To the Editor.
—Drs Margolis and Presson do not mention skin testing in their Editorial on hepatitis B vaccination.1 This may be an ill-advised omission, because a skin test response gives valuable information about the cellular limb of an individual's immune response. That reaction is important in infections and vaccinations with hepatitis B. In the former, there is evidence that patients who mount a strong cellular response avoid chronic hepatitis.2In vaccinees who get a subunit antigen, it would seem crucial to define the result by measuring not only antibody, but also intradermal reaction, since there can be disparity between the two shortly after vaccination and years later if antibody wanes. The significance of this needs to be ascertained. However, if skin test positivity is present, this would point not merely to retention of immune memory, but also to capability for some effector response. Thus, antibody level does
Needles CF. Immunogenicity of Hepatitis B Vaccines. JAMA. 1994;272(3):201-202. doi:10.1001/jama.1994.03520030041019