Is Hepatitis A and B Screening and Vaccination in Chronic Hepatitis C
H. S. Yee; S. L. Currie; M. K. Chapko; A. Monto.
Coinfection with hepatitis A virus (HAV) and/or hepatitis B virus (HBV) in
patients with chronic hepatitis C virus (HCV) infection can increase
morbidity and mortality. The NIH Consensus panel and the ACIP recommend
vaccinating against HAV and HBV in chronic HCV-infected patients who lack
immunity. However, limited data on provider practices with HAV and HBV
screening exist. Furthermore, in those who are vaccinated, antibody response
has been varied in patients with chronic HCV. The primary aim of this study
was to determine the proportion of HCV-infected veterans tested for HAV
and/or HBV immunity and appropriately referred for vaccination. A secondary
aim was to determine the antibody response in those vaccinated.
Data were retrospectively collected in 2,317 patients at the Veterans
Affairs Medical Center, San Francisco. Subjects were HCV positive and
accessing outpatient services between 2002 and 2003. Data were reviewed
between January 1, 1997 and December 31, 2003 for HAV and HBV antibody
status, vaccination referrals, and vaccine response. Additional information
collected included demographics, comorbid diseases and social habits.
In 2,317 veterans with chronic HCV, the mean age was 54.7 years, 97.5% were
male, 65.7% were Caucasian, and 31.7% were African American. Each patient
had 9.5 median outpatient clinic visits/year. Over 75% had been tested for
HAV antibody (HAVAb) and/or hepatitis B surface antibody (HBsAb). However,
referral for vaccination occurred in 53.6% of patients (435/812) who were
susceptible to HAV and 47.8% of patients (369/772) who were susceptible to
HBV. Post-vaccination antibody results were available in a subgroup of 119
patients who completed the HAV vaccine series and in another subgroup of 118
patients who completed the HBV vaccine series. HAVAb developed in 74.8% (p =
0.001) and HBsAb developed in 50.8% (p = 0.025) of patients, which is
significantly lower than previously published studies. In multivariate
logistic regression analysis, age >50, alcohol use, and advanced liver
disease were not independent factors in vaccine response.
Screening and immunization of HCV-infected persons for HAV and/or HBV
vaccinations are suboptimal. In addition, our data suggest that vaccine
response appears reduced by 25 to 50% in these patients. Further studies are
needed to determine whether vaccine screening and administration strategies
should be targeted to those at highest risk.