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Lee S, Lee K, Park J, Jeong YD, Jo H, Kim S, Woo S, Son Y, Kim HJ, Lee K, Ha Y, Oh NE, Lee J, Rhee SY, Smith L, Kang J, Rahmati M, Lee H, Yon DK. Global burden of vaccine-associated hepatobiliary and gastrointestinal adverse drug reactions, 1967-2023: A comprehensive analysis of the international pharmacovigilance database. J Med Virol 2024; 96:e29792. [PMID: 38993028 DOI: 10.1002/jmv.29792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/07/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
Although previous studies have focused on hepatobiliary and gastrointestinal adverse drug reactions (ADRs) associated with COVID-19 vaccines, literature on such ADRs with other vaccines is limited, particularly on a global scale. Therefore, we aimed to investigate the global burden of vaccine-associated hepatobiliary and gastrointestinal ADRs and identify the vaccines implicated in these occurrences. This study utilized data from the World Health Organization (WHO) international pharmacovigilance database to extract reports of vaccine-associated hepatobiliary and gastrointestinal ADRs from 1967 to 2023 (total reports = 131 255 418). Through global reporting counts, reported odds ratios (ROR) with 95% confidence interval (CI), and information components (IC) with IC0.25, the study examined the association between 16 vaccines and the incidence of hepatobiliary and gastrointestinal ADRs across 156 countries. Of the 6 842 303 reports in the vaccine-associated ADRs, 10 786 reports of liver injury, 927 870 reports of gastrointestinal symptoms, 2978 reports of pancreas and bile duct injury, and 96 reports of intra-abdominal hemorrhage between 1967 and 2023 were identified. Most hepatobiliary and gastrointestinal ADRs surged after 2020, with the majority of reports attributed to COVID-19 messenger RNA (mRNA) vaccines. Hepatitis A vaccines exhibited the highest association with liver injury (ROR [95% CI]: 10.30 [9.65-10.99]; IC [IC0.25]: 3.33 [3.22]), followed by hepatitis B, typhoid, and rotavirus. Specifically, ischemic hepatitis had a significant association with both Ad5-vectored and mRNA COVID-19 vaccines. Gastrointestinal symptoms were associated with all vaccines except for tuberculosis vaccines, particularly with rotavirus (11.62 [11.45-11.80]; 3.05 [3.03]) and typhoid (11.02 [10.66-11.39]; 3.00 [2.96]). Pancreas and bile duct injury were associated with COVID-19 mRNA (1.99 [1.89-2.09]; 0.90 [0.83]), MMR (measles, mumps, and rubella), and papillomavirus vaccines. For intra-abdominal hemorrhage, inactivated whole-virus COVID-19 vaccines (3.93 [1.86-8.27]; 1.71 [0.41]) had the highest association, followed by COVID-19 mRNA (1.81 [1.42-2.29]; 0.77 [0.39]). Most of these ADRs had a short time to onset, within 1 day, and low mortality rate. Through a global scale database, the majority of ADRs occurred within 1 day, emphasizing the importance of healthcare workers' vigilant monitoring and timely management.
