Hadler S C
Division of Viral and Rickettsial Diseases, Centers for Disease Control, Atlanta, Georgia.
Infect Dis Clin North Am. 1990 Mar;4(1):29-46.
Vaccines to prevent hepatitis B infection became available in 1982, and were recommended primarily for adults considered at high risk because of exposure in the workplace or lifestyles that lead to sexual or parenteral exposure to the virus. Plasma-derived and recombinant vaccines produced in yeast are highly immunogenic, safe, and effective for all age groups. Decreased response and protection by vaccine occur in older persons and in persons with immunosuppressive illnesses. The main issues concerning current vaccination programs include the possible use of lower doses to reduce the cost of the vaccine, the duration of protection and need for vaccine booster doses, and the need for postvaccination testing in hospitals. The failure of current vaccination programs to decrease disease incidence, a matter of great concern nationally, can be ascribed to failure to deliver vaccine to the groups at highest risk. More effective strategies for control, including the universal vaccination of infants or adolescents, must now be examined. Newer vaccines that incorporate other viral antigens and that may offer increased efficacy are being developed. Vaccines to prevent hepatitis A--both killed and live attenuated vaccines--are undergoing clinical trials and may become available in the next 5 years.
预防乙型肝炎感染的疫苗于1982年问世，最初主要推荐给因工作场所接触或因性行为或非肠道接触病毒的生活方式而被视为高危人群的成年人。血浆源性疫苗和酵母重组疫苗对所有年龄组都具有高度免疫原性、安全性和有效性。老年人以及患有免疫抑制疾病的人对疫苗的反应和保护作用会降低。当前疫苗接种计划的主要问题包括可能使用较低剂量以降低疫苗成本、保护期以及疫苗加强剂量的需求，以及医院中接种疫苗后检测的必要性。当前疫苗接种计划未能降低疾病发病率，这在全国范围内是一个令人高度关注的问题，可归因于未能将疫苗提供给风险最高的人群。现在必须研究更有效的控制策略，包括对婴儿或青少年进行普遍接种。正在研发包含其他病毒抗原且可能具有更高效力的新型疫苗。预防甲型肝炎的疫苗——包括灭活疫苗和减毒活疫苗——正在进行临床试验，可能在未来5年内上市。
