Combined hepatitis B immune globulin and vaccine for postexposure prophylaxis of accidental hepatitis B virus infection in hemodialysis staff members: Comparison with immune globulin without vaccine in historical controls

Authors

  • Takehiro Mitsui,

    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
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  • Keiko Iwano,

    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
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  • Shigeru Suzuki,

    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
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  • Chikao Yamazaki,

    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
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  • Kazuo Masuko,

    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
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  • Fumio Tsuda,

    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
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  • Shinobu Aihara,

    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
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  • Yoshihiro Akahane,

    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
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  • Yuzo Miyakawa,

    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
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  • Makoto Mayumi M.D.

    Corresponding author
    1. Masuko Hospital and Masuko Institute for Medical Research, Jichi Medical School, Japan
    2. Immunology Section, The Kitasato Institute, Jichi Medical School, Japan
    3. First Department of Internal Medicine, Yamanashi Medical College, Jichi Medical School, Japan
    4. Institute of Immunology; and Immunology Division, Jichi Medical School, Japan
    • Immunology Division, Jichi Medical School, Minamikawachi-Machi, Tochigi-Ken 329–04, Japan
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Abstract

Twenty-three staff members serving in a hemodi-alysis unit were exposed accidentally to needlestick contaminated with blood containing hepatitis B surface antigen and hepatitis B e antigen, as well as high levels of DNA polymerase activity (< 100 cpm). They received hepatitis B vaccine (20 μg) simultaneously with hepatitis B immune globulin (5 ml, 200 IU per ml) within 48 hr after the exposure, and the vaccination was repeated at 1 and 3 months. The protective efficacy was compared with that in a past study in the same unit in which 33 members were given hepatitis B immune globulin alone within 48 hr after the exposure to blood with similarly high levels of DNA polymerase activity. No differences were noted in age or sex between the staff members who were vaccinated and those who were not, nor were there any differences between their inocula in the titers of hepatitis B virus markers. During 12 months after the accident, only one (4%) of the 23 vaccinated members contracted hepatitis B virus infection, at a frequency significantly lower than 11 (33%) of the 33 members who did not receive vaccine (p < 0.02). These results indicate that hepatitis B vaccine, when given in combination with hepatitis B immune globulin, is efficacious for postexposure immunoprophylaxis of accidental infection.

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