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Article
April 25, 1986

Response to Deltoid Muscle Injection of Hepatitis B Vaccine After Failure to Respond to Gluteal Injections

Author Affiliations

University of North Carolina School of Medicine Chapel Hill

JAMA. 1986;255(16):2157. doi:10.1001/jama.1986.03370160055008
Abstract

To the Editor.—  We recently reported a multivariate analysis of the risk factors associated with a poor immunogenic response to the hepatitis B plasma vaccine among 194 employees of a community hospital.1 The vaccine had been stored and administered according to manufacturer's recommendations. Employees received all three doses of the vaccine in the buttock with a 2.5-cm, 23-gauge needle. Overall, only 56% (108/194) of the employees developed antibody to hepatitis B surface antigen (anti-HBs) as measured by the enzyme-linked immunosorbent assay (Abbott). A high body weight-height index (a measure of obesity) was found to be predictive of a lack of antibody response.To date, 41 of the 86 employees who initially failed to develop anti-HBs have received two additional doses of the vaccine in the deltoid using a 2.5-cm, 23-gauge needle. The initial repeated immunization was conducted 425 ± 15 days after the completion of the primary series, and

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