Re: E-DRUG: hep B vaccine-dose

["Dinesh Mehta" <dinesh@easynet.co.uk>]

E-DRUG: hep B vaccine-dose (4)
-----------------------------

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:
-----------------------------------------------------------------
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.
-----------------------------------------------------------------
<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.
-----------------------------------------------------------------
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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