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Affiliation(s)
- Sooji Lee
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Kyeongmin Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Yi Deun Jeong
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyesu Jo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Soeun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Yejun Son
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Kwanjoo Lee
- Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Yeonjung Ha
- Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Na-Eun Oh
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Jiseung Kang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille (APHM), Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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Lewin BJ, Rodriguez J, Yang SJ, Tartof SY. Predictors of hepatitis A immunity in adults in California in order to better utilize hepatitis A vaccine. Vaccine 2021; 39:5484-5489. [PMID: 34454784 DOI: 10.1016/j.vaccine.2021.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hepatitis A vaccine recommendations now include homelessness, illegal drug use, and HIV, as well as traditional risk factors and travel to areas endemic for hepatitis A. We examined a large diverse population for predictors of Hepatitis A immunity in order to better utilize Hepatitis A vaccine. METHODS We performed a cross-sectional descriptive study of members of a large integrated health plan with a test for Hepatitis A Immunoglobulin G (IgG) between January 1st, 2007, and December 31st, 2017. Exclusion criteria included age <18 years, <6 months of continuous enrollment, and Hepatitis A vaccine prior to Hepatitis A test. Variables of interest were age, gender, primary language spoken, ethnicity/race, neighborhood household income, and history of travel or history of jaundice. Multivariable logistic regression was performed to evaluate the association of risk factors on Hepatitis A immunity. RESULTS Of the 318,170 persons ≥ 18 years tested for Hepatitis A immunity, 155, 842 persons had a reactive Hepatitis A IgG test (49%). The lowest prevalence was for Whites at 28.1% followed by Blacks at 35.8%. Hispanics and Asian/Pacific Islanders had prevalence rates of 63% and 68.2% respectively. In adjusted analyses, Asian/Pacific Islanders, Hispanics and Blacks were 5.17, 3.44 and 1.42 times more likely to have Hepatitis A immunity than Whites. Those that spoke Spanish or language other than English or Spanish as their primary preferred language were 6.11 and 3.27 time more likely to have immunity than English speakers. Known travel history conferred a 2.16 likelihood of Hepatitis A immunity. CONCLUSIONS Persons of Hispanic and Asian/Pacific Islander background as well as persons with a preferred spoken language other than English have a high prevalence of Hepatitis A immunity. Testing for Hepatitis A immunity prior to vaccination should be considered for these groups.
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Affiliation(s)
- Bruno J Lewin
- Kaiser Permanente Southern California, Department of Family Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Clinical Science, United States.
| | - Janelle Rodriguez
- Kaiser Permanente Southern California, Department of Family Medicine, United States
| | - Su-Jau Yang
- Kaiser Permanente Southern California, Department of Research & Evaluation, United States
| | - Sara Y Tartof
- Kaiser Permanente Southern California, Department of Research & Evaluation, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, United States
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Maqsood MH, Kolli H, Kaur SP, Campoverde Reyes KJ, Guevara J, Shah PA, Talat A, Lau DTY. Improved hepatitis A and hepatitis B vaccination strategy is necessary for patients with chronic hepatitis C. Gastroenterol Rep (Oxf) 2020; 8:326-328. [PMID: 32843981 PMCID: PMC7434584 DOI: 10.1093/gastro/goaa024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/13/2020] [Accepted: 02/06/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Muhammad H Maqsood
- Division of Gastroenterology, Liver Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Himabindu Kolli
- Division of Gastroenterology, Liver Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Satinder P Kaur
- Division of Gastroenterology, Liver Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Karen J Campoverde Reyes
- Division of Gastroenterology, Liver Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Javier Guevara
- Division of Gastroenterology, Liver Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Pir A Shah
- Division of Gastroenterology, Liver Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arslan Talat
- Division of Gastroenterology, Liver Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daryl T Y Lau
- Division of Gastroenterology, Liver Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Herta T, Petroff D, Engelmann C, Herber A, Aehling N, Scheuermann U, Bartels M, Seehofer D, Berg T, Wiegand J. Hepatitis B Vaccination in Patients with Liver Cirrhosis Evaluated for Liver Transplantation - A Simple Intervention Ensures High Adherence. Ann Transplant 2019; 24:527-531. [PMID: 31515466 PMCID: PMC6755938 DOI: 10.12659/aot.917198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND There is an unmet need to improve the HBV vaccination status in patients with chronic liver diseases. Primary care physicians and outpatient hepatologists often fail to vaccinate as recommended. Thus, new strategies to improve the HBV vaccination rate are required. MATERIAL AND METHODS This study was performed in a cohort of patients with chronic liver diseases evaluated for liver transplantation. Vaccination status was taken from the patients' vaccination cards. HBsAg-, anti-HBc-, and anti-HBs-negative individuals were vaccinated against HBV at hospital discharge, and subsequent outpatient completion of the standard vaccination protocol was recommended in detail in the discharge letter. At months 2 and 8, titer controls were performed, and completion of vaccination was evaluated. RESULTS We prospectively recruited 37 patients. At baseline, the vaccination rate against HBV was 24% (N=9/37), and 3/9 HBV vaccinated patients presented with an anti-HBs-titer >10 IU/L. Thus, N=34 were vaccinated with Engerix® or Twinrix®. We evaluated 26/34 patients at month 2 and 10/26 again at month 8. The second vaccine dose was obtained by 21/26 (80%) of the patients seen at month 2, and 9/10 (90%) seen at month 8 obtained the third vaccine dose by primary care physicians or ambulant hepatologists. Only 2 patients presented with an anti-HBs-titer >10 IU/L at month 8. CONCLUSIONS Initiation of HBV vaccination during hospitalization and detailed recommendations on subsequent vaccinations in the discharge letter improve previously inadequate vaccination rates in the outpatient setting. Similar measures should be implemented at earlier time points of chronic liver diseases to achieve higher immune response rates.
