Der Internist

, Volume 52, Issue 3, pp 250–264 | Cite as

Prävention der Virushepatitis A bis E

Schwerpunkt

Zusammenfassung

Infektionen mit Hepatitisviren können einerseits zu einer akuten Hepatitis mit Leberversagen führen, andererseits können sich chronische Verlaufsformen zu Leberzirrhose und hepatozellulärem Karzinom entwickeln. Daher ist die Prävention der Virushepatitis und ihrer Folgen von großer Bedeutung. Die Impfung gegen Hepatitis A ist nahezu immer erfolgreich und führt sehr rasch zu einer Seroprotektion. Der Impfschutz besteht mindestens 20 Jahre und eine Booster-Impfung ist generell nicht erforderlich. Seit Einführung der Impfung hat es einen deutlichen Rückgang an HAV-Neuinfektionen gegeben. Ebenso gibt es eine sichere und sehr effektive Impfung gegen Hepatitis B. Bei immunsupprimierten und Dialysepatienten ist die Seroprotektionsrate geringer und besondere Impfmaßnahmen sind erforderlich. Neue Impfungen mit besseren Adjuvanzien werden momentan in Studien geprüft. Für die Prävention der Hepatitis C ist noch keine Impfung in Sicht. Vorsichtsmaßnahmen und die frühe antivirale Behandlung der akuten Hepatitis C stehen im Vordergrund der Präventionsmaßnahmen. Die Hepatitis Delta ist durch effektive Prävention der Hepatitis B zu verhindern. Für die Hepatitis E wurden Impfstoffe in Phase-III-Studien getestet. Die Entwicklung einer Impfung bekommt eine neue Tragweite, da zunehmend Fälle von chronischer Hepatitis bei immunsupprimierten Patienten berichtet werden.

Schlüsselwörter

Virale Hepatitis Hepatitisviren Präventionsmaßnahmen Impfung Impfstoffe 

Prevention of virus hepatitis A to E

Abstract

Infection with hepatitis viruses can lead to acute hepatitis with the risk of developing liver failure. Chronic viral hepatitis may evolve into liver cirrhosis and hepatocellular carcinoma. Thus, prevention of viral hepatitis and its sequels is essential. Vaccination against hepatitis A is successful in almost all individuals. Protective antibodies maintain for at least 20 years. Booster vaccinations are not necessary. Since the introduction of hepatitis A vaccines, the incidence of new HAV-infections has declined significantly. Hepatitis B vaccines are safe and highly effective. Special populations such as dialysis patients or immunocompromised patients require special vaccine schedules. New vaccines with improved adjuvants are currently being tested in clinical trials. So far there is no hepatitis C vaccine on the horizon. Prophylaxis of HCV-infections relies primarily on hygiene measures. Early therapy of acute hepatitis C can prevent chronic hepatitis C. HDV-infection can only be established if HBsAg is present. Thus, prevention of hepatitis B or elimination of HBsAg means prevention of hepatitis delta. Hepatitis E vaccines have been evaluated in phase III studies. The development of HEV vaccines becomes more relevant since chronic HEV infections have been reported in immunosuppressed individuals.

Keywords

Viral hepatitis Hepatitis viruses Prophylactic measures Vaccination Vaccines 

Notes

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin:

Beratertätigkeit für GSK (nicht für Vakzine).

Beratertätigkeit Roche, MSD (Medikamente zur Behandlung der Virushepatititis).

Vortragstätigkeit Roche, MSD, BMS, Gilead, Novartis (Medikamente zur Behandlung der Virushepatititis).

