Comparison of the Immunogenicity of Various Booster Doses of Inactivated Polio Vaccine Delivered Intradermally Versus Intramuscularly to HIV-Infected Adults

Abstract

Background: Inactivated polio vaccine (IPV) is necessary for global polio eradication because oral polio vaccine can rarely cause poliomyelitis as it mutates and may fail to provide adequate immunity in immunocompromised populations. However, IPV is unaffordable for many developing countries. Intradermal IPV shows promise as a means to decrease the effective dose and cost of IPV, but prior studies, all using 20% of the standard dose used in intramuscular IPV, resulted in inferior antibody titers.

Methods: We randomly assigned 231 adults with well-controlled human immunodeficiency virus infection at a ratio of 2:2:2:1 to receive 40% of the standard dose of IPV intradermally, 20% of the standard dose intradermally, the full standard dose intramuscularly, or 40% of the standard dose intramuscularly. Intradermal vaccination was done using the NanoPass MicronJet600 microneedle device.

Results: Baseline immunity was 87%, 90%, and 66% against poliovirus serotypes 1, 2, and 3, respectively. After vaccination, antibody titers increased a median of 64-fold. Vaccine response to 40% of the standard dose administered intradermally was comparable to that of the standard dose of IPV administered intramuscularly and resulted in higher (although not significantly) antibody titers. Intradermal administration had higher a incidence of local side effects (redness and itching) but a similar incidence of systemic side effects and was preferred by study participants over intramuscular administration.

Conclusions: A 60% reduction in the standard IPV dose without reduction in antibody titers is possible through intradermal administration.

Keywords: HIV; fractional dose; inactivated polio vaccine; intradermal; polio; vaccine.

© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Figures

Figure 1.

Baseline polio immunity, by age group in years. There were 30, 33, 79, 74, and 15 subjects aged 21–30, 31–40, 41–50, 51–60, and >60 years, respectively. The 95% confidence intervals of each proportion were calculated using the modified Wald method. A 2-tailed Fisher exact test revealed that the only significant differences in baseline immunity between age groups were for serotype 3 between the group aged 21–30 years and the groups aged 31–40 and 41–50 years (P = .03 and .04, respectively). Of note, the first 3 age groups (21–50 years) likely received oral polio vaccine as children and likely were not exposed to wild poliovirus, and the last 2 age groups (>51 years) likely received inactivated polio vaccine as children and may have been exposed to wild poliovirus.