Buisson Y, Meyran M
Hôpital d'Instruction des Armées Val-de-Grâce, Paris.
Bull Acad Natl Med. 1995 Feb;179(2):367-74; discussion 373-5.
In spite of low endemic levels in France, hepatitis A and hepatitis B remains major concerns for public health. Seroprevalence of antibodies against hepatitis A (anti-HAV), declining below 15% in the 20 years-aged subjects, highlights an increasing susceptibility to hepatitis A. Later in the life, HAV infections become more serious and expansive. Control measures against hepatitis B have nearly stopped HBV spread linked to blood transfusions and mothers to infants transmission. Now, common risk factors are first sexual exposure, then injecting drug use, especially among young people. Vaccination is recognized as the most effective process for prevention. Recombinant hepatitis B vaccines have taken the place of plasma-derived vaccines. Although non responder individuals and escape mutants of HBV may hamper vaccinal coverage, hepatitis vaccines are highly immunogenic in immunocompetent people, allowing simplified schedules and reduced HBsAg dosages for children. Inactivated HAV vaccines now licensed prove to be highly immunogenic after only one injection. Hepatitis B vaccination targeted on high risk groups remains imperative but inadequate for reducing hepatitis B occurrence. A universal hepatitis B vaccination program in childhood and early adolescence would nearly stop the spread of HBV in the populations before ten years. Likewise, hepatitis A vaccination of travelers to endemic areas, all individuals exposed to contaminations from fecal sources, and food handlers, could reduce the spread of HAV in the community but would not completely prevent outbreaks of hepatitis A. Advantages of universal immunization of babies are not proved yet. Implementation of preventive strategies first needs a comprehensive surveillance of viral hepatitis in France.
尽管法国的甲型和乙型肝炎地方流行水平较低，但它们仍然是公共卫生的主要关注点。20岁人群中抗甲型肝炎抗体（抗-HAV）的血清流行率降至15%以下，这凸显了对甲型肝炎易感性的增加。在生命后期，甲型肝炎感染变得更加严重且传播范围更广。针对乙型肝炎的控制措施几乎已阻止了与输血及母婴传播相关的乙肝病毒传播。现在，常见的危险因素首先是初次性接触，其次是注射吸毒，尤其是在年轻人中。疫苗接种被认为是最有效的预防措施。重组乙型肝炎疫苗已取代血浆源性疫苗。尽管无应答个体和乙肝病毒逃逸突变体可能会妨碍疫苗接种覆盖率，但肝炎疫苗在免疫功能正常的人群中具有高度免疫原性，使得儿童的接种程序得以简化且乙肝表面抗原剂量得以减少。现已获批的灭活甲型肝炎疫苗经单次注射后即被证明具有高度免疫原性。针对高危人群的乙型肝炎疫苗接种仍然至关重要，但对于减少乙型肝炎的发生并不充分。在儿童期和青春期早期实施普遍的乙型肝炎疫苗接种计划将在十年内几乎阻止乙肝病毒在人群中的传播。同样，对前往流行地区的旅行者、所有接触粪便源污染的个体以及食品从业人员进行甲型肝炎疫苗接种，可以减少甲型肝炎在社区中的传播，但无法完全预防甲型肝炎的暴发。婴儿普遍免疫的优势尚未得到证实。实施预防策略首先需要对法国的病毒性肝炎进行全面监测。
