JAMDA 15 (2014) 773e774
JAMDA journal homepage: www.jamda.com
Letters to the Editor
Intradermal Trivalent Inﬂuenza Vaccination in Nursing Home Older Adults To the Editor: The recent report on “Intradermal Trivalent Inﬂuenza Vaccination in Nursing Home Older Adults” is very interesting.1 Chan et al1 concluded that “ID vaccination is noninferior, and even superior in some parts of immunogenicity assessment, to IM vaccination without compromising safety in nursing home older adults.” In fact, there are many considerations on the present study. First, it must be noted that “the immune response appears to partially depend on the delivery device and route of injection.”2 The technique and injection device must be well selected to get the most appropriate immune response.2,3 The basic pitfall in medical practice is the incorrect intradermal administration technique. In addition, to get the best immunogenicity, a speciﬁc device for intradermal administration is required for successful intradermal delivery.2 Second, although the intradermal inﬂuenza vaccination is considered safe, a higher rate of local adverse effects (such as pain and erythema) is reported in some settings.4,5 References 1. Chan TC, Hung IF, Chan KH, et al. Immunogenicity and safety of intradermal trivalent inﬂuenza vaccination in nursing home older adults: A randomized controlled trial [published online ahead of print June 21, 2014]. J Am Med Dir Assoc. pii: S1525-8610(14)00285e0. 2. Levin Y, Kochba E, Kenney R. Clinical evaluation of a novel microneedle device for intradermal delivery of an inﬂuenza vaccine: Are all delivery methods the same? Vaccine 2014;32:4249e4252. 3. Van Damme P, Oosterhuis-Kafeja F, Van der Wielen M, et al. Safety and efﬁcacy of a novel microneedle device for dose sparing intradermal inﬂuenza vaccination in healthy adults. Vaccine 2009;27:454e459. 4. Hoon Han S, Hee Woo J, Weber F, et al. Immunogenicity and safety of Intanza(Ò)/IDﬂu(Ò) intradermal inﬂuenza vaccine in South Korean adults: A multicenter, randomized trial. Hum Vaccin Immunother 2013;9: 1971e1977. 5. Esposito S, Daleno C, Picciolli I, et al. Immunogenicity and safety of intradermal inﬂuenza vaccine in children. Vaccine 2011;29:7606e7610.
Viroj Wiwanitkit, MD Hainan Medical University, China Faculty of Medicine, University of Nis, Serbia Joseph Ayobabalola University, Nigeria Surin Rajabhat University, Thailand
Response to Comments on “Immunogenicity and Safety of Intradermal Trivalent Inﬂuenza Vaccination in Nursing Home Older Adults: A Randomized Controlled Trial” To the Editor: We thank Professor Wiwanitkit for his important comments, to which we agreed. First, although intradermal (ID) vaccination may induce noninferior or even superior immunogenicity, it may be more difﬁcult to deliver without a speciﬁc device. The technique also requires extra training when compared with intramuscular (IM) vaccination1 and the injection technique improves with experience. Incorrect administration affects the induced immunogenicity.2 Development of various ID vaccination devices makes ID vaccination less technically demanding. Nevertheless, immunogenicity induced by different devices may vary, which is supported by the randomized trial performed by Hung et al.3 That study compared the immunogenicity among IM inﬂuenza vaccination, ID vaccination using the BD Soluvia device (Intanza; Sanoﬁ-Pasteur, Lyon, France), and ID vaccination using the MicronJet600 (NanoPass Technologies, Nes Ziona, Israel). The immunogenicity of the ID group using the MicronJet600 appeared to be better than the ID group using the Soluvia device, which may be because of differences in the 2 microinjection systems. The Soluvia device has a single 1.5-mm needle penetrating perpendicularly to the skin and may result in a substantial proportion of the vaccination being injected into subcutaneous tissue. The MicronJet600 has 3 microneedles, each 0.6 mm in length, puncturing obliquely into the skin, and hence decreases the proportion of vaccination injected into subcutaneous tissue. Nevertheless, both ID devices resulted in better immunogenicity than IM vaccination. We agreed that ID vaccination has more local adverse effects. Our study demonstrated that these adverse effects were mild and resolved within 72 hours.4 It concurred with the vaccine report by Moro et al,5 which suggested that local adverse effects are the most common. However, according to the study performed by Durando et al,6 which compared acceptance between ID and IM vaccination among 500 elderly individuals, there was no signiﬁcant difference for acceptability and willingness to revaccinate between the 2 groups. References
Dr DY Patil Medical College, India http://dx.doi.org/10.1016/j.jamda.2014.07.004
1. Chi RC, Rock MT, Neuzil KM. Immunogenicity and safety of intradermal inﬂuenza vaccination in healthy older adults. Clin Infect Dis 2010;50:1331e1338. 2. Levin Y, Kochba E, Kenney R. Clinical evaluation of a novel microneedle device for intradermal delivery of an inﬂuenza vaccine: Are all delivery methods the same? Vaccine 2014;32:4249e4252.