疾病预防控制中心关于评估乙型肝炎病毒保护的卫生保健人员以及实施接触后管理的指南。
CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management.
出版信息
MMWR Recomm Rep. 2013 Dec 20;62(RR-10):1-19.
This report contains CDC guidance that augments the 2011 recommendations of the Advisory Committee on Immunization Practices (ACIP) for evaluating hepatitis B protection among health-care personnel (HCP) and administering post-exposure prophylaxis. Explicit guidance is provided for persons working, training, or volunteering in health-care settings who have documented hepatitis B (HepB) vaccination years before hire or matriculation (e.g., when HepB vaccination was received as part of routine infant [recommended since 1991] or catch-up adolescent [recommended since 1995] vaccination). In the United States, 2,890 cases of acute hepatitis B were reported to CDC in 2011, and an estimated 18,800 new cases of hepatitis B occurred after accounting for underreporting of cases and asymptomatic infection. Although the rate of acute hepatitis B virus (HBV) infections have declined approximately 89% during 1990-2011, from 8.5 to 0.9 cases per 100,000 population in the United States, the risk for occupationally acquired HBV among HCP persists, largely from exposures to patients with chronic HBV infection. ACIP recommends HepB vaccination for unvaccinated or incompletely vaccinated HCP with reasonably anticipated risk for blood or body fluid exposure. ACIP also recommends that vaccinated HCP receive postvaccination serologic testing (antibody to hepatitis B surface antigen [anti-HBs]) 1-2 months after the final dose of vaccine is administered (CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2011;60 [No. RR-7]). Increasing numbers of HCP have received routine HepB vaccination either as infants (recommended since 1991) or as catch-up vaccination (recommended since 1995) in adolescence. HepB vaccination results in protective anti-HBs responses among approximately 95% of healthy-term infants. Certain institutions test vaccinated HCP by measuring anti-HBs upon hire or matriculation, even when anti-HBs testing occurs greater than 2 months after vaccination. This guidance can assist clinicians, occupational health and student health providers, infection-control specialists, hospital and health-care training program administrators, and others in selection of an approach for assessing HBV protection for vaccinated HCP. This report emphasizes the importance of administering HepB vaccination for all HCP, provides explicit guidance for evaluating hepatitis B protection among previously vaccinated HCP (particularly those who were vaccinated in infancy or adolescence), and clarifies recommendations for postexposure management of HCP exposed to blood or body fluids.
本报告包含了疾病预防控制中心(CDC)的指导意见,该意见补充了免疫实践咨询委员会(ACIP) 2011 年关于评估医护人员(HCP)乙型肝炎保护和实施暴露后预防的建议。本报告为在医疗卫生环境中工作、培训或志愿工作的人员提供了明确的指导,这些人员在入职或入学前几年(例如,当乙型肝炎疫苗接种作为常规婴儿[自 1991 年起推荐]或青少年补种[自 1995 年起推荐]疫苗接种的一部分时)有乙型肝炎(HepB)疫苗接种记录。在美国,2011 年向疾病预防控制中心报告了 2890 例急性乙型肝炎病例,估计有 18800 例新的乙型肝炎病例发生,原因是病例报告和无症状感染的漏报。尽管自 1990 年至 2011 年期间,美国急性乙型肝炎病毒(HBV)感染率下降了约 89%,从每 10 万人 8.5 例降至 0.9 例,但医护人员职业性乙型肝炎病毒感染的风险仍然存在,主要是因为接触到慢性乙型肝炎病毒感染的患者。ACIP 建议对有合理预期会接触血液或体液的未接种或未完全接种乙型肝炎疫苗的 HCP 进行乙型肝炎疫苗接种。ACIP 还建议已接种疫苗的 HCP 在最后一剂疫苗接种后 1-2 个月进行疫苗接种后血清学检测(乙型肝炎表面抗原抗体[抗-HBs])(CDC。医护人员免疫接种:免疫实践咨询委员会(ACIP)的建议[ACIP]。MMWR 2011;60 [RR-7])。越来越多的 HCP 作为婴儿(自 1991 年起推荐)或青少年(自 1995 年起推荐)接种常规乙型肝炎疫苗。乙型肝炎疫苗接种可使约 95%的健康足月婴儿产生保护性抗-HBs 反应。某些机构在入职或入学时通过测量抗-HBs 来检测接种疫苗的 HCP,即使抗-HBs 检测发生在疫苗接种后 2 个月以上。本指南可以帮助临床医生、职业健康和学生健康提供者、感染控制专家、医院和医疗培训计划管理员以及其他人员选择评估接种疫苗的 HCP 的乙型肝炎保护的方法。本报告强调了为所有 HCP 接种乙型肝炎疫苗的重要性,为评估以前接种过乙型肝炎疫苗的 HCP(特别是在婴儿期或青少年期接种疫苗的 HCP)的乙型肝炎保护情况提供了明确的指导,并澄清了对接触血液或体液的 HCP 进行暴露后管理的建议。