human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve study of a low-dose ( one-tenth ) intradermal regimen using recombinant hepatitis B vaccine was undertaken during two consecutive years in 4th-year medical students . Eighty-one per cent of the vaccinees ( 123/152 ) sero-converted with anti-HBs levels of greater than 10 IU/l . The lower titre of hepatitis B surface antibodies compared with published studies on intramuscular immunisation , together with a sero-conversion rate of only 81 % , makes the intradermal method , in our opinion , a suboptimal form of hepatitis B immunisation A recombinant hepatitis B vaccine was administered to high-risk hospital personnel by intramuscular ( 20 micrograms ) or intradermal ( 2 micrograms ) injections for the primary immunization ( n = 69 ) with three doses and booster immunization ( n = 51 ) with one dose . Basic vaccination performed intramuscularly gave rise to significantly higher seroconversion levels ( 97.2 % versus 78.1 % ) and geometric mean titres of antibody ( 1649 versus 126 IUl-1 ) as compared with the intradermal route . Intradermal administration did not boost antibody titres in patients previously vaccinated intradermally . Adverse reactions were not serious or severe . The intramuscular route is recommended as the procedure of choice when vaccinating against hepatitis Health care workers at risk for hepatitis B virus infection are recommended for vaccination . Low-dose intradermal ( i.d . ) administration of vaccine has been suggested as a less expensive alternative to intramuscular ( i.m . ) inoculation . To evaluate the i.d . vaccination route , health care workers were included in a prospect i ve study . The subjects were vaccinated with 0.1 ml (= 2 microg ) recombinant vaccine ( Engerix B , SmithKline Beecham ) i.d . at 0 , 1 and 6 months . Two months after the third vaccination , measurement of the anti-HBs level was conducted . An anti-HBs level > or = 10 IU/l was considered protective . Those with an anti-HBs level < 10 IU/l were given a fourth dose with new serological control after another 2 months . The results are based on the 1406 subjects that it was possible to evaluate . The seroconversion rate to protective anti-HBs level after 3 doses was 68 % and after 3 or 4 doses 89 % . Factors associated with a lower response rate were increasing age ( p<0.05 ) and smoking ( p<0.001 ) . Sex or body mass index had no influence on the results . Vaccination technique seems to be of utmost importance when the i.d . route is used . Well instructed and experienced nurses are required and quality control with follow-up of overall seroconversion rate within each centre is needed The immunogenicity and reactogenicity of low-dose , recombinant DNA and plasma-derived hepatitis B vaccines were investigated in a prospect i ve , double-blind , r and omized , controlled trial . Volunteers ( 153 ) received either recombinant vaccine , 10 micrograms in 1 ml intramuscularly ; plasma-derived vaccine , 2 micrograms in 0.1 ml intradermally or recombinant vaccine , 1 microgram in 0.1 ml intradermally at 0 , 30 , and 150 days . Peak geometric mean concentrations of antibody to hepatitis B surface antigen at day 200 were 1094 , 387 , and 43 mIU/ml , respectively . By day 360 , these concentrations had fallen to 346 , 124 , and 19 mIU/ml , respectively ( P less than .05 between groups both date s ) . Number of subjects with antibody greater than or equal to 10 mIU/ml at day 200 was similar between the 10-micrograms recombinant and 2-micrograms plasma-derived groups ( 94 % vs. 90 % ) , while only 78 % of the 1-microgram recombinant group had protective concentrations of antibodies ( P less than .05 ) . Erythema and in duration occurred in most subjects in both intradermal groups , while pain was prominent at the intramuscular site especially after the second dose . Thus , plasma-derived vaccine , 2 micrograms in 0.1 ml intradermally , appears to be an acceptable cost-saving method for hepatitis B immunization , while recombinant-derived vaccine , 1 microgram in 0.1 ml intradermally , produced less satisfactory results The intradermal route of hepatitis B vaccine administration has been tested in several clinical trials and has produced various degrees of immunogenicity , but usually among small groups of participants . To assess more adequately the immunogenicity of hepatitis B vaccine using the intradermal route , the Centers for Disease Control conducted a clinical trial among 425 well health-care workers in a hospital setting . Participants were r and omly assigned to one of two treatment groups : those receiving a 20 micrograms intramuscular injection , and those receiving a 2 micrograms intradermal injection . Participants