Literatur

  1. 1.
    Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC) (2007) Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 56:1080–1084Google Scholar
  2. 2.
    Alavian SM, Tabatabaei SV (2010) The effect of diabetes mellitus on immunological response to hepatitis B virus vaccine in individuals with chronic kidney disease: A meta-analysis of current literature. Vaccine 28:3773–3777PubMedCrossRefGoogle Scholar
  3. 3.
    Alter MJ, Moyer LA (1998) The importance of preventing hepatitis C virus infection among injection drug users in the United States. J Acquir Immune Defic Syndr Hum Retrovirol 18 (Suppl 1):S6–10PubMedGoogle Scholar
  4. 4.
    Arslan M, Wiesner RH, Poterucha JJ et al (2001) Safety and efficacy of hepatitis A vaccination in liver transplantation recipients. Transplantation 72:272–276PubMedCrossRefGoogle Scholar
  5. 5.
    Balayan MS, Andjaparidze AG, Savinskaya SS et al (1983) Evidence for a virus in non-A, non-B hepatitis transmitted via the fecal-oral route. Intervirology 20:23–31PubMedCrossRefGoogle Scholar
  6. 6.
    Bovier PA, Bock J, Ebengo TF et al (2010) Predicted 30-year protection after vaccination with an aluminum-free virosomal hepatitis A vaccine. J Med Virol 82:1629–1634PubMedCrossRefGoogle Scholar
  7. 7.
    Brown RS, Buti M, Goodwin D et al (2009) Hepatitis B virus (HBV) drugs in pregnancy: findings from the antiretroviral pregnancy registry. Columbia University, College of Physicians and Surgeons, New York, NY USA, diane.goodwin@gilead.comGoogle Scholar
  8. 8.
    Chang MH, Chen CJ, Lai MS et al (1997) Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med 336:1855–1859PubMedCrossRefGoogle Scholar
  9. 9.
    Choo QL, Kuo G, Weiner AJ et al. (1989) Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science 244:359–362PubMedCrossRefGoogle Scholar
  10. 10.
    Chou HY, Lin XZ, Pan WY et al (2010) Hydrogel-delivered GM-CSF overcomes nonresponsiveness to hepatitis B vaccine through the recruitment and activation of dendritic cells. J Immunol 185:5468–5475PubMedCrossRefGoogle Scholar
  11. 11.
    Clemens R, Sanger R, Kruppenbacher J et al (1997) Booster immunization of low- and non-responders after a standard three dose hepatitis B vaccine schedule – results of a post-marketing surveillance. Vaccine 15:349–352PubMedCrossRefGoogle Scholar
  12. 12.
    Coates T, Wilson R, Patrick G et al (2001) Hepatitis B vaccines: assessment of the seroprotective efficacy of two recombinant DNA vaccines. Clin Ther 23:392–403PubMedCrossRefGoogle Scholar
  13. 13.
    Cornberg M, Jaroszewicz J, Manns MP et al (2010) Treatment of chronic hepatitis B. Minerva Gastroenterol Dietol 56:451–465PubMedGoogle Scholar
  14. 14.
    Cornberg M, Protzer U, Dollinger MM et al (2007) Prophylaxis, Diagnosis and Therapy of Hepatitis-B-Virus- (HBV-) Infection: upgrade of the guideline, AWMF-Register 021/011. Z Gastroenterol 45:525–574PubMedCrossRefGoogle Scholar
  15. 15.
    Dalton HR, Bendall RP, Keane FE et al (2009) Persistent carriage of hepatitis E virus in patients with HIV infection. N Engl J Med 361:1025–1027PubMedCrossRefGoogle Scholar
  16. 16.
    Daniels D, Grytdal S, Wasley A (2009) Surveillance for acute viral hepatitis – United States, 2007. MMWR Surveill Summ 58:1–27PubMedGoogle Scholar
  17. 17.
    Fabrizi F, Dixit V, Messa P, Martin P (2010) Intradermal vs intramuscular vaccine against hepatitis B infection in dialysis patients: a meta-analysis of randomized trials. J Viral Hepat [Epub ahead of print]Google Scholar
