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Evidence summaries

Vaccines for Preventing Hepatitis B in Health-Care Workers

Plasma-derived vaccine (PDV) prevents hepatitis B events. Recombinant vaccine (RV) appears to be able to elicit similar protective anti-HBs levels than PDV. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 21 randomised trials, all with methodological weaknesses. PDV versus placebo decreased hepatitis B events (RR 0.51, 95% CI 0.35-0.73, 4 trials, n=2697). 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 µg) by the intradermal route resulted in significantly more participants without protective anti-HBs level compared with high-dose (10 or 20 µg) by the intramuscular route (RR 1.41, 95% CI 1.13-1.76). The intradermal route caused more local adverse events, while the intramuscular route caused more systemic adverse events. The deltoid injection produced significantly more protective anti-HBs level than the gluteal injection. The prevalence of anti-HBs seroconversion by rapid vaccination (0, 1, and 2 months) was significantly lower than that by standard vaccination (0, 1, and 6 months).

Authors' comment: It is unclear whether booster vaccination of non-responders offers higher anti-HBs seroconversion and hepatitis B vaccine prevents the infection of hepatitis B mutants in health-care workers.

Comment: The quality of evidence is downgraded by study quality (e.g., inadequate or unclear allocation concealment and inadequate intention-to-treat adherence).

    References

    • Chen W, Gluud C. Vaccines for preventing hepatitis B in health-care workers. Cochrane Database Syst Rev 2005 Oct 19;(4):CD000100. [PubMed]

Primary/Secondary Keywords