Low Prevalence of Vaccination or Documented Immunity to Hepatitis A and Hepatitis B Viruses Among Individuals with Chronic Liver Disease

Wong, Robert J.; Gish, Robert G.; Cheung, Ramsey; Chitnis, Amit S.

doi:10.1016/j.amjmed.2021.02.008

Cited by 3 publications

(4 citation statements)

References 46 publications

(47 reference statements)

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“…The predominant reason for this lack of compliance was identified as the absence of discussion by the physician, where the risk/benefit analysis of vaccination is not addressed during clinical appointments—in 31% to 78% of cases, which is followed by loss to follow-up (35%). Moreover, factors such as etiology of CLD, higher Child–Pugh score, older age, and lower education level are also independently associated with lower vaccination rates [ 68 , 69 ].…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

Advancements in Vaccine Strategies for Chronic Liver Disease Patients: Navigating Post-COVID Challenges and Opportunities

Al-Dury,

Kanberg

2024

Vaccines

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This review addresses the vital role of vaccinations in managing patients with chronic liver disease (CLD), especially in the context of the post-COVID-19 landscape. The pandemic has highlighted the unique vulnerabilities of CLD patients, including those awaiting liver transplantation and post-transplant individuals, who face heightened risks of infection due to compromised immune responses. Recent advancements in vaccine technology, such as mRNA platforms, novel adjuvants, and advanced delivery systems, have significantly accelerated vaccine development, enhancing both speed and efficacy. Moreover, the emergence of personalized vaccines, tailored to everyone’s unique immunological profile, presents new opportunities, particularly for those with chronic conditions. This review synthesizes the current state of evidence regarding vaccine recommendations for CLD patients, focusing on their response to vaccinations and proposing effective strategies to protect this vulnerable group from vaccine-preventable diseases. It also explores the challenges in implementing these strategies and considers the impact of emerging vaccine delivery systems on improving outcomes for CLD patients. The paper aims to provide nuanced guidance on vaccination in the rapidly evolving healthcare landscape, addressing both technological innovations and comprehensive patient care strategies.

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Section: Discussion and Future Directionsmentioning

confidence: 99%

Advancements in Vaccine Strategies for Chronic Liver Disease Patients: Navigating Post-COVID Challenges and Opportunities

Al-Dury,

Kanberg

2024

Vaccines

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“…34 Notably, increased mortality among patients with chronic liver disease with HAV superinfection has been well documented. [35][36][37] Despite the distressing effect of active HAV infection among patients with chronic liver disease, Wong et al 38 using data from the 2011-2018 NHANES report, found that almost 40% of patients with NAFLD were unvaccinated against HAV. Taken together, future studies examining the association between NAFLD and HAV are needed, and importantly an increased effort to raise awareness about the importance of timely vaccination against HAV in patients with chronic liver disease is warranted.…”

Section: Discussionmentioning

confidence: 99%

Impact of prior HBV, HAV, and HEV infection on non‐alcoholic fatty liver disease

Vassilopoulos

Kalligeros

Vassilopoulos

et al. 2023

Journal of Viral Hepatitis

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Non‐alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease. The association between prior hepatitis B virus (HBV), hepatitis A virus (HAV), hepatitis E virus (HEV) infection and NAFLD remains unclear. We utilized the 2017–2020 National Health and Nutrition Examination Survey (NHANES) and performed multivariable logistic regression analyses to examine the association of prior HBV, HAV and HEV infection with NAFLD, as well as high risk non‐alcoholic steatohepatitis (NASH) and liver fibrosis. Our analysis included 2565 participants with available anti‐HBc serology results, 1480 unvaccinated participants with anti‐HAV results, and 2561 participants with anti‐HEV results. Among participants with NAFLD, the age‐adjusted prevalence of prior HBV, HAV and HEV infection was 3.48%, 32.08% and 7.45%, respectively. Prior infection with HBV, HAV and HEV was not associated with NAFLD (cut‐off 285 dB/m) [aOR: 0.99 (95% CI, 0.77–1.29), 1.29 (95% CI, 0.95–1.75), and 0.94 (95% CI, 0.70–1.27), respectively] or high‐risk NASH [aOR 0.72 (95% CI, 0.45–1.17), 0.92 (95% CI, 0.55–1.52), and 0.89 (95% CI, 0.41–1.94), respectively]. Participants with anti‐HBc and anti‐HAV seropositivity were more likely to have significant fibrosis [aOR: 1.53 (95% CI, 1.05–2.23) and 1.69 (95% CI, 1.16–2.47), respectively]. The odds of significant fibrosis are 53%, and 69% greater for participants with prior history of HBV and HAV infection. Healthcare providers should prioritize vaccination efforts and employ a tailored approach to NAFLD in patients with prior viral hepatitis and especially HBV or HAV infection to limit disease‐related outcomes.