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Affiliation(s)
- Toni Herta
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Center, University of Leipzig, Leipzig, Germany
| | | | - Adam Herber
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
| | - Niklas Aehling
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
| | - Uwe Scheuermann
- Department of Visceral, Vascular, Thoracic, and Transplant Surgery, University of Leipzig, Leipzig, Germany
| | - Michael Bartels
- Department of General, Visceral, Thoracic, and Vascular Surgery, Helios Park Hospital Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Vascular, Thoracic, and Transplant Surgery, University of Leipzig, Leipzig, Germany
| | - Thomas Berg
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
| | - Johannes Wiegand
- Clinic for Gastroenterology, University of Leipzig, Leipzig, Germany
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Ayoola R, Larion S, Poppers DM, Williams R. Clinical factors associated with hepatitis B screening and vaccination in high-risk adults. World J Hepatol 2019; 11:86-98. [PMID: 30705721 PMCID: PMC6354120 DOI: 10.4254/wjh.v11.i1.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/27/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis B virus is a viral infection that can lead to acute and/or chronic liver disease, and hepatocellular carcinoma (HCC). Hepatitis B vaccination is 95% effective in preventing infection and the development of chronic liver disease and HCC due to hepatitis B. In 2011, the Centers for Disease Control updated their guidelines recommending that adults at high-risk for hepatitis B infection be vaccinated against hepatitis B including those with diabetes mellitus (DM). We hypothesize that adults at high-risk for hepatitis B infection are not being adequately screened and/or vaccinated for hepatitis B in a large urban healthcare system.
AIM To investigate clinical factors associated with Hepatitis B screening and vaccination in patients at high-risk for Hepatitis B infection.
METHODS We conducted a retrospective review of 999 patients presenting at a large urban healthcare system from 2012-2017 at high-risk for hepatitis B infection. Patients were considered high-risk for hepatitis B infection based on hepatitis B practice recommendations from the Center for Disease Control. Medical history including hepatitis B serology, concomitant medical diagnoses, demographics, insurance status and social history were extracted from electronic health records. Multivariate logistic regression was used to identify clinical risk factors independently associated with hepatitis B screening and vaccination.
RESULTS Among the 999 patients, 556 (55.7%) patients were screened for hepatitis B. Of those who were screened, only 242 (43.5%) patients were vaccinated against hepatitis B. Multivariate regression analysis revealed end-stage renal disease [odds ratio (OR): 5.122; 2.766-9.483], alcoholic hepatitis (OR: 3.064; 1.020-9.206), and cirrhosis or end-stage liver disease (OR: 1.909; 1.095-3.329); all P < 0.05 were associated with hepatitis B screening, while age (OR: 0.785; 0.680-0.906), insurance status (0.690; 0.558-0.854), history of DM (OR: 0.518; 0.364-0.737), and human immunodeficiency virus (OR: 0.443; 0.273-0.718); all P < 0.05 were instead not associated with hepatitis B screening. Of the adults vaccinated for hepatitis B, multivariate regression analysis revealed age (OR: 0.755; 0.650-0.878) and DM were not associated with hepatitis B vaccination (OR: 0.620; 0.409-0.941) both P < 0.05.
CONCLUSION Patients at high-risk for hepatitis B are not being adequately screened and/or vaccinated. Improvements in hepatitis B vaccination should be strongly encouraged by all healthcare systems.