  18. 18.
    Fabrizi F, Dixit V, Messa P, Martin P (2010) Meta-analysis: levamisole improves the immune response to hepatitis B vaccine in dialysis patients. Aliment Pharmacol Ther 32:756–762PubMedCrossRefGoogle Scholar
  19. 19.
    Fabrizi F, Ganeshan SV, Dixit V et al (2006) Meta-analysis: the adjuvant role of granulocyte macrophage-colony stimulating factor on immunological response to hepatitis B virus vaccine in end-stage renal disease. Aliment Pharmacol Ther 24:789–796PubMedCrossRefGoogle Scholar
  20. 20.
    Fattovich G, Bortolotti F, Donato F (2008) Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol 48:335–352PubMedCrossRefGoogle Scholar
  21. 21.
    Fiore AE (2004) Hepatitis A transmitted by food. Clin Infect Dis 38:705–715PubMedCrossRefGoogle Scholar
  22. 22.
    Fiore AE, Wasley A, Bell BP (2006) Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 55:1–23Google Scholar
  23. 23.
    Gerlach JT, Diepolder HM, Zachoval R et al (2003) Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. Gastroenterology 125:80–88PubMedCrossRefGoogle Scholar
  24. 24.
    Gust ID, Coulepis AG, Feinstone SM et al (1983) Taxonomic classification of hepatitis A virus. Intervirology 20:1–7PubMedCrossRefGoogle Scholar
  25. 25.
    Hadem J, Wedemeyer H, Manns MP (2004) Hepatitis als Reisekrankheit. Internist (Berl) 45:655–668Google Scholar
  26. 26.
    Hammitt LL, Bulkow L, Hennessy TW et al (2008) Persistence of antibody to hepatitis A virus 10 years after vaccination among children and adults. J Infect Dis 198:1776–1782PubMedCrossRefGoogle Scholar
  27. 27.
    Han G, Zhao W, Cao M et al (2010) A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus (HBV) to the infants. Hepatology 52:427A–428ACrossRefGoogle Scholar
  28. 28.
    Hezode C, Forestier N, Dusheiko G et al (2009) Telaprevir and peginterferon with or without ribavirin for chronic HCV infection. N Engl J Med 360:1839–1850PubMedCrossRefGoogle Scholar
  29. 29.
    Hoofnagle JH (2002) Course and outcome of hepatitis C. Hepatology 36:S21–S29PubMedCrossRefGoogle Scholar
  30. 30.
    Hwang LY, Grimes CZ, Tran TQ et al (2010) Accelerated hepatitis B vaccination schedule among drug users: a randomized controlled trial. J Infect Dis 202:1500–1509PubMedCrossRefGoogle Scholar
  31. 31.
    Innis BL, Snitbhan R, Kunasol P et al (1994) Protection against hepatitis A by an inactivated vaccine. JAMA 271:1328–1334PubMedCrossRefGoogle Scholar
  32. 32.
    Iwarson S, Lindh M, Widerstrom L (2002) Excellent booster response 4–6 y after a single primary dose of an inactivated hepatitis A vaccine. Scand J Infect Dis 34:110–111PubMedCrossRefGoogle Scholar
  33. 33.
    Jahresstatistik des Robert Koch-Instituts. www.rki.deGoogle Scholar
  34. 34.
    Jilg W, Schmidt M, Deinhardt F (1990) Inoculation failure following hepatitis B vaccination. The effect of additional vaccinations. Dtsch Med Wochenschr 115:1545–1548PubMedCrossRefGoogle Scholar
  35. 35.
    Kallinowski B, Jilg W, Buchholz L et al (2003) Immunogenicity of an accelerated vaccination regime with a combined hepatitis a/b vaccine in patients with chronic hepatitis C. Z Gastroenterol 41:983–990PubMedCrossRefGoogle Scholar
  36. 36.
    Kamar N, Mansuy JM, Cointault O et al (2008) Hepatitis E virus-related cirrhosis in kidney- and kidney-pancreas-transplant recipients. Am J Transplant 8:1744–1748PubMedCrossRefGoogle Scholar
