PubMed · 836451
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S Hnatko. 1977. Protection protocol for hepatitis.. https://pubmed.ncbi.nlm.nih.gov/836451/
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BACKGROUND: The convenience of carrying out pre-vaccination screening of VHB markers depends on the relative costs of screening and vaccination and also on the prevalence of susceptible subjects in each group of the population. The aim of the present work was to analyse the efficiency of pre-vaccination screening of antiHBc in Catalonia in 1991. METHODS: The per-unit cost of screening was calculated at 1366 ptas. The formula applied was: cost per-unit of screening + (1-X) x the cost per-unit of vaccination of anti-HBc (-) = cost of vaccinating the group. "X" being the threshold of prevalence of markers below which screening cases to be efficient. This prevalence is compared with those expected in the groups of the population to be vaccinated. RESULTS: By applying the above-mention ned formula and taking into account costs in time and travel of the people to be vaccinated, a prevalence threshold of 23% is obtained. This prevalence is much higher than that found in adolescents and students of medicine and nursing, similar to that found in health professionals and lower than that of other risk groups. CONCLUSIONS: Systematic screening of anti-HBc is only recommended in groups of the population where a prevalence higher than 20-25% can be expected. Below this threshold vaccination without previous study of markers is more efficient. This enormously simplifies the strategies of universal vaccination of children, adolescents or both.
OBJECTIVE: To identify the risk of hepatic failure in hepatitis B virus (HBV) carriers given intermittent immunosuppressive therapy. DATA SOURCES: The key words "immunosuppression" and "hepatitis B" were used to search MEDLINE for relevant articles in English published from 1970 to 1990; the bibliographies of these articles were reviewed for additional publications. Also included were articles published in 1991. STUDY SELECTION: Articles were included if they documented the use of immunosuppressive drugs to treat chronic hepatitis B or another condition in patients at high risk for the HBV carrier state. RESULTS: Long-term immunosuppressive therapy has not improved the survival of patients with chronic hepatitis B. The withdrawal of such therapy from HBV carriers has resulted in a flare-up of potentially fatal hepatitis in 20% to 50%, regardless of whether underlying liver disease was present. The presence of replicating viral DNA in the serum of HBV carriers may identify those who are at high risk of the deleterious effects of immunosuppressive therapy. CONCLUSIONS: Long-term immunosuppressive therapy is not advised for liver disease in HBV carriers. For other conditions in such people continuous rather than intermittent therapy is safer. Patients at high risk for hepatitis B should be screened for this virus when immunosuppressive therapy is contemplated.
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