Preventing and treating hepatitis B infection
http://www.100md.com
《英国医生杂志》
EDITOR—The immunisation advice in the hepatitis B review by Aggarwal and Ranjan is potentially misleading.1
Firstly, recommending three doses at 0, 1, and 6 months is unnecessarily limiting; delaying the third dose can lead to lower compliance. Hepatitis B vaccine has been shown to be immunogenic when a wide range of schedules is used.2 Although increasing the time between the second and third doses leads to higher antibody concentrations, it seems to be the immune memory rather than antibody concentrations that is of primary importance. A two dose schedule was approved for adolescents in the United States in 1999; it has also been suggested as being adequate for infants.3
Secondly, the importance of hepatitis B immune globulin is overstated. It provides comparatively little additional protection to immunisation in preventing infection in infants of HBeAg positive mothers.4 5
Thirdly, although recommending giving vaccine to infants of HBeAg positive mothers as soon as possible after birth is reasonable, the data are limited on the precise timing. A dose of hepatitis B vaccine given with immunisation leads to higher protection (70% to 95%) than if given after one week (50% to 57%),2 w1-w3 but one study found protective efficacy of 75% for those who received vaccine alone in week two.w4
As the authors note, immunisation is the most important strategy in controlling hepatitis B.
Osman David Mansoor, public health physician
Public Health Consulting, 4/14 College Street, Wellington, New Zealand oz@phc.org.nz
Nick Wilson, senior lecturer
Department of Public Health Wellington, School of Medicine and Health Sciences, PO Box 7343, Wellington South 6005, New Zealand
Competing interests: None declared.
References w1-w4 are available on bmj.com
References
Aggarwal R, Ranjan P. Preventing and treating hepatitis B infection. BMJ 2004;329: 1080-6. (6 November.)
West DJ, Calandra GB, Hesley TM, Ioli V, Miller WJ. Control of hepatitis B through routine immunization of infants: the need for flexible schedules and new combination vaccine formulations. Vaccine 1993;11(suppl 1): S21-7.
Nokes DJ, Wilson JN. Do we need 3 doses of hepatitis B vaccine? Vaccine 1999;17: 2667-73.
Andre FE, Zuckerman AJ. Review: protective efficacy of hepatitis B vaccines in neonates. J Med Virol 1994;44: 144-51.
Poovorawan Y, Sanpavat S, Pongpunglert W, Chumdermpadetsuk S, Sentrakul P, Vandepapelière P, et al. Long term efficacy of hepatitis B vaccine in infants born to hepatitis B e antigen-positive mothers. Pediatr Infect Dis J 1992;11: 816-21.
Firstly, recommending three doses at 0, 1, and 6 months is unnecessarily limiting; delaying the third dose can lead to lower compliance. Hepatitis B vaccine has been shown to be immunogenic when a wide range of schedules is used.2 Although increasing the time between the second and third doses leads to higher antibody concentrations, it seems to be the immune memory rather than antibody concentrations that is of primary importance. A two dose schedule was approved for adolescents in the United States in 1999; it has also been suggested as being adequate for infants.3
Secondly, the importance of hepatitis B immune globulin is overstated. It provides comparatively little additional protection to immunisation in preventing infection in infants of HBeAg positive mothers.4 5
Thirdly, although recommending giving vaccine to infants of HBeAg positive mothers as soon as possible after birth is reasonable, the data are limited on the precise timing. A dose of hepatitis B vaccine given with immunisation leads to higher protection (70% to 95%) than if given after one week (50% to 57%),2 w1-w3 but one study found protective efficacy of 75% for those who received vaccine alone in week two.w4
As the authors note, immunisation is the most important strategy in controlling hepatitis B.
Osman David Mansoor, public health physician
Public Health Consulting, 4/14 College Street, Wellington, New Zealand oz@phc.org.nz
Nick Wilson, senior lecturer
Department of Public Health Wellington, School of Medicine and Health Sciences, PO Box 7343, Wellington South 6005, New Zealand
Competing interests: None declared.
References w1-w4 are available on bmj.com
References
Aggarwal R, Ranjan P. Preventing and treating hepatitis B infection. BMJ 2004;329: 1080-6. (6 November.)
West DJ, Calandra GB, Hesley TM, Ioli V, Miller WJ. Control of hepatitis B through routine immunization of infants: the need for flexible schedules and new combination vaccine formulations. Vaccine 1993;11(suppl 1): S21-7.
Nokes DJ, Wilson JN. Do we need 3 doses of hepatitis B vaccine? Vaccine 1999;17: 2667-73.
Andre FE, Zuckerman AJ. Review: protective efficacy of hepatitis B vaccines in neonates. J Med Virol 1994;44: 144-51.
Poovorawan Y, Sanpavat S, Pongpunglert W, Chumdermpadetsuk S, Sentrakul P, Vandepapelière P, et al. Long term efficacy of hepatitis B vaccine in infants born to hepatitis B e antigen-positive mothers. Pediatr Infect Dis J 1992;11: 816-21.