成人でのB型肝炎ワクチンの接種

小児で定期接種になり、日本でも根絶に向かうB型肝炎ウイルス
小児と成人では接種ルートが違いますのでご注意ください。

本邦では皮下注・筋注が認められておりますが、陽転率で10-30%の差があるため海外では、筋注以外の接種法は無効です。



UPTODATE
HepB vaccines are administered intramuscularly (IM) [49]. HepB vaccine administered by any route other than IM should not be counted as valid and should be repeated

Intradermal, subcutaneous or intramuscular administration of hepatitis B vaccine: side effects and antibody response
Scand J Infect Dis. 1987;19(6):617-21.
The trial was performed in 58 healthy volunteers 20-43 (mean 30) years old. No statistically significant difference in seroconversion rate was observed when the intradermal (i.d.) (2 micrograms) and intramuscular (i.m.) (20 micrograms) routes were compared (100% and 96% seroconversion, respectively). The 2 microgram dose administered subcutaneously gave a seroconversion rate of only 63%（皮下注）.

The importance of injecting vaccines into muscle
BMJ. 2000 Nov 18; 321(7271): 1237–1238.
Compared with intramuscular administration, subcutaneous injection of hepatitis B vaccine leads to significantly lower seroconversion rates and more rapid decay of antibody response
支持論文：
1) Poland GA, Borrud A, Jacobson RM, McDermott K, Wollan PC, Brakke D, et al. Determination of deltoid fat pad thickness: implications for needle length in adult immunization. JAMA. 1997;277:1709–1711
2) Shaw FE, Jr, Guess HA, Roets JM, Mohr FE, Coleman PJ, Mandel EJ, et al. Effect of anatomic site, age and smoking on the immune response to hepatitis B vaccination. Vaccine. 1989;7:425–430