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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 3; 335(7626): 909.
PMCID: PMC2048871
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Hepatitis A vaccination is effective after exposure

We can try to prevent hepatitis A infection in people at risk with two different approaches—immune globulin and vaccination. They both provide good protection, but the effect is more permanent with vaccination. A recent large trial from Kazakhstan suggests there is little to choose between them.

Contacts of people with hepatitis A were given an intramuscular injection of immune globulin or vaccinated against the virus at some time during the two weeks after exposure. Fewer than 5% of both groups developed symptomatic hepatitis A (25/568 (4.4%) receiving the vaccine v 17/522 (3.3%) receiving immunoglobulin). The small difference wasn't significant and the authors declared the vaccine “non-inferior” to immunoglobulin.

Vaccination is more convenient and potentially less painful than an injection of immunoglobulin. It is also more readily available. In the US, for example, the public health authorities rely on a single supplier of immunoglobulin. Stocks are limited and prices are rising.

These difficulties, coupled with worries about the safety of blood products, have prompted many developed countries to switch from immunoglobulin to vaccination for post exposure prophylaxis. This first head to head trial suggests their citizens will come to no harm. Authorities in the US have just reached the same conclusion and announced a change in policy.


  • N Engl J Med 2007;357:1685-94

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