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Postexposure Prophylaxis for Hepatitis A

Until now, researchers had never directly compared immune globulin with hepatitis A vaccine for postexposure prophylaxis.

Immune globulin has been recommended for use as postexposure prophylaxis against hepatitis A for years. The practice has continued, even though hepatitis A vaccine has shown efficacy for this indication in both animal and noncomparative human studies. Now, researchers have performed the first direct comparison of immune globulin with hepatitis A vaccine in preventing clinical illness.

In this double-blind, noninferiority trial conducted in Kazakhstan, healthy day-care and household contacts, aged 2 to 40, were randomized to receive one dose of either hepatitis A vaccine or immune globulin within 14 days after exposure to a patient with hepatitis A. Among 4524 contacts, 1090 (average age, 12) were eligible for the per-protocol analysis. Exposure to the index patient occurred within the household for 83.2% and at day care for 16.8%. Most often, prophylaxis was administered during the second week after exposure.

Both methods of postexposure prophylaxis were efficacious. Only 4.4% of vaccine recipients and 3.3% of immune-globulin recipients developed symptomatic hepatitis A (relative risk among vaccine recipients, 1.4; 95% confidence interval, 0.7–2.7).

Comment: The finding that hepatitis A vaccine was efficacious in preventing clinical illness in this group of healthy contacts supports a recent resolution from the Advisory Committee on Immunization Practices. Other well-recognized features of this vaccine, including long-term protection, abundant supply, and ease of administration, as well as lower cost than immune globulin, will benefit both patients and clinicians.

— Larry M. Baddour, MD

Dr. Baddour is a Professor of Medicine at the Mayo Clinic College of Medicine, Rochester, Minnesota.

Published in Journal Watch Infectious Diseases October 18, 2007

Citation(s):

Victor JC et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med 2007 Oct 25; 357:1685 [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMoa070546)

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• Medline abstract (Free)

Baker CJ. Another success for hepatitis A vaccine. N Engl J Med 2007 Oct 25; 357:1757 [e-pub ahead of print]. (http://dx.doi.org/10.1056/NEJMe078189)

• Original article (Subscription may be required)
• Medline abstract (Free)