see note below), 3 doses of 1 mL (20
micrograms), the second 1 month and the third 6 months after the first dose;
more rapid (e.g. for travellers), third dose 2 months after first dose with
booster at 12 months; CHILD birth to 12 years 3 doses of 0.5 mL (10
micrograms); INFANTS born to HBsAg-positive mothers (see also above), 3
doses of 0.5 mL (10 micrograms), first dose at birth with hepatitis B
immunoglobulin injection (separate site)
Note. Deltoid muscle is preferred site of injection in adults; anterolateral
thigh is preferred site in infants and children; not to be injected into the
buttock (vaccine efficacy reduced); subcutaneous route used for patients
with haemophilia.
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N.B. <PoM> = Prescription-only medicine
<Reg> = registered trade mark
Since I'm working from home, I don't have access to our notes. But we (on
the British National Formulary) did query the strengths with the
manufacturers and we have been assured that 10 micrograms of HB-Vax is
equivalent to 20 micrograms of Engerix B! The thing to look for is the
adult dose in millilitres - you will see that it is 1 mL for both versions
of the vaccine.
I cannot however substantiate your impression that the same strength is used
for adults and children. As shown above, the dose for children in both
cases is half that for adults.
I hope this helps a little - or at least doesn't add any further to the
confusion!
Dinesh Mehta
A post-script: Dialysis and predialysis patients require a higher dose in
order to obtain a satisfactory level of protection. Furthermore, these (and
immunocompromised) patient lose their immunity more readily than other
individuals. In the UK a new preparation has been introduced for dialysis
and predialysis patients - HB-Vax II 40 - it contains 40 micrograms/mL; the
dose is 1 mL by intramuscular injection. Kirsten Myhr of Norway also
mentioned the 40-microgram dose for dialysis patients.
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