  37. 37.
    Kamar N, Selves J, Mansuy JM et al (2008) Hepatitis E virus and chronic hepatitis in organ-transplant recipients. N Engl J Med 358:811–817PubMedCrossRefGoogle Scholar
  38. 38.
    Keeffe EB, Iwarson S, McMahon BJ et al (1998) Safety and immunogenicity of hepatitis A vaccine in patients with chronic liver disease. Hepatology 27:881–886PubMedCrossRefGoogle Scholar
  39. 39.
    Kubitschke A, Bader C, Tillmann HL et al (2007) Verletzungen mit Hepatitis-C-Virus-kontaminierten Nadeln. Internist (Berl) 48:1165–1172Google Scholar
  40. 40.
    Kwo PY, Lawitz EJ, McCone J et al (2010) Efficacy of boceprevir, an NS3 protease inhibitor, in combination with peginterferon alfa-2b and ribavirin in treatment-naive patients with genotype 1 hepatitis C infection (SPRINT-1): an open-label, randomised, multicentre phase 2 trial. Lancet 376:705–716PubMedCrossRefGoogle Scholar
  41. 41.
    Landry P, Tremblay S, Darioli R et al (2000) Inactivated hepatitis A vaccine booster given >/=24 months after the primary dose. Vaccine 19:399–402PubMedCrossRefGoogle Scholar
  42. 42.
    Liaw YF, Chen TJ, Chu CM et al (1990) Acute hepatitis delta virus superinfection in patients with liver cirrhosis. J Hepatol 10:41–45PubMedCrossRefGoogle Scholar
  43. 43.
    Manns MP, Wedemeyer H, Cornberg M (2006) Treating viral hepatitis C: efficacy, side effects, and complications. Gut 55:1350–1359PubMedCrossRefGoogle Scholar
  44. 44.
    Pecoraro ML, Martin JT, Halperin S et al (2009) A phase 3 safety and efficacy study comparing immunogenicity of two doses of HBsAg combined with immunostimulatory sequence with three doses of licensed hepatitis vaccine. Dynavax Technol, Berkeley, CA USA,mpecoraro@dynavax.comGoogle Scholar
  45. 45.
    Perz JF, Armstrong GL, Farrington LA et al (2006) The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 45:529–538PubMedCrossRefGoogle Scholar
  46. 46.
    Pischke S, Potthoff A, Hauroder B et al (2010) Hepatitis E virus infection: a paradigm shift? Dtsch Med Wochenschr 135:1129–1133PubMedCrossRefGoogle Scholar
  47. 47.
    Pischke S, Suneetha PV, Baechlein C et al (2010) Hepatitis E virus infection as a cause of graft hepatitis in liver transplant recipients. Liver Transpl 16:74–82PubMedCrossRefGoogle Scholar
  48. 48.
    Poorolajal J, Mahmoodi M, Majdzadeh R et al (2010) Long-term protection provided by hepatitis B vaccine and need for booster dose: a meta-analysis. Vaccine 28:623–631PubMedCrossRefGoogle Scholar
  49. 49.
    Rehermann B, Nascimbeni M (2005) Immunology of hepatitis B virus and hepatitis C virus infection. Nat Rev Immunol 5:215–229PubMedCrossRefGoogle Scholar
  50. 50.
    Rizzetto M, Verme G (1985) Hepatitis D. Internist (Berl) 26:628–632Google Scholar
  51. 51.
    Robert Koch-Institut (2001) Zu Übertragungswegen und Übertragungsfaktoren der Hepatitis A – Ergebnisse einer epidemiologischen Untersuchung in Hamburg. Epidemiol Bull 50:383–384Google Scholar
  52. 52.
    Robert Koch-Institut (2007) Zur Situation wichtiger Infektionskrankheiten in Deutschland: Virushepatitis B, C und D im Jahr 2006. Epidemiol Bull 49:457–468Google Scholar
  53. 53.
    Robert Koch-Institut (2008) Hepatitis E – Epidemiologie und Risikofaktoren in Deutschland. Epidemiol Bull 49:435–464Google Scholar
  54. 54.
    Robert Koch-Institut (2008) Zur Situation der Hepatitis A in Deutschland im Jahr 2007. Epidemiol Bull 44:379–384Google Scholar
