Steele M, Cochrane A, Wakefield C, Stain A-M, Ling S, Blanchette V, Gold R, Ford-Jones L
The Hospital for Sick Children, Toronto, ON, Canada.
Haemophilia. 2009 Mar;15(2):437-47. doi: 10.1111/j.1365-2516.2008.01954.x.
Hepatitis A and B vaccines are highly effective tools that can greatly reduce infection risk in the bleeding disorder population. Although hepatitis A and B immunization for individuals with bleeding disorders is universally recommended, various advisory bodies often differ with respect to many practical aspects of vaccination. To review the published literature and guidelines and form a practical, comprehensive and consistent approach to hepatitis A and B immunization for individuals with bleeding disorders. We reviewed published immunization guidelines from North American immunization advisory bodies and published statements from North American and international haemophilia advisory bodies. A search of the MEDLINE database was performed to find original published literature pertaining to hepatitis A or B immunization of patients with haemophilia or bleeding disorder patients that provided supporting or refuting evidence for advisory body guidelines. Various advisory bodies' immunization guidelines regarding individuals with bleeding disorders have contradictory statements and often did not clarify issues (e.g. post vaccination surveillance). Published literature addressing immunization in bleeding disorder patients is sparse and mostly examines route of vaccine administration, complications and corresponding antibody response. Although the risk of hepatitis A and B infection is low, the use of simple measures such as vaccination is reasonable and advocated by haemophilia advisory bodies. Following our review of the available literature and North American guidelines, we have developed comprehensive and practical recommendations addressing hepatitis A and B immunization for the bleeding disorder population that may be applicable in Bleeding Disorder clinics.
甲型和乙型肝炎疫苗是非常有效的工具，能大大降低出血性疾病人群的感染风险。尽管普遍建议对出血性疾病患者进行甲型和乙型肝炎免疫接种，但各咨询机构在疫苗接种的许多实际方面往往存在差异。为了回顾已发表的文献和指南，并形成一种针对出血性疾病患者进行甲型和乙型肝炎免疫接种的实用、全面且一致的方法。我们回顾了北美免疫咨询机构发布的免疫指南以及北美和国际血友病咨询机构发布的声明。对MEDLINE数据库进行了检索，以查找与血友病患者或出血性疾病患者的甲型或乙型肝炎免疫接种相关的原始已发表文献，这些文献为咨询机构指南提供了支持或反驳的证据。各咨询机构关于出血性疾病患者的免疫指南存在相互矛盾的表述，且往往未阐明相关问题（如接种后监测）。关于出血性疾病患者免疫接种的已发表文献稀少，且大多研究疫苗接种途径、并发症及相应的抗体反应。尽管甲型和乙型肝炎感染风险较低，但采用诸如接种疫苗等简单措施是合理的，并且得到了血友病咨询机构的倡导。在对现有文献和北美指南进行回顾之后，我们针对出血性疾病人群制定了全面且实用的甲型和乙型肝炎免疫接种建议，这些建议可能适用于出血性疾病诊所。