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“…This primarily stems from the observation that HAV or HBV co-infection in CLD patients is associated with more rapid and progressive liver injury, acute decompensation, and increased risks of death [ 1 - 4 ]. Despite this recommendation, vaccinations rates remain suboptimal [ 10 ]. Kramer et al evaluated US adults with chronic HCV and observed that only 21.9% and 20.7% received HAV or HBV vaccination, respectively [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…The importance of screening for hepatitis A virus (HAV) and hepatitis B virus (HBV) and subsequent documentation of immunity or initiation of vaccination among patients with CLD in particular is supported by national societies and guideline recommendations [ 5 , 6 ]. However, existing studies have demonstrated that vaccination for HAV and HBV among patients with CLD remains suboptimal [ 5 , 7 - 10 ]. This is a particularly important public health concern given that HAV and HBV are vaccine preventable diseases, whereby timely screening, vaccination, and linkage to care, particularly among individuals with underlying CLD, can significantly improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Ethnic Minorities and Low Socioeconomic Status Patients With Chronic Liver Disease Are at Greatest Risk of Being Uninsured

et al. 2021

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Background Chronic liver disease (CLD) predominantly affects ethnic minorities and socially vulnerable populations, who have high prevalence of risk factors (e.g., suboptimal insurance coverage) predisposing to healthcare disparities. We evaluate prevalence and predictors of uninsured status among CLD adults, and secondarily, how this affects documented immunity or vaccination for hepatitis A virus (HAV) and hepatitis B virus (HBV). Methods Using 2011 - 2018 National Health and Nutrition Examination Survey data, self-reported insurance status was determined among adults with CLD. Prevalence of uninsured status was stratified by patient characteristics and evaluated using multivariable logistic regression models. Prevalence of self-reported completion of vaccination as well as laboratory value-based documented immunity to HAV and HBV was stratified by insurance status. Results Overall, 19.0% of adults with CLD reported having no insurance, which was highest among individuals of Hispanic ethnicity (33.5%), less than high school education (33.7%), and below poverty status (35.3%). On multivariable analyses, significantly lower odds of having any insurance coverage was observed in men, Hispanics, and individuals with lower education and lower household income. Prevalence of documented immunity or vaccination for HAV was low across all insurance categories, ranging from 46.5% to 54.0%. Prevalence of documented immunity or vaccination for HBV was similarly low across all insurance categories, ranging from 24.3% to 40.8%. Conclusion Prevalence of uninsured status among CLD was more than twice the US adult population, and lack of insurance particularly impacted Hispanics and individuals with low education and low household income. Low prevalence of documented immunity or vaccination for HAV and HBV across all insurance categories is concerning.

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Low Prevalence of Vaccination or Documented Immunity to Hepatitis A and Hepatitis B Viruses Among Individuals with Chronic Liver Disease

Cited by 3 publications

References 46 publications

Advancements in Vaccine Strategies for Chronic Liver Disease Patients: Navigating Post-COVID Challenges and Opportunities

Advancements in Vaccine Strategies for Chronic Liver Disease Patients: Navigating Post-COVID Challenges and Opportunities

Impact of prior HBV, HAV, and HEV infection on non‐alcoholic fatty liver disease

Ethnic Minorities and Low Socioeconomic Status Patients With Chronic Liver Disease Are at Greatest Risk of Being Uninsured

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