h. Passive immunization
Passive immunity obtained through anti-HBs could protect individuals from infection and chronic hepatitis B infection if administered soon after exposure, using the immunoglobulin containing anti-HBs titers are high. Post-exposure prophylaxis is given to babies born to mothers who suffer from Hepatitis B, mucous membrane or skin exposure to blood infected with Hepatitis B virus, and sexual contact in patients who are HBsAg positive. Hepatitis B immunoglobulin (HBIG) is also used to protect patients from recurrent hepatitis B infection after liver transplantation. Effectiveness of Hepatitis B immunoglobulin is 75% to prevent Hepatitis B which manifests clinically or career circumstances when used immediately after exposure. Protection generated by HBIG only lasted a few months.
One major use is as an adjuvant HBIG Hepatitis B vaccine in preventing perinatal transmission of Hepatitis B. Data studies have shown that combination therapy of HBIG and Hepatitis B vaccine may increase the effectiveness of prevention of perinatal infection by 85-95% and provide long-term protective effect.
Hepatitis B immunoglobulin is also indicated for post-exposure prophylaxis syringes or other skin injuries, which are exposed to body fluids of patients with hepatitis B virus ininfeksi Prophylaxis of Hepatitis B vaccine before exposure to reduce the need for HBIG. A study states that if untreated, 30% of individuals infected needles will experience the Hepatitis B virus infection and clinical use of HBIG has 75% effectiveness in preventing clinically manifested disease. Efficacy of HBIG in the prevention of clinical hepatitis B and chronic hepatitis B is 75% bull given within 7 days after exposure.
i. Active immunization
Development of Vaccines
Hepatitis B vaccine safe, immunogenic, and effective has been marketed since 1982. Hepatitis B vaccine containing HBsAg purified ayng. Vaccines can be obtained from the culture results of HBsAg from the plasma of patients with chronic hepatitis B infection (plasma-derived vaccine) or by inserting plasmids containing the viral S gene and in some cases pre-S1 and pre S2 or into yeast or mammalian cells. This insertion would induce cells expressing HBsAg, which assemble into immunogenic particles (recombinant DNA vaccine). The vaccine has suffered inactivation, purified, and coupled alminium aluminum phosphate or hydroxide, and preserved with thimerosal.
Examples of Hepatitis B vaccine products on the market are Recombivax HB (Merck) and Engerix-B (Glaxo Smith Kline). Both vaccines have similar efficacy. The vaccine includes a recombinant DNA vaccine, which vaccine induces T cells specific for HBsAg and B cells are dependent on T cells to produce anti-HBs antibodies as soon as 2 weeks after the first dose of vaccine.
Some vaccine manufacturers produce a combination vaccine containing components of Hepatitis B. Combinations of existing vaccines include: diphtheria, tetanus, pertussis - hepatitis B (DTP-Hep B); diphtheria, tetanus, diphtheria aseluler - Hepatitis B (DTaP-Hep B); diphtheria, tetanus, diphtheria aseluler - Hepatitis B - Haemophilus influenza type b (DTaP-Hep B-Hib) and diphtheria, tetanus, diphtheria aseluler - Hepatitis B - Haemophilus influenza type b - Inactivated polio (DTaP-Hep B-IPV-Hib). It also terdapan Hepatitis B combination vaccines with Hepatitis A. No increase in side effects or interverensi between hepatitis B vaccine with other vaccines.
Hepatitis B vaccine should be stored at 2-8oC. Vaccines are experiencing freezing will reduce the effectiveness of the vaccine. Hepatitis B Vaccine tersmasuk thermostable vaccine. Heating at a temperature of 45 ° for 1 week or 37 ° C for 1 month did not alter the immunogenicity and reactivity of vaccines.
j. Hepatitis B Vaccine Indications
Hepatitis B vaccine is given to groups of individuals with high risk of contracting Hepatitis B, which are:
Workers in health
Security officers who are vulnerable to exposure to blood
Social workers in nursing
Hemodialysis patients
Patients who need blood transfusions or blood components
Contact or sexual intercourse with a career Hepatitis B or Hepatitis B infection
Tourists who travel to an endemic area of Hepatitis B.
Injecting drug users
Bisexual and homosexual men
People who have sex with more than one partner
Patients with chronic liver disease
Patients who could potentially run the transplanted organ.
k. Providing Immunization and Dosage
Hepatitis B vaccine should be administered intramuscularly in the deltoid muscle in adults. In adults, the immunogenicity of the vaccine will be reduced if the vaccine is injected in the gluteus. The length of needles used should then from 1 to 1.5 inches to ensure the vaccine into the muscle tissue.
Intradermal injection of the vaccine is not recommended because of immunogenicity in young age is lower, which is not consistent antibody response in the elderly, health professionals lack of experience in performing intradermal injections, and lack of data on long-term effectiveness.
Hepatitis B vaccine given in 3 doses at month 0, 1, and 6. Two of the first dose is the dose necessary to form antibodies. The third dose is given to achieve anti-HBs antibody levels are high.
Table 1. Hepatitis B Vaccine Dose Recommendations
Situation | Recombivax HB (10 µg/ml) | Engerix B (20 µg/ml) |
Baby* and kids < 11 years old | 2,5 µg/ml | 10 µg/ml |
kids / teenage (11-19 tahun) | 5 µg/ml | 20 µg/ml |
Adult (> 20 tahun) | 10 µg/ml | 20 µg/ml |
Hemodialisis patients | 40 µg/ml (1 ml)# | 40 µg/ml (2 ml) ## |
imunokompromais Patients | 10 µg/ml (1 ml)# | 40 µg/ml (2 ml) ## |
recommended schedule o month, first month, and sixth month *baby that born by mom with HBsAg (-) # Special folmulalitation ## 2 dosis 1 ml injected to one side in 4 dosis (o month, first month,second month, and sixth month) | ||
l. vaccine effectiveness
Giving three doses of Hepatitis B vaccine is intramuskluar induce protective antibody responses in more than 90% of healthy adults younger than 40 years. After 40 years of age, immunity is reduced below 90%, and at the age of 60 years is only 65-76% of vaccines had a protective effect against hepatitis B virus infection Although other host factors such as smoking, obesity, HIV infection, and chronic disease causing the low immunogenicity of the vaccine, but age is an important determinant factor.
m. Side Effects and Contraindications
Hepatitis B vaccine is a vaccine that includes safe. The effects of pain at the injection site, fever, anaphylactic reactions, and Guillain-Barre Syndrome. Allergic reactions to vaccine components, including thimerosal vaccine is contraindicated.
n. Recent Developments
Imunogenisistas Hepatitis B vaccine can be improved by using a more potent adjuvant. HBVsAg/AS04 vaccine contains 3'-deacylated monophosphoryl lipid A (MPL) and the MF59 adjuvant containing surface antigen and pre-S2. Both have a better effect. The use of granulocyte colony stimulating factor may also increase anti-HBs antibodies. HBV immunization using DNA encoding for Hepatitis B surface antigen and nucleoprotein interesting to study as well as for prophylactic therapy. DNA-based vaccine that generates humoral and cellular immunity, as well as the response of CD4 + cells and CD 8 +.
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