Immunoglobulin prophylaxis for viral hepatitis.

The indications and dosage of immunoglobulin prophylaxis for viral hepatitis types A and B are well defined. Hepatitis B immune globulin (HBIG) is specific and effective for hepatitis B, but its value is offset by its high cost. Immune serum globulin (ISG) is primarily for hepatitis A, but it also has been found to be effective for hepatitis B and should be considered the choice from a cost-effective point of view. There is no specific immune globulin for hepatitis non-A, non-B, and the efficacy in using ISG has been undetermined. The prerequisite for a rational approach to immunoprophylaxis for viral hepatitis is laboratory determination of serological markers, which confirms the diagnosis of the precise hepatitis type of the index case. Serological testing of the contacts or potential contacts is indicated so that chronic carriers and those with active immunity should be exempted from passive immunization. The expense of laboratory tests is compromised by situations which require the costly HBIG and when the individual is inclined to repeated hepatitis exposure. Viral hepatitis remains a major public health hazard in spite of recent advances in its prevention. Another stride in future control of viral hepatitis will depend on the introduction of vaccines for all types of hepatitis and reliable laboratory tests for the detection of hepatitis non-A, non-B.