TY - JOUR
T1 - Comparison of equivalent fractional vaccine doses delivered by intradermal and intramuscular or subcutaneous routes: A systematic review
AU - Schnyder, Jenny L.
AU - Garcia Garrido, Hannah M.
AU - de Pijper, Cornelis A.
AU - Daams, Joost G.
AU - Stijnis, Cornelis
AU - Goorhuis, Abraham
AU - Grobusch, Martin P.
N1 - Publisher Copyright: © 2021 The Author(s)
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Background: For certain vaccines, dosing can be reduced by intradermal (ID) immunization without loss of immunogenicity, as an alternative to standard routes of administration. However, a certain level of dose-sparing might also be achieved by reducing doses of intramuscular (IM) or subcutaneous (SC) vaccines. Method: We conducted a systematic review comparing identical reduced amounts of antigen delivered by either ID, or IM/SC routes (PROSPERO registration no. CRD42020151725). Results: Of 6015 articles identified, we included 26 articles, covering eight different vaccines. Equivalent immune responses were demonstrated in 19/26 studies, and 7/26 studies suggested inferior immune responses after IM/SC immunization. Conclusions: We conclude that fractional dosed IM/SC vaccination is at best as immunogenic, but potentially inferior to ID vaccination. The safety profiles were at large comparable, although minor local adverse events were more common after ID delivery. Future vaccine trials, depending on the platform used, should add a fractional dose IM/SC arm, besides a fractional dose ID arm.
AB - Background: For certain vaccines, dosing can be reduced by intradermal (ID) immunization without loss of immunogenicity, as an alternative to standard routes of administration. However, a certain level of dose-sparing might also be achieved by reducing doses of intramuscular (IM) or subcutaneous (SC) vaccines. Method: We conducted a systematic review comparing identical reduced amounts of antigen delivered by either ID, or IM/SC routes (PROSPERO registration no. CRD42020151725). Results: Of 6015 articles identified, we included 26 articles, covering eight different vaccines. Equivalent immune responses were demonstrated in 19/26 studies, and 7/26 studies suggested inferior immune responses after IM/SC immunization. Conclusions: We conclude that fractional dosed IM/SC vaccination is at best as immunogenic, but potentially inferior to ID vaccination. The safety profiles were at large comparable, although minor local adverse events were more common after ID delivery. Future vaccine trials, depending on the platform used, should add a fractional dose IM/SC arm, besides a fractional dose ID arm.
KW - Drug administration routes
KW - antibody response
KW - intradermal injection
KW - intramuscular injection
KW - subcutaneous injection
KW - vaccination
UR - http://www.scopus.com/inward/record.url?scp=85103025387&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.tmaid.2021.102007
DO - https://doi.org/10.1016/j.tmaid.2021.102007
M3 - Review article
C2 - 33711425
SN - 1477-8939
VL - 41
JO - Travel medicine and infectious disease
JF - Travel medicine and infectious disease
M1 - 102007
ER -