TITLE

New Recommendations for the Prevention of Hepatitis A

AUTHOR(S)
Deresinski, Stan
PUB. DATE
January 2008
SOURCE
Travel Medicine Advisor;Jan2008, Vol. 18 Issue 1, p1
SOURCE TYPE
Periodical
DOC. TYPE
Article
ABSTRACT
Previously, the recommendation in the United States for post-exposure prophylaxis of hepatitis A virus (HAV) infection has consisted of the administration of a single dose of immune serum globulin (ISG). While some other countries recommended the use of HAV vaccine for this purpose, the evidence to support this stance had been judged to be inadequate. New data, however, have now led to a change in recommendations in the United States. Victor and colleagues randomized household and day-care center contacts of individuals with acute hepatitis A virus (HAV) infection who were 2 to 40 years of age to receive, within 14 days after exposure, either a single dose of HAV vaccine or of immune serum globulin. Of the 1414 subjects who were susceptible to HAV infection, 1090 were included in the final analysis of this study performed in Kazakhstan. The mean age of the subjects was 12 years and the mean interval from exposure to prophylaxis receipt was 18 days. Laboratory-confirmed symptomatic HAV infection occurred in 25 (4.4%) of the vaccine recipients and in 17 (3.3%) of those given ISG (relative risk, 1.35; 95% CI, 0.70 to 2.67), thus meeting pre-set criteria for non-inferiority of vaccine prophylaxis. It is noted by Victor et al, however, that at all study points examined, infection rates for vaccine recipients were higher than those observed in those given ISG. Nonetheless, "the risk of infection in the vaccine group was never more than 1.5% greater than that in the immune globulin group." These results have led to a change in the APIC and CDC recommendations for post-exposure prophylaxis of HAV infection, as well as for prophylaxis in the international traveler, as discussed below.
ACCESSION #
28720239

 

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