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Postexposure Vaccination Will Prevent Hepatitis A

For some exposed individuals, it works as well as immune globulin injections.

For years the CDC-recommended postexposure prophylaxis for hepatitis A was an injection of immune globulin (IG). Hepatitis A vaccination has recently become the preferred prophylaxis in some cases, partially because of the results of this large blinded study, which received some financial support from the vaccine manufacturer. The study was performed in Kazakhstan, where hepatitis A is considerably more common than in the U.S.

Household or day-care contacts, aged 2 to 40, were randomized to receive one dose of either immune globulin or vaccine within 14 days of exposure. A tiny minority of contacts in both groups (about 4% of vaccine recipients vs. about 3% of IG recipients) developed symptomatic hepatitis A, diagnosed by both serologic and clinical criteria. These results indicated that vaccine was noninferior to IG, which has an estimated prophylactic efficacy of 80% to 90%. Some variables suggested that IG patients had milder breakthrough disease than vaccine patients.

Comment: Shot for shot, the hepatitis A vaccine has many advantages over immune globulin, including better availability, easier administration, and longer duration of protection; both treatments are similar in cost. Whether vaccine is as effective as IG for infants younger than 12 months, adults older than 40, or those with chronic liver disease or immunocompromise (all of whom were excluded from this trial) awaits more data — for these individuals, the CDC continues to recommend IG as well as vaccination if indicated.

— Abigail Zuger, MD

Published in Journal Watch General Medicine November 1, 2007

Citation(s):

Victor JC et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med 2007 Oct 25; 357:1685.

• Original article (Subscription may be required)
• Medline abstract (Free)

Baker CJ. Another success for hepatitis A vaccine. N Engl J Med 2007 Oct 25; 357:1757.

• Original article (Subscription may be required)
• Medline abstract (Free)