Comparación de dos estrategias de vacunación frente a la hepatitis A y B en individuos con hepatitis crónica C

Abstract

Objective: although the vaccination against hepatitis A (VAH) and hepatitis B (VBH) is recommended in patients with HCV, the most cost-effective strategy has not been established. Our objective was to compare the cost-effectiveness of universal strategy (vaccination all patients) with selective strategy (vaccination only patients against virus they lack immunity to) in patients with HCV.Patients and methods: we compared the direct medical costs of the two vaccination strategies against both viruses in 313 patients with HC. Serological markers for HAV (anti-HAV) and HBV (HbsAg, anti HBs, anti HBc) were determined in the 313 patients and the costs of the vaccines and the blood tests necessary to determinate the immunity state in our care system were considered.Results: the prevalence of anti-HAV was 81,2% and of antiHBc was 24,6%. The prevalence of anti-HAV increases with age. HAV vaccination with universal strategy has a cost of 19.806,64 € and with selective one of 9.899,62 €. HBV vaccination with universal strategy rose to 18.780 € and to 20.385,57 € with selective one (employing anti-HBc). Costs were analysed in different groups of age and several hepatitis HBV risk factors.Conclusions: the selective vaccination strategy against HAV was most cost-effective in our patients with HCV. However, when the prevalence of the anti-HAV decreased to less than 20% universal strategy will be the best option. Difference of cost-effective between the two vaccination strategies against HBV was small, on behalf of universal one, so in groups with higher anti-HBc prevalence, like parenteral drugs users and tattoos, the selective strategy could be the best option.Key words: HAV vaccine. HBV vaccine. Chronic hepatitis C. Cost-effectiveness. INTRODUCTIONWe currently recommend vaccination against the hepatitis A (HAV) and hepatitis B (HBV) viruses as a part of preventive measures for patients with chronic liver disease (1,2). This is due to the knowledge that the presence of an underlying liver disease, together with age, is one of the most important factors for increased morbidity and mortality after infection with these viruses.Hepatitis by HAV is usually a self-limited condition with a fatality rate of 0.01 to 0.5% in adults. However, when it occurs in individuals with chronic HBV infection, mortality can be up to 50 times higher than expected in healthy individuals (3). In relation to chronic liver disease by HCV, a controversial study was published (4) reflecting the development of liver failure in 41.2% of patients with HCV-related chronic hepatitis who had acute infection with HAV, which led to death in 6 cases. Similarly, other studies have confirmed the worse course of acute hepatitis A when it occurs in individuals with chronic liver disease either secondary to alcohol or cryptogenetic in nature (5).The consequences of acute HBV superinfection in patients with chronic liver disease by HCV are uncertain. Although some individuals experience a rapid progression to fulminant hepatic failure, others may present a resolution o...

Hepatitis A Virus among Drug Users and the Role of Vaccination: A Review

“…Travel to high-risk areas in young people was associated with a significant increased risk of HAV infection (Diez Redondo et al, 2009). These aspects have a wide validity but they become crucial when DUs are considered.…”