Elsevier

Vaccine

Volume 30, Issue 21, 2 May 2012, Pages 3155-3158
Vaccine

Short communication
Effect of needle length for response to hepatitis B vaccine in macrosomic neonates: A prospective randomized study

https://doi.org/10.1016/j.vaccine.2012.02.068Get rights and content

Abstract

Objectives

The objective of this study was to determine whether use of a longer (1 in.) rather than a standard (5/8 in.) needle used for macrosomic neonates (birthweight over 4000 g) may affect antibody titers after immunization against hepatitis B virus (HBV).

Methods

Fifty nine healthy infants were vaccinated at birth, 1, and 6 months of age with hepatitis B vaccine, with follow up to 7 months of age. Infants were randomized into two groups according to needle length of first vaccine at birth. First group vaccinated with standart needle length and other group received vaccine by longer needle length.

Results

Macrosomic infants who were immunized with a longer needle achieved significantly higher antibody titers to hepatitis B surface antigen than standart needle length (median, 3890.2 vs 1311.7 mIU/mL, respectively; p = 0.001).

Conclusions

Macrosomic neonates benefit from longer needle length with higher levels of antibody titers after HBV vaccination.

Highlights

► Macrosomic infants need longer needle length for HBV vaccination. ► This procedure support the “adecuate muscle penetration” hypothesis for vaccines. ► Neonatal HBV vaccination is important for HBV protection for remaining lifetime.

Introduction

Hepatitis B virus (HBV) is a significant health problem worldwide, with an estimated 350 million people infected. In the United States, 700,000–1.4 million people are infected with the virus, and most are unaware of their infection status. The risk for chronic HBV infection is highest with neonatal acquisition. As many as 90% of infants who acquire HBV infection from their mothers at birth become chronically infected, compared with 30–50% of children infected at ages 1–5 years [1], [2]. Immunisation is the most effective way to prevent HBV transmission and the consequent development of acute or chronic hepatitis B. In the 1990s, the World Health Organisation (WHO) set a goal for all countries to introduce HBV vaccine into national routine infant immunization programs by 1997 [3]. Countries such as Turkey now administer HBV vaccine at birth and at 1 and 6 months of age.

The appropriate needle length for the vaccination depends on age and body mass. The Centers for Disease Control (CDC) and Prevention state that for all intramuscular injections, the needle should be long enough to reach the muscle mass in order to prevent the vaccine from seeping into subcutaneous tissue. The decisions on needle size and the injection site must be made for each child based on the size of the muscle and the thickness of the adipose tissue at the injection site [4]. The CDC and the American Academy of Pediatrics both recommend using a 5/8-in.-long needle in neonates (first 28 days of life) and a 1-in.-long needle in infants (1–12 months) [4].

Several studies have demonstrated that obese adolescents and adults achieve lower antibody titres in response to hepatitis B virus vaccine [5]. Middleman et al. reported that a longer needle length resulted in higher antibody titres among adolescents who were immunised with HBV in the thigh [5]. Conversely, Çekmez et al. found that macrosomic infants with a birth weight of more than 4000 g had lower antibody levels than small- and appropriate-for-gestational age infants after immunisation with needles of the same length [6]. No data are available on the immune response of macrosomic neonates to vaccination with various needle lengths. The objective of this study was to determine whether the use of a longer, rather than a standard, needle in macrosomic neonates would result in higher antibody titres after immunisation against HBV.

Section snippets

Materials and methods

All term macrosomic neonates (birth weight >4000 g) born in Zekai Tahir Burak Maternity Teaching Hospital (Ankara, Turkey) between February 2011 and April 2011 were included in the study. Informed consent and ethics approval were obtained before initiation of the study.

Demographic data, including maternal infections and anthropometric measures such as weight and thigh and arm circumferences, were collected using standard methods. Using a random numbers table, starting at the beginning, those who

Results

During the study period, 102 infants were born with birth weights of more than 4000 g. Forty-three infants were excluded for HBsAg positivity (n = 8), cord blood antibody titre >20 IU/ml (n = 10), parent refusal (n = 19), and lack of follow-up (n = 6). In total, 59 infants met the eligibility criteria (Fig. 1). There were 30 infants in the 5/8-in. group and 29 infants in the 1-in. group. The mean birth weight (4273 vs. 4221 g, 5/8-in. vs. 1-in. group; p = 0.4) and gestational age at birth (40.1 vs. 39.9

Discussion

Immunisation is the most effective way to prevent the transmission of HBV and the consequent development of acute or chronic hepatitis B. The national strategy to eliminate transmission of the virus in the United States includes vaccination of all newborn infants, children, adolescents, and high-risk adults. Seroprotection after vaccination is achieved in more than 95% of all vaccinees [9]. A poor antibody response to hepatitis B vaccine has been reported in obese individuals and overweight

References (11)

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