Hepatitis B vaccine booster dose: Low-dose recombinant hepatitis B vaccines as a booster dose

Background: The timing and best regimen for a booster dose of hepatitis B vaccine have not been determined. Methods: Two studies were conducted to determine the response to a booster dose of 5 mu g recombinant hepatitis B vaccine. In the first study, a 5 mu g (0.5 ml) dose of Recombivax HB was administered intramuscularly 38 months after the initial dose to 71 volunteers. In a second study, we offered a 5 mu g dose recombinant hepatitis B vaccine, either Recombivax HB (0.5 ml) or Engerix B (0.25 ml), to students who had previously been immunized with three doses of vaccine. Results: In the first study, among the 44 persons for whom postbooster sera were available, the geometric mean concentration of anti-hepatitis B surface antigens increased from 42 to 2090 mIU/ml after the 5 mu g (0.5 ml) dose of Recombivax. In the second study, after a 5 mu g (0.5 ml) dose of Recombivax, the geometric mean concentration increased from 43 to 990 mIU/ml (n = 48), and in the group that received a 5 mu g (0.25 ml) dose of Engerix B, the concentration increased from 83 to 2337 mIU/ml (n = 45) (p = 0.18 for postdose concentrations). Conclusion: A 5 mu g dose of recombinant vaccine results in an excellent booster response at a cost one fourth to one half that of a full 1 ml dose of vaccine.