[Hepatitis B vaccination].

Since 1982 two hepatitis B (HB) vaccines have been commercialized. Both contain mainly non-infectious hepatitis B surface antigen particles and are manufactured from purified and inactivated plasma of healthy HBs-antigen carriers. H-B- Vax (Merck, Sharp & Dohme) is administered intramuscularly in two 20 micrograms doses one month apart, followed by a booster injection six months after the initial dose. Hevac B Pasteur is injected subcutaneously in three 5 micrograms doses at monthly intervals, with a booster dose 12 months after the first. Side effects are mild and not significantly more frequent than after placebo. Both vaccines are effective, as shown by the appearance of antibodies against HBs antigen in over 95% of healthy vaccines. HB infection occurred only in the first months after vaccination and in people with insufficient antibody response. Patients with compromised immune reactivity, such as those with endstage renal failure or with a transplanted organ, develop anti-HBs less often and also in lower titers than healthy individuals. In Western Europe and in the United States HB vaccination should be restricted to persons at high risk such as medical and dental personnel, patients with endstage renal failure, i.v. drug users, male homosexuals, close contacts of HBs carriers, refugees from countries with high HB endemicity and travellers to such countries. In developing countries with very high prevalence of hepatitis B, extensive programmes of vaccination in infants should be initiated. Serotesting before vaccination is only useful in people with an exposed probability of positive HBV markers well over 10%. Serotesting after vaccination should be done in health care personnel where non-responders can be protected with intermittent injections of HB immunoglobulin. In selected cases combined passive-active immunization may be useful.