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Background paper to the revised recommendation for hepatitis B vaccination of persons at particular risk and for hepatitis B postexposure prophylaxis in Germany
- Source :
- Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 56(11)
- Publication Year :
- 2013
-
Abstract
- The German Standing Committee on Vaccination (Standige Impfkommission, STIKO) recommends vaccinating risk groups against hepatitis B and gives advice for postexposure prophylaxis. STIKO has recently revised this recommendation, focusing on: (i) classification of risk groups, (ii) duration of protection after primary immunization, and (iii) anti-HBs threshold that defines successful hepatitis B vaccination. Orientating literature reviews were performed for the first objective. Examples of population subgroups at increased risk were identified and classified into three indication groups. Systematic reviews on the duration of vaccine-induced protection identified one randomized controlled trial (RCT) and nine cohort studies. When applying the grading of recommendation, assessment, development, and evaluation (GRADE) methodology, evidence from RCTs was considered of very low quality regarding the question of whether hepatitis B can be prevented for 15 years after successful primary vaccination (anti-HBs ≥ 10 IU/l) with a vaccine efficacy of 96 % against chronic hepatitis, 89 % against HBsAg positivity, and 73 % against isolated anti-HBc positivity. However, seven cohort studies showed that no cases of clinical hepatitis B or HBsAg positivity occurred during a maximum follow-up period of 10 years in settings comparable to the situation in Germany when anti-HBs ≥ 10 IU/l was used to indicate vaccination success. Less than 1 % of vaccinated study participants had isolated anti-HBc positivity. GRADE assessment of two cohort studies revealed that evidence of very low quality exists that the use of anti-HBs ≥ 100 IU/l to measure vaccination success leads to a lower frequency of anti-HBc positivity during follow-up than the use of anti-HBs ≥ 10 IU/l. The recommendation was revised according to this evidence.
- Subjects :
- Pediatrics
medicine.medical_specialty
medicine.medical_treatment
Population
law.invention
Randomized controlled trial
law
medicine
Humans
Hepatitis B Vaccines
Post-exposure prophylaxis
education
education.field_of_study
Evidence-Based Medicine
business.industry
Vaccination
Public Health, Environmental and Occupational Health
Hepatitis B
medicine.disease
Vaccine efficacy
Systematic review
Treatment Outcome
Immunology
business
Post-Exposure Prophylaxis
Cohort study
Subjects
Details
- ISSN :
- 14371588
- Volume :
- 56
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
- Accession number :
- edsair.doi.dedup.....cada0656c5e02d2bda7cb154c3cdb5f1