Intradermal, epidermal and transcutaneous vaccination: from immunology to clinical practice

Abstract

The dermis and epidermis are alternative sites for prophylactic vaccination that have received renewed interest in recent years, not only because of the ease of access to the skin, but also its unique immunological properties. This review discusses the characteristics of the skin, current knowledge on skin immunity and clinical experience with cutaneous immunization against infectious diseases, with a special focus on intradermal immunization. The most widely accepted paradigm explaining the efficacy of cutaneous immunization is reviewed and recent research suggesting where this paradigm may need some refinement is highlighted. Clinical investigations that have concentrated on the intradermal route to vaccinate against influenza, rabies or hepatitis B support the current knowledge on skin immunity and, when combined with recent progress made in the development of user-friendly injection systems, have stimulated the ongoing clinical development of novel vaccines.

Keywords::

• dermal dendritic cell
• epidermal vaccination
• immunology
• intradermal vaccination
• skin
• transdermal vaccination

Acknowledgements

J-F Nicolas and B Guy would like to acknowledge Jean Kanitakis at Édouard Herriot Hospital in Lyon for kindly providing the histological images, Florence Boudet and Fred Vogel at Sanofi Pasteur for their insight, and Grenville Marsh at Sanofi Pasteur, for editorial assistance in preparing this manuscript. We would also like to acknowledge the numerous important contributions to the field of skin immunity and vaccination that have not been cited in our review, which was not intended as an exhaustive review of all studies done in this field.

Financial & competing interests disclosure

J-F Nicolas has participated in scientific expert discussions and meetings organized by sanofi pasteur and Sanofi Pasteur, MSD without receiving honoraria and declares to have no relevant affiliations or financial involvement with any organization or entity with a financial interest or financial conflict with the subject matter or materials discussed in the manuscript. B Guy is employed by sanofi pasteur. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Editorial assistance was provided by G Marsh at Sanofi Pasteur.