received the plasma-derived hepatitis B vaccine by the st and ard schedule at 0 , 1 and 6 months , and serum sample s were collected at 3 , 8 , 12 and 24 months after the first dose . Antibody response rates ( anti-HBs titre greater than or equal to 10 sample ratio units by radioimmunoassay ) for the intradermal vaccination group were consistently lower than those for the intramuscular vaccination group at each testing interval . The differences were greatest for the 3-month test and decreased over time . Geometric mean titres for anti-HBs for the intradermal group were significantly lower than those for the intramuscular group at the 8-month test point . In addition to inoculation route , factors of gender , smoking and age were found to have significant effects on immune response . The results suggest that intradermal vaccination with hepatitis B vaccine may be appropriate under certain conditions and for certain population subgroups In a r and omized controlled trial , 165 healthy medical students were immunized either by the intramuscular route ( IM group ) or by the intradermal route ( ID group ) with low-dose ( 2 micrograms ) plasma hepatitis B vaccine ( HB-VAX ) at months 0 , 1 , 2 , and 6 . At month 7 , protective immunity ( anti-HBs greater than 10 IU/l ) was observed in 90 % ( 95 % confidence interval [ Cl ] : 84 - 97 ) of group IM and in 94 % ( 95 % Cl : 89 - 99 ) of group ID ; also geometric mean titres ( IM : 533 IU/l ; ID:541 IU/l ) were very similar at month 7 . Sixty-six ( IM : 29 ; ID : 37 ) of 107 vaccinees with anti-HBs less than 1,000 IU/l at month 7 received a 2 micrograms booster injection at month 12 . Long-term immunity ( anti-HBs greater than 1,000 IU/l ) was finally observed in 58 % for group IM and 66 % for group ID . For low-dose hepatitis B immunization , which reduces costs to about 16 % , the IM route is to be preferred in young healthy individuals in view of an ease of administration , avoidance of long-term local side effects , and the known protective immunity of intramuscularly induced anti-HBs antibodies BACKGROUND Hepatitis B virus ( HBV ) infection is an occupational health hazard among the healthcare workers .  Vaccination against HBV has been established to be the most effective preventive strategy . The present study was design ed to assess the efficacy of low dose intradermal HBV vaccine among the nursing staff in a tertiary care hospital setting . PATIENTS AND METHODS Staff nurses working in our hospital were included in the study as vaccine recipients . Each staff nurse was tested for HBsAg and anti-HBs ( commercial ELISA ) . Those who tested negative for both the above markers were r and omized to receive either three doses of intramuscular ( i.m . ) HBV vaccine ( 20 micrograms m each dose ) at 0 , 1 and 6 month interval or three doses of intradermal HBV vaccine ( 2 micrograms m each dose ) at similar intervals . Each vaccine recipient was tested for the presence of anti HBs ( commercial ELISA ) at the end of 1 month and 1 year after the last dose of the vaccine . The anti-HBs titres were also estimated simultaneously in them . RESULTS Out of 153 staff nurses screened , 19 were either positive for HBsAg ( n = 1 ) or anti HBs ( n = 18 ) . 96(72 % ) of the remaining 134 nurses agreed to receive HBV vaccine ( i.m.--48 , intradermal--48 ) . At the end of 1 month after last dose of the vaccine , all vaccinees in both the group tested positive for anti-HBs . However the anti-HBs titres at 1 month were significantly higher among intramuscular vaccinees than the nurses receiving the vaccine through intra-dermal route ( 253 + /- 127.7 mIU/ml vs 151.3 + /- 92.8 mIU/ml , P < 0.001 ) . Eighty four ( 85.5 % ) of these 96 vaccine recipient were available for evaluation of anti-HBs titre at the end of 1 year after the last dose of vaccine ( 1 M group = 40 , Intradermal group = 44 ) . All the nurses continued to be positive for anti-HBs at the end of 1 year but the anti HBs-titre among i.m . vaccine recipient continued to remain at a significantly higher level than the similar titre among the intradermal vaccine recipients ( 256.4 + /- 124.7 mIU/ml vs 121.6 + /- 122.4 mIU/ml p < 0.001 ) . CONCLUSION Intradermal route for HBV vaccine had similar immunogenic efficacy as the conventional intramuscular route , but the dose required in the former route is one tenth of the intramuscular route . Therefore intradermal route may reduce the cost of HBV vaccine markedly Three trials of intradermal hepatitis B virus ( HBV ) vaccines were made in Gambian children . In the first trial HBV vaccine ( 1 microgram ) was given to neonates in the same syringe with BCG followed by two further does of 1.0 microgram of intradermal HBV vaccine . The trial