乙型肝炎疫苗接种、筛查和与医疗保健机构的对接：美国医师学院和疾病控制与预防中心的最佳实践建议。

Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention.

机构信息

From Centers for Disease Control and Prevention, Atlanta, Georgia; American College of Physicians, Philadelphia, Pennsylvania; and Alaska Native Tribal Health Consortium and Centers for Disease Control and Prevention, Anchorage, Alaska.

出版信息

Ann Intern Med. 2017 Dec 5;167(11):794-804. doi: 10.7326/M17-1106. Epub 2017 Nov 21.

DOI:10.7326/M17-1106

PMID:29159414

Abstract

BACKGROUND

Vaccination, screening, and linkage to care can reduce the burden of chronic hepatitis B virus (HBV) infection. However, recommendations vary among organizations, and their implementation has been suboptimal. The American College of Physicians' High Value Care Task Force and the Centers for Disease Control and Prevention developed this article to present best practice statements for hepatitis B vaccination, screening, and linkage to care.

METHODS

A narrative literature review of clinical guidelines, systematic reviews, randomized trials, and intervention studies on hepatitis B vaccination, screening, and linkage to care published between January 2005 and June 2017 was conducted.

BEST PRACTICE ADVICE 1: Clinicians should vaccinate against hepatitis B virus (HBV) in all unvaccinated adults (including pregnant women) at risk for infection due to sexual, percutaneous, or mucosal exposure; health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease (including hemodialysis patients), or HIV infection; travelers to HBV-endemic regions; and adults seeking protection from HBV infection.

BEST PRACTICE ADVICE 2: Clinicians should screen (hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease (including hemodialysis patients), blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels (≥19 IU/L for women and ≥30 IU/L for men), incarcerated persons, pregnant women, and infants born to HBV-infected mothers.

BEST PRACTICE ADVICE 3: Clinicians should provide or refer all patients identified with HBV (HBsAg-positive) for posttest counseling and hepatitis B-directed care.

摘要

背景

疫苗接种、筛查和与治疗机构的联系可以减轻慢性乙型肝炎病毒（HBV）感染的负担。然而，各组织的建议存在差异，其实施情况也不尽人意。美国医师学院高价值医疗保健工作组和疾病控制与预防中心共同制定了本文，旨在提出乙型肝炎疫苗接种、筛查和与治疗机构联系的最佳实践声明。

方法

对 2005 年 1 月至 2017 年 6 月期间发表的乙型肝炎疫苗接种、筛查和与治疗机构联系的临床指南、系统评价、随机试验和干预研究进行了叙述性文献回顾。

最佳实践建议 1：临床医生应在所有有感染风险的未接种疫苗的成年人（包括孕妇）中接种乙型肝炎病毒（HBV）疫苗，这些成年人有因性、经皮或黏膜接触而感染的风险；有血液接触风险的医疗保健和公共安全工作者；有慢性肝病、终末期肾病（包括血液透析患者）或 HIV 感染的成年人；前往 HBV 流行地区的旅行者；以及寻求乙型肝炎病毒感染保护的成年人。

最佳实践建议 2：临床医生应筛查（乙型肝炎表面抗原、乙型肝炎核心抗原抗体和乙型肝炎表面抗原抗体）有 HBV 感染风险的人，包括出生在 HBV 流行率为 2%或以上的国家的人、男同性恋者、注射毒品者、HIV 阳性者、HBV 感染者的家庭和性接触者、需要免疫抑制治疗的人、终末期肾病（包括血液透析患者）患者、血液和组织供体、感染丙型肝炎病毒的人、丙氨酸氨基转移酶水平升高（女性≥19IU/L，男性≥30IU/L）的人、被监禁者、孕妇和乙型肝炎病毒感染母亲所生婴儿。

最佳实践建议 3：临床医生应向所有检测出 HBV（HBsAg 阳性）的患者提供或转介接受检测后咨询和乙型肝炎定向治疗。