Hyporesponsiveness to intradermal administration of hepatitis B vaccine in insulin dependent diabetes mellitus

Abstract

The immune response to intradermal or intramuscular hepatitis B vaccine in 18 children with insulin dependent diabetes mellitus (IDDM) compared with 24 healthy children was studied. Patients were divided into responders, hyporesponders, and non-responders according to their antihepatitis B serum concentrations after hepatitis B vaccination. We also studied HLA class II antigen distribution and did delayed type hypersensitivity (DTH) tests on children with IDDM and controls.No diVerence in the immune response (antihepatitis B surface antigen antibody titres) was found with intramuscular administration, whereas with intradermal administration a statistically lower immune response (p < 0.001) was observed in children with IDDM v controls. This hyporesponsiveness cannot be attributed to HLA class II antigen distribution because their frequency was the same in both groups of children with IDDM.It is suggested that the poor immune response to intradermal hepatitis B vaccine may be due to impaired macrophage activity resulting in failure of antigen presentation, which may be of importance in the immune dysfunction in children with IDDM. This hypothesis is suggested by a significantly lower score on a DTH test to a battery of antigens in the IDDM group when compared with controls. It is therefore suggested that when the hepatitis B vaccination is oVered to children with IDDM it may be preferable to give it intramuscularly. (Arch Dis Child 1998;78:54-57)

Immune Response of Hepatitis B Vaccine Among Persons With Diabetes

“…Li Volti et al (38) reported 77.8% seroprotection with intradermal administration compared with 100.0% seroprotection with intramuscular administration. Among children without diabetes, 100.0% in both intradermal and intramuscular arms achieved seroprotection (38). Other studies have found improved results with intradermal administration of the hepatitis B vaccine in dialysis patients (48).…”

Immune dysfunction in patients with diabetes mellitus (DM)

“…A lower immune response in children with DM type 1 compared to controls was found after intradermal (instead of intramuscular) administration of the hepatitis B vaccine [5]. It has been suggested that this lower response is probably partly the result of an impaired macrophage function in this patient group [5].…”

Implant Healing in Experimental Animal Models of Diabetes

“…For instance, adaptive humoral immunity in diabetic patients expresses normal levels of serum antibodies and normal response to vaccinations. 18,[51][52][53] In adaptive cellular immunity, the proliferative response of lymphocytes in diabetic patients is inhibited with some stimuli, such as Staphylococcus aureus and phytohemagglutinin, and normal with others. 10 However this alteration does not appear to enhance infection susceptibility in diabetic patients.…”