第一选择
肌肉注射免疫球蛋白
:
单次剂量为0.02ml/kg肌肉注射
或
肌内注射丙种球蛋白进行暴露后预防，并及时进行血清学检测，已被证实是有效的，并被认为是标准防护。[2]Brundage SC, Fitzpatrick AN. Hepatitis A. Am Fam Physician. 2006;73:2162-2168.http://www.aafp.org/afp/20060615/2162.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/16848078?tool=bestpractice.com[6]World Health Organization. Hepatitis A. 2000. http://www.who.int/ (last accessed 27 March 2017).http://www.who.int/csr/resources/publications/hepatitis/WHO_CDS_CSR_EDC_2000_7/en/[29]World Health Organization. Hepatitis A vaccines: WHO position paper. Wkly Epidemiol Rec. 2000;75:38-44.http://www.who.int/docstore/wer/pdf/2000/wer7505.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10693358?tool=bestpractice.com
美国疾病预防控制中心修订了指南，现在甲型肝炎疫苗允许应用于1-40岁有甲肝病毒暴露史的健康人群。暴露后显性甲肝病毒感染的发展：来自一项研究的高质量证据显示，对2-40岁的近期有暴露史（14天内）的人群应用丙种球蛋白、甲肝疫苗（保护率超过95%）进行暴露后预防，可减低显性感染发病率。[44]Victor JC, Monto AS, Surdina TY, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med. 2007;357:1685-1694.http://www.nejm.org/doi/full/10.1056/NEJMoa070546#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/17947390?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。更新后的指南在免疫预防方案选择上提供了指导，年龄12个月到40岁的人群建议首先选择单一抗原甲肝疫苗。超过40岁的人群首选丙种球蛋白，不可用时选用甲肝疫苗。小于12个月的幼儿、免疫受损人群、慢性肝病患者以及对甲肝疫苗过敏者应选择接种免疫球蛋白。[43]Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). 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. 2007;56:1080-1084.http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5641a3.htmhttp://www.ncbi.nlm.nih.gov/pubmed/17947967?tool=bestpractice.com
不同国家的建议可能会略有不同，因此需要咨询相应国家的指南。[6]World Health Organization. Hepatitis A. 2000. http://www.who.int/ (last accessed 27 March 2017).http://www.who.int/csr/resources/publications/hepatitis/WHO_CDS_CSR_EDC_2000_7/en/[29]World Health Organization. Hepatitis A vaccines: WHO position paper. Wkly Epidemiol Rec. 2000;75:38-44.http://www.who.int/docstore/wer/pdf/2000/wer7505.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10693358?tool=bestpractice.com[30]Public Health England. Hepatitis A: the green book, chapter 17. December 2013. https://www.gov.uk/ (last accessed 27 March 2017).https://www.gov.uk/government/publications/hepatitis-a-the-green-book-chapter-17
可能需要于专科医院接种肌内注射丙种球蛋白，因其尚未商业化推广。
