甲型肝炎和乙型肝炎疫苗接种对慢性丙型肝炎感染者的反应：证据回顾和当前建议。
Hepatitis A and hepatitis B vaccination responses in persons with chronic hepatitis C infections: A review of the evidence and current recommendations.
机构信息
BC Centre for Disease Control, University of British Columbia, Vancouver, British Columbia.
出版信息
Can J Infect Dis Med Microbiol. 2008 Mar;19(2):197-202. doi: 10.1155/2008/410362.
UNLABELLED
In persons with chronic hepatitis C virus (HCV) infections, superinfection by hepatitis A virus (HAV) or hepatitis B virus (HBV) can cause serious complications, including fulminating hepatitis or increased severity of hepatitis. Therefore, it is important to adequately protect persons with chronic HCV infections by immunization. Suboptimal response to vaccines has been reported in patients with chronic liver disease. The present article reviews HAV and HBV vaccine responses reported in the literature when administered to individuals with chronic HCV infection, and reviews current national and international recommendations.
RESULTS
Persons with chronic HCV respond well to HAV vaccine, but studies exploring HBV vaccine efficacy in this population have equivocal results. Vaccine schedules and participant characteristics differ among studies, and most do not adjust for confounders. Some studies found no difference in HBV vaccine response between patients with chronic HCV and controls. However, HBV vaccine response was generally reduced in those with cirrhosis and HCV genotype 1. Organizations recommend HAV and HBV vaccines for persons with chronic HCV, but do not suggest alterations in schedule or dose.
RECOMMENDATIONS
Because HAV vaccine response is good and routine laboratory testing may not detect lower levels of vaccine-induced anti-HAV, the standard HAV vaccine schedule is recommended without postimmunization testing. HBV vaccine should be administered early in the course of chronic HCV infection because response may be lower in patients with cirrhosis. Reflex testing of anti-HCV reactive sera for anti-HAV and hepatitis B surface antibody can facilitate appropriate follow-up and timely immunization. Determination of postimmunization hepatitis B surface antibody, especially in patients with cirrhosis or genotype 1, will allow HBV vaccine boosters to be offered.
目的
在慢性丙型肝炎病毒 (HCV) 感染者中，甲型肝炎病毒 (HAV) 或乙型肝炎病毒 (HBV) 的重叠感染可导致严重并发症，包括暴发性肝炎或肝炎加重。因此，通过免疫接种充分保护慢性 HCV 感染者非常重要。慢性肝病患者的疫苗反应不佳已有报道。本文综述了文献中报道的在慢性 HCV 感染者中接种 HAV 和 HBV 疫苗的反应，并回顾了当前的国家和国际建议。
结果
慢性 HCV 感染者对 HAV 疫苗的反应良好，但在该人群中探索 HBV 疫苗疗效的研究结果不一致。研究之间的疫苗接种方案和参与者特征不同，并且大多数都没有调整混杂因素。一些研究发现慢性 HCV 患者与对照组之间的 HBV 疫苗反应没有差异。然而，在肝硬化和 HCV 基因型 1 患者中，HBV 疫苗反应通常降低。各组织建议为慢性 HCV 感染者接种 HAV 和 HBV 疫苗，但不建议改变疫苗接种方案或剂量。
建议
由于 HAV 疫苗反应良好，并且常规实验室检测可能无法检测到较低水平的疫苗诱导的抗-HAV，因此建议使用标准的 HAV 疫苗接种方案，无需接种后检测。由于在肝硬化患者中反应可能较低，因此应在慢性 HCV 感染过程的早期接种 HBV 疫苗。对 HCV 反应性血清进行抗-HAV 和乙型肝炎表面抗体的反射性检测，有助于进行适当的随访和及时免疫接种。测定接种后乙型肝炎表面抗体，特别是在肝硬化或基因型 1 患者中，将有助于提供 HBV 疫苗加强针。
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