HYPORESPONSIVENESS TO INTRADERMAL ADMINISTRATION OF HEPATITIS-B VACCINE IN INSULIN-DEPENDENT DIABETES-MELLITUS

The immune response to intradermal or intramuscular hepatitis B vaccin e in 18 children with insulin dependent diabetes (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 hypersensitivit y (DTH) tests on children with IDDM and controls. No difference in the immune response (antihepatitis B surface antigen antibody titres) was found with intramuscular administration, whereas with intradermal adm inistration a statistically lower immune response (p < 0.001) was obse rved in children with IDDM v controls. This hyporesponsiveness cannot be attributed to HLA class II antigen distribution because their frequ ency was the same in both groups of children with IDDM. It is suggeste d that the poor immune response to intradermal hepatitis B vaccine may be due to impaired macrophage activity resulting in failure of antige n presentation, which may be of importance in the immune dysfunction i n 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 w hen compared with controls. It is therefore suggested that when the he patitis B vaccination is offered to children with IDDM it may be prefe rable to give it intramuscularly.