Is Hepatitis A and B Screening and Vaccination in Chronic Hepatitis C Patients Effective?
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.