Human Normal Immunoglobulin (Nihon Pharmaceutical Co., Ltd.)

Hepatitis A virus (HAV) infection is endemic in developing countries and remains a public health problem elsewhere. A total of 7430 cases was notified in England and Wales in 1991. Children and young adults were most frequently affected. Risk factors include travel to countries of high endemicity, contact with an infected person and shellfish consumption. Person-to-person spread is common within families, closely knit communities and schools (especially nurseries). The provision of safe water and sanitary disposal of faeces are prerequisites for control of HAV throughout the world. In developed countries, human normal immunoglobulin (HNIG) is used for post-exposure prophylaxis and is given to those travelling abroad prior to possible exposure. Recommendations for the use of hepatitis A vaccine have have recently been made but it is expensive. Further studies on risk factors for infection, and on the efficacy of hepatitis A vaccine in outbreak control, are needed.

One hundred and seventy-two cases of viral hepatitis A (or 'infective hepatitis' or 'infective jaundice' judged to be viral hepatitis A) were notified in Birmingham in the 15 months from January 1990 to March 1991. Forty patients had travelled abroad in the three months prior to onset, 30 of whom had been to the Indian subcontinent. A survey of general practitioners attending to patients going abroad indicated that human normal immunoglobulin (HNIG) was rarely given to intending travellers, whereas other recommended immunisations often were. Furthermore, a sizeable proportion of travellers did not attend their general practitioners prior to departure. Interventions aimed at encouraging attendance, and the administration of HNIG prior to travel to endemic areas, could reduce the incidence of hepatitis A substantially, particularly in areas with a large population of Asian origin.