Balli F, Di Biase A R, Viola L
Dipartimento di Scienze Ostetrico-Ginecologiche e Pediatriche, Università di Modena, Italia.
Pediatr Med Chir. 1996 May-Jun;18(3):259-62.
The epidemiology of hepatitis A, a disease endemic in various countries, is in a state of continuous change. Adults are more exposed to infection and considering the frequent absence of immunity, in contrast to children in whom the disease is almost always asymptomatic, the disease is often serious and prolonged with a mortality of up to 2.5%. The mode of transmission of HAV is predominantly the fecal-oral route; the virus is isolated during the prodromic period of the disease from the feces, blood, bile and seminal fluid. The virus can also be found in saliva (OMS '95); in addition it may also be transmitted by the maternal-fetal route. The HAV infects cells in vitro but does not cause a direct cytopathic effect. At the beginning of the acute phase of the disease the production of anti-HAV antibodies is of the IgM type followed later by IgG. Some studies have shown a potential role of cellular immunity in clearance of the virus from the hepatocytes and in the pathogenesis of the infection of HAV. The efficacy of immunoglobulin serum in the prevention of hepatitis A has been demonstrated since 1944. As regards active immunity two types of vaccinations have been prepared. One with live attenuated HAV carried by either bacteria or virus. The other, killed inactivated HAV, HAV capsule, antigenic subunit, synthetic peptides, anti-idiotypes or virosomes. The recent literature describe the vaccine produced by Merck Sharp & Dohme and by Smith Kline Beecham (SKB); both vaccines are made from HAV, grown in vitro, inactivated with formalin and adsorbed to aluminum hydroxide. The protection of the vaccine begins 14 days after administration and lasts from one month to one year. Numerous studies have been conducted which have shown that the vaccine is effective when given in 2 doses and confers protection against HAV for at least one year. The results have shown that the vaccination causes seroconversion in approximately 100% of subjects, and does not cause serious side effects and the acceptance of the vaccination worldwide has been good.
甲型肝炎在各国均为地方性疾病,其流行病学状况处于持续变化之中。与儿童相比,成人更容易受到感染,且由于常常缺乏免疫力,而儿童感染该疾病几乎总是无症状的,所以成人患病往往较为严重且病程迁延,死亡率高达2.5%。甲型肝炎病毒(HAV)的传播途径主要是粪口途径;在疾病的前驱期,可从粪便、血液、胆汁和精液中分离出该病毒。病毒也可在唾液中发现(世界卫生组织,1995年);此外,它还可能通过母婴途径传播。HAV可在体外感染细胞,但不会引起直接的细胞病变效应。在疾病急性期开始时,抗HAV抗体的产生为IgM型,随后为IgG型。一些研究表明,细胞免疫在将病毒从肝细胞中清除以及甲型肝炎病毒感染的发病机制中可能发挥作用。自1944年以来,已证实免疫球蛋白血清在预防甲型肝炎方面具有疗效。关于主动免疫,已制备了两种疫苗。一种是由细菌或病毒携带的减毒活HAV疫苗。另一种是灭活的HAV疫苗、HAV胶囊、抗原亚单位、合成肽、抗独特型或病毒体疫苗。最近的文献描述了默克夏普&多贺美公司和史克必成公司(SKB)生产的疫苗;这两种疫苗均由体外培养的HAV制成,经福尔马林灭活并吸附于氢氧化铝。疫苗接种后14天开始产生保护作用,持续时间为1个月至1年。已进行了大量研究,结果表明该疫苗分两剂接种时有效,且能提供至少一年的抗HAV保护。结果显示,接种疫苗后约100%的受试者会发生血清转化,且不会引起严重的副作用,该疫苗在全球范围内的接受度良好。