Vacuna Hepatitis B

Páginas: 8 (1801 palabras) Publicado: 20 de octubre de 2011
The

new england journal

of

medicine

clinical practice

Prevention of Hepatitis B with the Hepatitis B Vaccine
Gregory A. Poland, M.D., and Robert M. Jacobson, M.D.
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The articleends with the authors’ clinical recommendations.

A 25-year-old registered nurse comes for a visit to initiate prenatal care after receiving a positive result on a pregnancy test. On review of her vaccination status, she reports that she declined hepatitis B vaccination when it was offered by her current employer, since she does not draw blood and thus does not consider herself at risk forinfection. Should she receive the vaccine? What are the current recommendations for hepatitis B vaccination?

the clinical problem
From the Mayo Vaccine Research Group (G.A.P., R.M.J.), the Program in Translational Immunovirology and Biodefense (G.A.P.), the Department of Internal Medicine (G.A.P.), and the Department of Pediatric and Adolescent Medicine (R.M.J.), Mayo Clinic, Rochester, Minn.Address reprint requests to Dr. Poland at the Mayo Vaccine Research Group, Mayo Clinic and Foundation, 611C Guggenheim Bldg., 200 First St. SW, Rochester, MN 55905, or at poland.gregory@mayo.edu. N Engl J Med 2004;351:2832-8.
Copyright © 2004 Massachusetts Medical Society.

hepatitis b virus and infection

The hepatitis B virus (HBV) is an enveloped, double-stranded DNA virus. It is the smallestDNA virus known to infect humans. The virus is very infectious in nonimmune persons. The incubation period for acute infection is 45 to 160 days, with a mean incubation period of 90 days. The primary reservoir is chronically infected people. There are no known animal reservoirs and no clear evidence that insects are responsible for transmission of HBV. Acute HBV infection can be symptomatic orasymptomatic. The acute phase is followed by either a clearance of the infection or a chronic, indolent infection that can lead to cirrhosis, liver failure, hepatocellular carcinoma, and death. The risk of the development of the chronic carrier state is inversely related to the age at the time of infection. The risk of chronic carriage in infected neonates is as high as 90 percent. Prospective studiesof infection in Taiwan demonstrate that 25 percent of persons who have a persistent HBV infection in infancy or early childhood ultimately die from either hepatocellular carcinoma or cirrhosis. The death rate declines to 15 percent for persistent infection that develops in adolescents and young adults.1
epidemiology

HBV infection occurs throughout the world and is endemic in Africa, EasternEurope, the Middle East, Central Asia, China, Southeast Asia, the Pacific Islands, and the Amazon basin of South America. In these areas, most persons become infected as infants or young children, and up to 70 percent of the adult population tests positive for prior infection. Among those populations, 8 to 15 percent have chronic HBV infection. Globally, this translates into more than 2 billionpeople with evidence of previous HBV infection and more than 350 million chronic carriers of the virus, with an estimated 1 million deaths each year due to cirrhosis and hepatocellular carcinoma. Widespread immunization programs against HBV, which have been implemented in more than 100 countries, have dramatically reduced the occurrence of chronic HBV infection and hepatocellular carcinoma, and thevaccine can thus be considered the first anticancer vaccine.2 In the

2832

n engl j med 351;27

www.nejm.org

december 30, 2004

The New England Journal of Medicine Downloaded from nejm.org on October 19, 2011. For personal use only. No other uses without permission. Copyright © 2004 Massachusetts Medical Society. All rights reserved.

clinical practice

United States, screening...
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