Intradermal vaccine delivery: Will new delivery systems transform vaccine administration?

doi:10.1016/j.vaccine.2008.03.095

Vaccine

Volume 26, Issue 26, 19 June 2008, Pages 3197-3208

https://doi.org/10.1016/j.vaccine.2008.03.095 Get rights and content

Abstract

There has been a recent resurgence of interest in intradermal vaccine delivery. The physiological advantages of intradermal vaccine delivery have been known for some time, but the difficulties associated with performing an intradermal injection have historically limited its use. New delivery systems currently in development facilitate convenient intradermal vaccination, unlocking the potential advantages of this delivery route, and potentially transforming vaccine delivery.

Section snippets

History of intradermal vaccination

The discovery of the principles of vaccination is often described as one of the most important developments in public health. The practice of inoculating small amounts of material from sick patients, such as powdered smallpox scabs or pus, into the nose or skin of healthy individuals to prevent disease was widespread across parts of Africa, Asia and the Ottoman empire, before inoculation into the skin – variolation – was introduced to Europe in 1721. Inoculated patients would generally develop

Current situation and future needs of innovative vaccine delivery systems

An ideal vaccine is safe, cost-effective, and efficient after a single dose [34]. The way in which a vaccine is delivered can have considerable bearing on these factors through its influence on the efficiency of the procedure, the dose required, compliance, and safety. For vaccination to succeed holistically in contributing to public health, vaccine delivery systems must allow efficient delivery without compromising product stability during storage and transport and without negatively

Skin anatomy

An increasing understanding of skin physiology means that this organ is now recognized as a potentially excellent site for vaccination. It is easily accessible and has both cellular and humoral immune system components. The skin is comprised of three primary layers from outside to inside: epidermis, dermis and hypodermis (Fig. 1). Vaccine delivery into these layers is known, respectively as transdermal, intradermal and subcutaneous vaccination.

The epidermis is the outermost layer of the skin

Clinical experience, techniques and devices for intradermal vaccination

Considerable clinical research has been conducted to compare the intradermal route with other routes of vaccine delivery (Table 2) and into new techniques for intradermal delivery to eliminate some of the problems associated with the methods currently available. This section will describe the available techniques, as well as those in clinical research or earlier development.

Conclusions

As recognition of the potential of the dermis to generate powerful immune responses has grown, pressure has increased to develop intradermal delivery methods to take full advantage of this ideal vaccination site, whilst overcoming the drawbacks of traditional intradermal injection methods. Indeed, although numerous clinical studies have confirmed the comparable or superior immunogenicity of this route compared with standard intramuscular or subcutaneous routes, the difficulty of correctly

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ReviewIntradermal vaccine delivery: Will new delivery systems transform vaccine administration?

Abstract

Section snippets

History of intradermal vaccination

Current situation and future needs of innovative vaccine delivery systems

Skin anatomy

Clinical experience, techniques and devices for intradermal vaccination

Conclusions

Biologicals

Lancet

Lancet

Vaccine

Lancet

Lancet

Vaccine

Vaccine

Am J Kidney Dis

Vaccine

Adv Drug Deliv Rev

Vaccine

Curr Opin Immunol

Vaccine

Immunity

Vaccine

J Photochem Photobiol

Chest

Lancet

Public Health

Tubercle Lung Dis

Vaccine

Vaccine

Offit PA vaccines

L’intradermo-réaction a la tuberculine et son interprétation clinique

Presse Medicale

Percutaneous or intradermal BCG vaccine?

J Pediatria

Antibody response of patients after postexposure rabies vaccination with small intradermal doses of purified chick embryo cell vaccine or purified Vero cell rabies vaccine

Bull WHO

A simplified technique for vaccination against small pox

Pediatrics

Active immunization against thyphoid fever, with particular reference to an intradermal method

J Lab Clin Med

Comparative study of the antibody response after various methods of administration of mixed thyphoide vaccine

J Infect Dis

The antibody response of human subjects vaccinated with the virus of human influenza

J Exp Med

Influenza vaccination: comparison of intracutaneous and subcutaneous methods

Naval Med Bull

Immunlogic reactions following the intradermal inoculation of influenza A and B vaccine

Proc Soc Exp Biol Med

Comparative trial of live attenuated measles vaccine in Hong Kong by intramuscular and intradermal injection

Bull WHO

Comparison of intradermal and subcutaneous routes of cholera vaccine administration

Lancet

Economical multiple-site intradermal immunization with human diploid-cell-strain vaccine intradermal immunisationwith human diploid-cell-strain vaccine is effective for post-exposure rabies prophylaxis

Lancet

Intradermal hepatitis B virus vaccination

N Z Med J

Intradermal inoculation with hepatavax-B immune response and histologic evaluation of injection sites

JAMA

Antibody responses of patients alter postexposure rabies vaccination with small intradermal doses of purified chick embryo cell vaccine or purified Vero cell rabies vaccine

Bull WHO

Intradermal hepatitis B vaccination

Ann Parmacother

Immune response of intradermal hepatitis B vaccination at lower dose versus intramuscular vaccination at double standard dose in predialytic chronic renal failure patients

J Med Assoc Thai

Comparative immunogenicity of trivalent influenza vaccine administered by intradermal or intramuscular route in healthy adults

Vaccine

Immunization with Asian-strain influenza vaccine

N Engl J Med

Immunogenicity of a novel influenza vaccine delivered by intradermal microinjection in over 60 year-olds

The safety and efficacy of dose-sparing intradermal administration of influenza vaccine in immunodeficiency virus-positive patients

Arch Intern Med

Duration of immunity after B vaccination: efficacy of low dose booster vaccine

Ann Inter Med

Vaccine development strategies for improving immunization: the role of modern immunology

Nat Immunol

Unsafe injections in the developing world and transmission of bloodborne pathogens: a review

Bull WHO

Safety of immunization injections in Africa: not simply a problem of logistics

Review
Intradermal vaccine delivery: Will new delivery systems transform vaccine administration?