  55. 55.
    Robert Koch-Institut (2010) Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut/Stand: Juli 2010. Epidemiol Bull 30:279–298Google Scholar
  56. 56.
    Sarrazin C, Berg T, Ross RS et al (2010) Prophylaxis, diagnosis and therapy of hepatitis C virus (HCV) infection: the German guidelines on the management of HCV infection. Z Gastroenterol 48:289–351PubMedCrossRefGoogle Scholar
  57. 57.
    Shepard CW, Finelli L, Alter MJ (2005) Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 5:558–567PubMedCrossRefGoogle Scholar
  58. 58.
    Shrestha MP, Scott RM, Joshi DM et al (2007) Safety and efficacy of a recombinant hepatitis E vaccine. N Engl J Med 356:895–903PubMedCrossRefGoogle Scholar
  59. 59.
    Tiollais P, Pourcel C, Dejean A (1985) The hepatitis B virus. Nature 317:489–495PubMedCrossRefGoogle Scholar
  60. 60.
    Van Damme P, Banatvala J, Fay O et al (2003) Hepatitis A booster vaccination: is there a need? Lancet 362:1065–1071CrossRefGoogle Scholar
  61. 61.
    Van Effelterre TP, Zink TK, Hoet BJ et al (2006) A mathematical model of hepatitis a transmission in the United States indicates value of universal childhood immunization. Clin Infect Dis 43:158–164CrossRefGoogle Scholar
  62. 62.
    Van Herck K, Leroux-Roels G, Van Damme P et al (2007) Ten-year antibody persistence induced by hepatitis A and B vaccine (Twinrix) in adults. Travel Med Infect Dis 5:171–175CrossRefGoogle Scholar
  63. 63.
    Victor JC, Monto AS, Surdina TY et al (2007) Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med 357:1685–1694PubMedCrossRefGoogle Scholar
  64. 64.
    Wedemeyer H, Manns MP (2010) Epidemiology, pathogenesis and management of hepatitis D: update and challenges ahead. Nat Rev Gastroenterol Hepatol 7:31–40PubMedCrossRefGoogle Scholar
  65. 65.
    Werzberger A, Mensch B, Kuter B et al (1992) A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children. N Engl J Med 327:453–457PubMedCrossRefGoogle Scholar
  66. 66.
    Wiegand J, Deterding K, Cornberg M et al (2008) Treatment of acute hepatitis C: the success of monotherapy with (pegylated) interferon alpha. J Antimicrob Chemother 62:860–865PubMedCrossRefGoogle Scholar
  67. 67.
    Williams JL, Bruden DA, Cagle HH et al (2003) Hepatitis A vaccine: immunogenicity following administration of a delayed immunization schedule in infants, children and adults. Vaccine 21:3208–3211PubMedCrossRefGoogle Scholar
  68. 68.
    Wismans P, Hattum J van, Stelling T et al (1988) Effect of supplementary vaccination in healthy non-responders to hepatitis B vaccination. Hepatogastroenterology 35:78–79PubMedCrossRefGoogle Scholar
  69. 69.
    Wolters B, Junge U, Dziuba S et al (2003) Immunogenicity of combined hepatitis A and B vaccine in elderly persons. Vaccine 21:3623–3628PubMedCrossRefGoogle Scholar
  70. 70.
    Woo EJ, Miller NB, Ball R (2006) Adverse events after hepatitis A B combination vaccine. Vaccine 24:2685–2691PubMedCrossRefGoogle Scholar
  71. 71.
    World Health Organization (2000) WHO position paper on hepatitis A vaccines. Can Commun Dis Rep 26:33–38Google Scholar
  72. 72.
    Zhu FC, Zhang J, Zhang XF et al (2010) Efficacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet 376:895–902PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Klinik für Gastroenterologie, Hepatologie und EndokrinologieMedizinische Hochschule HannoverHannoverDeutschland

Personalised recommendations