was a failure , for 19 of 32 subjects had an HBV surface antibody response of less than 10 m.i.u./ml . In the second trial in young children two different regimes were used : two doses of 2 micrograms HBV vaccine were given intradermally after a 20 micrograms intramuscular dose or three doses of 2 micrograms were given intradermally . In both cases geometric mean antibody responses were significantly lower than in the control group who were given 20 micrograms HBV intramuscularly followed by two 10 micrograms doses intramuscularly . Vaccine failures , defined as the presence of HBV surface antigen or core antibody or absence of surface antibody , were also significantly higher in the intradermal groups . In the third trial 4 micrograms of vaccine were given intradermally to 20 young children with a multiple orifice head fired by a jet gun : all had a good HBV surface antibody response of greater than 100 m.i.u./ml of serum A total of 280 apparently healthy volunteers were screened for hepatitis B ( HB ) markers out of which 49 subjects ( 17.5 % ) were positive for HB surface antigen ( HBsAg ) and 82 ( 29.3 % ) were positive for antibody to HBsAg ( anti-HBs ) . Three doses of DMR-HB vaccine , 0.15 ml per dose were administered to 95 subjects , who were serologically negative for both HB markers . The vaccination was given by the intradermal route on the flexor surface of the left forearm , at 1 month intervals according to the 0 , 1 and 2 months schedule . The subjects were carefully monitored to record any adverse reaction of the vaccine . Blood specimen was collected from each subject , 1 month after the second and third vaccinations , to determine the anti-HBs antibody response to the vaccine . The study results showed that local pain was the only side effect noted and protective antibodies ( anti-HBs ) were detected in 69 ( 72.6 % ) of the vaccinees after the second dose of the vaccine and 89 ( 93.6 % ) after the third dose of the vaccine . Thus the intradermal route , which would require approximately one-seventh of the st and ard dose , would be suitable for use in certain groups such as high risk adults , when the cost of the vaccine is the inhibiting factor for routine or mass vaccination Two hundred infants and two hundred preschool children were r and omly assigned to receive either 10 micrograms of recombinant hepatitis 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve study of a low-dose ( one-tenth ) intradermal regimen using recombinant hepatitis B vaccine was undertaken during two consecutive years in 4th-year medical students . Eighty-one per cent of the vaccinees ( 123/152 ) sero-converted with anti-HBs levels of greater than 10 IU/l . The lower titre of hepatitis B surface antibodies compared with published studies on intramuscular immunisation , together with a sero-conversion rate of only 81 % , makes the intradermal method , in our opinion , a suboptimal form of hepatitis B immunisation A recombinant hepatitis B vaccine was administered to high-risk hospital personnel by intramuscular ( 20 micrograms ) or intradermal ( 2 micrograms ) injections for the primary immunization ( n = 69 ) with three doses and booster immunization ( n = 51 ) with one dose . Basic vaccination performed intramuscularly gave rise to significantly higher seroconversion levels ( 97.2 % versus 78.1 % ) and geometric mean titres of antibody ( 1649 versus 126 IUl-1 ) as compared with the intradermal route . Intradermal administration did not boost antibody titres in patients previously vaccinated intradermally . Adverse reactions were not serious or severe . The intramuscular route is recommended as the procedure of choice when vaccinating against hepatitis Health care workers at risk for hepatitis B virus infection are recommended for vaccination . Low-dose intradermal ( i.d . ) administration of vaccine has been suggested as a less expensive alternative to intramuscular ( i.m . ) inoculation . To evaluate the i.d . vaccination route , health care workers were included in a prospect i ve study . The subjects were vaccinated with 0.1 ml (= 2 microg ) recombinant vaccine ( Engerix B , SmithKline Beecham ) i.d . at 0 , 1 and 6 months . Two months after the third vaccination , measurement of the anti-HBs level was conducted . An anti-HBs level > or = 10 IU/l was considered protective . Those with an anti-HBs level < 10 IU/l were given a fourth dose with new serological control after another 2 months . The results are based on the 1406 subjects that it was possible to evaluate . The seroconversion rate to protective anti-HBs level after 3 doses was 68 % and after 3 or 4 doses 89 % . Factors associated with a lower response rate were increasing age ( p<0.05 ) and smoking ( p<0.001 ) . Sex or body mass index had no influence on the results . Vaccination technique seems to be of utmost importance when the i.d . route is used . Well instructed and experienced nurses are required and quality control with follow-up of overall seroconversion rate within each centre is needed The immunogenicity and reactogenicity of low-dose , recombinant DNA and plasma-derived hepatitis B vaccines were investigated in a prospect i ve , double-blind , r and omized , controlled trial . Volunteers ( 153 ) received either recombinant vaccine , 10 micrograms in 1 ml intramuscularly ; plasma-derived vaccine , 2 micrograms in 0.1 ml intradermally or recombinant vaccine , 1 microgram in 0.1 ml intradermally at 0 , 30 , and 150 days . Peak geometric mean concentrations of antibody to hepatitis B surface antigen at day 200 were 1094 , 387 , and 43 mIU/ml , respectively . By day 360 , these concentrations had fallen to 346 , 124 , and 19 mIU/ml , respectively ( P less than .05 between groups both date s ) . Number of subjects with antibody greater than or equal to 10 mIU/ml at day 200 was similar between the 10-micrograms recombinant and 2-micrograms plasma-derived groups ( 94 % vs. 90 % ) , while only 78 % of the 1-microgram recombinant group had protective concentrations of antibodies ( P less than .05 ) . Erythema and in duration occurred in most subjects in both intradermal groups , while pain was prominent at the intramuscular site especially after the second dose . Thus , plasma-derived vaccine , 2 micrograms in 0.1 ml intradermally , appears to be an acceptable cost-saving method for hepatitis B immunization , while recombinant-derived vaccine , 1 microgram in 0.1 ml intradermally , produced less satisfactory results The intradermal route of hepatitis B vaccine administration has been tested in several clinical trials and has produced various degrees of immunogenicity , but usually among small groups of participants . To assess more adequately the immunogenicity of hepatitis B vaccine using the intradermal route , the Centers for Disease Control conducted a clinical trial among 425 well health-care workers in a hospital setting . Participants were r and omly assigned to one of two treatment groups : those receiving a 20 micrograms intramuscular injection , and those receiving a 2 micrograms intradermal injection . Participants received the plasma-derived hepatitis B vaccine by the st and ard schedule at 0 , 1 and 6 months , and serum sample s were collected at 3 , 8 , 12 and 24 months after the first dose . Antibody response rates ( anti-HBs titre greater than or equal to 10 sample ratio units by radioimmunoassay ) for the intradermal vaccination group were consistently lower than those for the intramuscular vaccination group at each testing interval . The differences were greatest for the 3-month test and decreased over time . Geometric mean titres for anti-HBs for the intradermal group were significantly lower than those for the intramuscular group at the 8-month test point . In addition to inoculation route , factors of gender , smoking and age were found to have significant effects on immune response . The results suggest that intradermal vaccination with hepatitis B vaccine may be appropriate under certain conditions and for certain population subgroups In a r and omized controlled trial , 165 healthy medical students were immunized either by the intramuscular route ( IM group ) or by the intradermal route ( ID group ) with low-dose ( 2 micrograms ) plasma hepatitis B vaccine ( HB-VAX ) at months 0 , 1 , 2 , and 6 . At month 7 , protective immunity ( anti-HBs greater than 10 IU/l ) was observed in 90 % ( 95 % confidence interval [ Cl ] : 84 - 97 ) of group IM and in 94 % ( 95 % Cl : 89 - 99 ) of group ID ; also geometric mean titres ( IM : 533 IU/l ; ID:541 IU/l ) were very similar at month 7 . Sixty-six ( IM : 29 ; ID : 37 ) of 107 vaccinees with anti-HBs less than 1,000 IU/l at month 7 received a 2 micrograms booster injection at month 12 . Long-term immunity ( anti-HBs greater than 1,000 IU/l ) was finally observed in 58 % for group IM and 66 % for group ID . For low-dose hepatitis B immunization , which reduces costs to about 16 % , the IM route is to be preferred in young healthy individuals in view of an ease of administration , avoidance of long-term local side effects , and the known protective immunity of intramuscularly induced anti-HBs antibodies BACKGROUND Hepatitis B virus ( HBV ) infection is an occupational health hazard among the healthcare workers .  