NSW Public Health Officer Training Program, NSW Ministry of Health, Australia; School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Australia.
School of Public Health and Community Medicine, Faculty of Medicine, The University of New South Wales, Australia.
Vaccine. 2014 Sep 22;32(42):5509-13. doi: 10.1016/j.vaccine.2014.07.048. Epub 2014 Aug 8.
In 2009, national guidelines for hepatitis A control in Australia changed to recommend hepatitis A vaccine (HAV), instead of normal human immune globulin (NHIG), for post-exposure prophylaxis (PEP).
(1) Determine whether the uptake of PEP among contacts of hepatitis A cases changed after the introduction of the new guidelines, and (2) assess the field effectiveness of the HAV used as PEP in preventing infection among contacts of hepatitis A cases.
A retrospective cohort of contacts from hepatitis A cases reported to metropolitan Public Health Units in Sydney, Australia, between October 2008 and June 2010, was identified. Contacts were analysed by time period, age, PEP type, and susceptibility to hepatitis A. The relative risk (RR) of hepatitis A infection among susceptible contacts who received HAV, compared with susceptible contacts who had not received HAV, was calculated to estimate the effectiveness of the HAV when used as PEP.
The uptake of PEP by susceptible contacts increased from 76% (n=133) to 89% (n=127) after the introduction of the new guidelines. Before the change in guidelines, no one who received PEP was later reported with hepatitis A. After the change in guidelines, one of the 123 contacts who received HAV as PEP was subsequently reported with hepatitis A. However, this case was likely to have been co-exposed with a primary case. Conservatively, assuming this was a secondary case, the vaccine effectiveness of HAV was 95.6% (66.1%-99.4%). Nine of 10 incident cases of hepatitis A were contacts who did not receive any PEP.
The improved uptake of PEP and the high estimate of the effectiveness of HAV provides support for using HAV for PEP. The very high occurrence of hepatitis A among contacts who did not receive any PEP further highlights the importance of PEP in preventing hepatitis A infection.
2009 年，澳大利亚国家肝炎 A 控制指南发生改变，建议使用甲型肝炎疫苗（HAV）而非普通人类免疫球蛋白（NHIG）进行暴露后预防（PEP）。
（1）确定在新指南推出后，肝炎 A 病例接触者接受 PEP 的情况是否发生变化，以及（2）评估用作 PEP 的 HAV 预防肝炎 A 病例接触者感染的实际效果。
我们确定了 2008 年 10 月至 2010 年 6 月期间向澳大利亚悉尼大都市公共卫生部门报告的肝炎 A 病例的接触者的回顾性队列。按时间、年龄、PEP 类型和对肝炎 A 的易感性对接触者进行分析。计算易感性接触者接受 HAV 与未接受 HAV 的接触者发生肝炎 A 感染的相对风险（RR），以评估用作 PEP 的 HAV 的有效性。
新指南推出后，易感性接触者接受 PEP 的比例从 76%（n=133）增加到 89%（n=127）。在指南改变之前，接受 PEP 的人中没有人后来报告患有肝炎 A。在指南改变之后，接受 HAV 作为 PEP 的 123 名接触者中，有 1 人随后报告患有肝炎 A。然而，该病例很可能与原发性病例同时暴露。保守地假设这是一个二次病例，HAV 的疫苗有效性为 95.6%（66.1%-99.4%）。10 例新发肝炎 A 病例中有 9 例是未接受任何 PEP 的接触者。
PEP 接受率的提高和 HAV 高估计的有效性为使用 HAV 进行 PEP 提供了支持。未接受任何 PEP 的接触者中肝炎 A 发生率非常高，进一步强调了 PEP 在预防肝炎 A 感染中的重要性。
