Evaluation of Hepatitis A Vaccine in Post-Exposure Prophylaxis, The Netherlands, 2004-2012Report as inadecuate




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Background

The secondary attack rate of hepatitis A virus HAV among contacts of cases is up to 50%. Historically, contacts were offered immunoglobulin IG, a human derived blood product as post-exposure prophylaxis PEP. Amid safety concerns about IG, HAV vaccine is increasingly recommended instead. Public health authorities’ recommendations differ, particularly for healthy contacts ≥40 years old, where vaccine efficacy data is limited. We evaluated routine use of HAV vaccine as an alternative to immunoglobulin in PEP, in those considered at low risk of severe infection in the Netherlands.

Methods

Household contacts of acute HAV cases notified in Amsterdam 2004-2012 were invited ≤14 days post-exposure, for baseline anti-HAV testing and PEP according to national guidelines: immunoglobulin if at risk of severe infection, or hepatitis A vaccine if healthy and at low risk aged <30, or, 30-50 years and vaccinated <8 days post-exposure. Incidence of laboratory confirmed secondary infection in susceptible contacts was assessed 4-8 weeks post-exposure. In a vaccinated subgroup, relative risk RR of secondary infection with estimated using Poisson regression.

Results

Of 547 contacts identified, 191 were susceptible to HAV. Per-protocol, 167 87% were vaccinated mean:6.7 days post-exposure, standard deviationsd=3.3 and 24 13% were given immunoglobulin mean:9.7 days post-exposure, sd=2.8. At follow-up testing, 8-112 7% had a laboratory confirmed infection of whom 7 were symptomatic. All secondary infections occurred in vaccinated contacts, and half were >40 years of age. In healthy contacts vaccinated per-protocol ≤8 days post-exposure, RRref. ≤15 years of secondary infection in those >40 years was 12.0 95%CI:1.3-106.7.

Conclusions

Timely administration of HAV vaccine in PEP was feasible and the secondary attack rate was low in those <40 years. Internationally, upper age-limits for post-exposure vaccination vary. Pending larger studies, immunoglobulin should be considered PEP of choice in people >40 years of age and those vulnerable to severe disease.



Author: Jane Whelan , Gerard J. Sonder, Lian Bovée, Arjen Speksnijder, Anneke van den Hoek

Source: http://plos.srce.hr/



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