Vaccination against HBV has been established to be the most effective preventive strategy . The present study was design ed to assess the efficacy of low dose intradermal HBV vaccine among the nursing staff in a tertiary care hospital setting . PATIENTS AND METHODS Staff nurses working in our hospital were included in the study as vaccine recipients . Each staff nurse was tested for HBsAg and anti-HBs ( commercial ELISA ) . Those who tested negative for both the above markers were r and omized to receive either three doses of intramuscular ( i.m . ) HBV vaccine ( 20 micrograms m each dose ) at 0 , 1 and 6 month interval or three doses of intradermal HBV vaccine ( 2 micrograms m each dose ) at similar intervals . Each vaccine recipient was tested for the presence of anti HBs ( commercial ELISA ) at the end of 1 month and 1 year after the last dose of the vaccine . The anti-HBs titres were also estimated simultaneously in them . RESULTS Out of 153 staff nurses screened , 19 were either positive for HBsAg ( n = 1 ) or anti HBs ( n = 18 ) . 96(72 % ) of the remaining 134 nurses agreed to receive HBV vaccine ( i.m.--48 , intradermal--48 ) . At the end of 1 month after last dose of the vaccine , all vaccinees in both the group tested positive for anti-HBs . However the anti-HBs titres at 1 month were significantly higher among intramuscular vaccinees than the nurses receiving the vaccine through intra-dermal route ( 253 + /- 127.7 mIU/ml vs 151.3 + /- 92.8 mIU/ml , P < 0.001 ) . Eighty four ( 85.5 % ) of these 96 vaccine recipient were available for evaluation of anti-HBs titre at the end of 1 year after the last dose of vaccine ( 1 M group = 40 , Intradermal group = 44 ) . All the nurses continued to be positive for anti-HBs at the end of 1 year but the anti HBs-titre among i.m . vaccine recipient continued to remain at a significantly higher level than the similar titre among the intradermal vaccine recipients ( 256.4 + /- 124.7 mIU/ml vs 121.6 + /- 122.4 mIU/ml p < 0.001 ) . CONCLUSION Intradermal route for HBV vaccine had similar immunogenic efficacy as the conventional intramuscular route , but the dose required in the former route is one tenth of the intramuscular route . Therefore intradermal route may reduce the cost of HBV vaccine markedly Three trials of intradermal hepatitis B virus ( HBV ) vaccines were made in Gambian children . In the first trial HBV vaccine ( 1 microgram ) was given to neonates in the same syringe with BCG followed by two further does of 1.0 microgram of intradermal HBV vaccine . The trial was a failure , for 19 of 32 subjects had an HBV surface antibody response of less than 10 m.i.u./ml . In the second trial in young children two different regimes were used : two doses of 2 micrograms HBV vaccine were given intradermally after a 20 micrograms intramuscular dose or three doses of 2 micrograms were given intradermally . In both cases geometric mean antibody responses were significantly lower than in the control group who were given 20 micrograms HBV intramuscularly followed by two 10 micrograms doses intramuscularly . Vaccine failures , defined as the presence of HBV surface antigen or core antibody or absence of surface antibody , were also significantly higher in the intradermal groups . In the third trial 4 micrograms of vaccine were given intradermally to 20 young children with a multiple orifice head fired by a jet gun : all had a good HBV surface antibody response of greater than 100 m.i.u./ml of serum A total of 280 apparently healthy volunteers were screened for hepatitis B ( HB ) markers out of which 49 subjects ( 17.5 % ) were positive for HB surface antigen ( HBsAg ) and 82 ( 29.3 % ) were positive for antibody to HBsAg ( anti-HBs ) . Three doses of DMR-HB vaccine , 0.15 ml per dose were administered to 95 subjects , who were serologically negative for both HB markers . The vaccination was given by the intradermal route on the flexor surface of the left forearm , at 1 month intervals according to the 0 , 1 and 2 months schedule . The subjects were carefully monitored to record any adverse reaction of the vaccine . Blood specimen was collected from each subject , 1 month after the second and third vaccinations , to determine the anti-HBs antibody response to the vaccine . The study results showed that local pain was the only side effect noted and protective antibodies ( anti-HBs ) were detected in 69 ( 72.6 % ) of the vaccinees after the second dose of the vaccine and 89 ( 93.6 % ) after the third dose of the vaccine . Thus the intradermal route , which would require approximately one-seventh of the st and ard dose , would be suitable for use in certain groups such as high risk adults , when the cost of the vaccine is the inhibiting factor for routine or mass vaccination Two hundred infants and two hundred preschool children were r and omly assigned to receive either 10 micrograms of recombinant hepatitis 
    Output:
    