Vaccinare anti HV?

Vaccinare anti HV?Hepatita viral B n 2011, rile membre UE/EEA au raportat 17.276 cazuri de infecii cu VHB (3,5 cazuri la 100.000 locuitori), dintre care 2.832 acute (16,4%), 11.705 (67,8%) cronice i restul clasificate cu statut necunoscut. Incidena global a hepatitei acute B (0,8 la 100.000 locuitori) este mult mai redus versus rata cazurilor cronice (8,1 la 100.000 locuitori). La cazurile acute, transmiterea heterosexual s-a situat pe primul loc, urmat de cea nosocomial i prin utilizare de droguri injectabile. Pentru cazurile cronice, caile de transmitere au fost mai ales cea materno-fetala si heterosexual. Declinul cazurilor acute este legat probabil de implementarea vaccinrii antiVHB n Europa, n timp ce creterea numrului cazurilor cronice poate fi explicat prin lrgirea screening-ului populaiei cu risc.ECDC!) Annual!epidemiological!report 2013!) Reporting!on!2011!surveillance!data and!2012!epidemic! intelligence!data,!http://www.ecdc.europa.eu/en/publications/Publications/annual5epidemiological5 report52013.pdfn 2012, Romnia a nregistrat 332 cazuri de hepatit viral acut cu VHB i 30 cazuri cronice, cele mai multe la grupa de vrst 25-34 ani. Doar 16 pacieni din cei cu infecii acute aveau vaccinarea antihepatit B complet, cu 3 doze. Transmiterea a fost heterosexual (n 26,2% cazuri), nosocomial (22,9%) pentru hepatita viral acut, respectiv cea heterosexual (36,7%) si contactul intrafamilial cu un bolnav de hepatit B (10%), pentru cea cronic. Centrul!Naional!de!Supraveghere!i!Control!al!Bolilor!Transmisibile!) Raport!pentru!anul!2012!) Analiza! evoluiei!bolilor!transmisibile!aflate!n!supraveghere,!http://www.insp.gov.ro/cnscbt/index.php?option=< com_docman&Itemid=11We searched thetrialregisters ofThe Cochrane Hepato-Biliary Group,The Cochrane Library,MEDLINE andEMBASEto February 2003.Chen W, Gluud C, 21 January 2009Main results:We identified 21 randomised trials, all with one or more methodological weaknesses. Four trials demonstrated that PDV versusplacebosignificantly decreased hepatitis B events at maximum follow-up (RR0.51, 95%CI0.35 to 0.73). RV did not differ significantly from PDV in eliciting a protective hepatitis B surface antibody (anti-HBs) level in two trials. Both vaccines were well tolerated. Low-dose vaccine (1 or 2 g) by the intradermal route resulted in significantly more participants without protective anti-HBs level compared with high-dose (10 or 20 g) by theintramuscularroute (RR1.41, 95%CI1.13 to 1.76). Chen W, Gluud C, 21 January 2009The intradermal route caused significantly more local adverse events, while theintramuscularroute caused significantly moresystemicadverse events. The gluteal injection produced significantly more participants without protective anti-HBs level than the deltoid injection. Theprevalenceof anti-HBs seroconversion by rapid vaccination (0, 1, and 2 months) was significantly lower than that by standard vaccination (0, 1, and 6 months). Booster vaccinations with different RV doses (2.5, 5, 10, 20, or 40 g) produced similar prevalenceof anti-HBs seroconversion in three trials assessing participants who did not respond to previous HBV vaccination.

ENGERIX B/EUVAX B

20 g/mlsuspensie injectabilaVaccin impotriva hepatitei B (ADNr) (adsorbit) (VHB)

Irving GJ, Holden J, Yang R, Pope D11 July 2012 Hepato-Biliary GroupMain results:We included a total of 11 clinical studies, of which only three were considered to have lowriskofbias; two were quasi-randomised studies in which we only addressed harms. Nine randomised trials with 732,380 participants addressed the primaryoutcomeof clinically confirmed hepatitis A. Of these, four trials assessed the inactivated hepatitis A vaccine (41,690 participants) and five trials assessed the live attenuated hepatitis A vaccine (690,690 participants). In the three randomised trials with lowriskofbias(all assessing inactivated vaccine), clinically apparent hepatitis A occurred in 9/20,684 (0.04%) versus 92/20,746 (0.44%) participants in the HAV vaccine andcontrolgroups respectively (RR0.09, 95%CI0.03 to 0.30).

Irving GJ, Holden J, Yang R, Pope D11 July 2012 Hepato-Biliary GroupIn all nine randomised trials, clinically apparent hepatitis A occurred in 31/375,726 (0.01%) versus 505/356,654 (0.18%) participants in the HAV vaccine andcontrolgroups respectively (RR0.09, 95%CI0.05 to 0.17). These results were supported bytrialsequential analyses. Subgroup analyses confirmed the clinicaleffectivenessof both inactivated hepatitis A vaccines (RR0.09, 95%CI0.03 to 0.30) and live attenuated hepatitis A vaccines (RR0.07, 95%CI0.03 to 0.17) on clinically confirmed hepatitis A. Inactivated hepatitis A vaccines had a significant effect on reducing the lack of sero-protection (less than 20 mIU/L) (RR0.01, 95%CI0.00 to 0.03). Notrial reported on a sero-protective threshold less than 10 mIU/L. Theriskof both non-serious local andsystemicadverse events was comparable toplacebofor the inactivated HAV vaccines. There were insufficientdatato draw conclusions on adverse events for the live attenuated HAV vaccine.

Havrix Adult 1440

Antigen de virus hepatitic A (VHA)vaccin hepatitic A inactivat, adsorbit, suspensie injectabila