1School of Public Health, The University of Queensland, Australia. Electronic address: firstname.lastname@example.org.
2Queensland Children's Medical Research Institute, Brisbane, Australia.
3School of Public Health, The University of Queensland, Australia.
4Queensland Children's Medical Research Institute, Brisbane, Australia; WHO Collaborating Centre for Children's Health and Environment, The University of Queensland, Australia; Travel Medicine Alliance Clinics, Australia.
An estimated 5-10% of adults do not seroconvert after a three-dose primary course of hepatitis B vaccines, and are considered non-responders. Many approaches have been used to induce immunity in healthy adult non-responders, but few studies have compared their relative effectiveness. We conducted a systematic review and meta-analysis of seroconversion rates after additional doses of four approaches: 20mcg or 40mcg intramuscular (IM), and 5mcg or 20mcg intradermal (ID). The search identified 13 articles encompassing 16 studies (N=1067) that met the eligibility criteria. Seroconversion rates after additional doses of each approach were pooled and estimated. After one additional dose, the four approaches produced very similar seroconversion rates and we did not find any evidence to support the use of 40mcg IM in healthy adults.