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Affiliation(s)
- Rotimi Ayoola
- Department of Medicine, Division of Gastroenterology, Howard University, Washington, DC 20059, United States
| | - Sebastian Larion
- Department of Medicine, Augusta University, Augusta, Georgia 30912, United States
| | - David M Poppers
- Department of Medicine, Division of Gastroenterology, New York University Langone Health, New York, NY 10016, United States
| | - Renee Williams
- Department of Medicine, Division of Gastroenterology, New York University Langone Health, New York, NY 10016, United States
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Yue X, Black CL, O'Halloran A, Lu PJ, Williams WW, Nelson NP. Hepatitis A and hepatitis B vaccination coverage among adults with chronic liver disease. Vaccine 2018; 36:1183-1189. [PMID: 29395521 PMCID: PMC5805590 DOI: 10.1016/j.vaccine.2018.01.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Infection with hepatitis A and hepatitis B virus can increase the risk of morbidity and mortality in persons with chronic liver disease (CLD). The Advisory Committee on Immunization Practices recommends hepatitis A (HepA) and hepatitis B (HepB) vaccination for persons with CLD. METHODS Data from the 2014 and 2015 National Health Interview Surveys (NHIS), nationally representative, in-person interview surveys of the non-institutionalized US civilian population, were used to assess self-reported HepA (≥1 and ≥2 doses) and HepB vaccination (≥1 and ≥3 doses) coverage among adults who reported a chronic or long-term liver condition. Multivariable logistic regression was used to identify factors independently associated with HepA and HepB vaccination among adults with CLD. RESULTS Overall, 19.4% and 11.5% of adults aged ≥ 18 years with CLD reported receiving ≥1 dose and ≥2 doses of HepA vaccine, respectively, compared with 14.7% and 9.1% of adults without CLD (p < .05 comparing those with and without CLD, ≥1dose). Age, education, geographic region, and international travel were associated with receipt of ≥2 doses HepA vaccine among adults with CLD. Overall, 35.7% and 29.1% of adults with CLD reported receiving ≥1 dose and ≥3 doses of HepB vaccine, respectively, compared with 30.2% and 24.7% of adults without CLD (p < .05 comparing those with and without CLD, ≥1 dose). Age, education, and receipt of influenza vaccination in the past 12 months were associated with receipt of ≥3 doses HepB vaccine among adults with CLD. Among adults with CLD and ≥10 provider visits, only 13.8% and 35.3% had received ≥2 doses HepA and ≥3 doses HepB vaccine, respectively. CONCLUSIONS HepA and HepB vaccination among adults with CLD is suboptimal and missed opportunities to vaccinate occurred. Providers should adhere to recommendations to vaccinate persons with CLD to increase vaccination among this population.
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Affiliation(s)
- Xin Yue
- Leidos Inc., Atlanta, GA, United States.
| | - Carla L Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Noele P Nelson
- Division of Viral Hepatitis, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Physicians infrequently adhere to hepatitis vaccination guidelines for chronic liver disease. PLoS One 2013; 8:e71124. [PMID: 23923056 PMCID: PMC3724808 DOI: 10.1371/journal.pone.0071124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/02/2013] [Indexed: 01/12/2023] Open
Abstract
Background and Goals Hepatitis A (HAV) and hepatitis B (HBV) vaccination in patients with chronic liver disease is an accepted standard of care. We determined HAV and HBV vaccination rates in a tertiary care referral hepatology clinic and the impact of electronic health record (EHR)-based reminders on adherence to vaccination guidelines. Methods We reviewed the records of 705 patients with chronic liver disease referred to our liver clinic in 2008 with at least two follow-up visits during the subsequent year. Demographics, referral source, etiology, and hepatitis serology were recorded. We determined whether eligible patients were offered vaccination and whether patients received vaccination. Barriers to vaccination were determined by a follow-up telephone interview. Results HAV and HBV serologic testing prior to referral and at the liver clinic were performed in 14.5% and 17.7%; and 76.7% and 74% patients, respectively. Hepatologists recommended vaccination for HAV in 63% and for HBV in 59.7% of eligible patients. Patient demographics or disease etiology did not influence recommendation rates. Significant variability was observed in vaccination recommendation amongst individual providers (30–98.6%), which did not correlate with the number of patients seen by each physician. Vaccination recommendation rates were not different for Medicare patients with hepatitis C infection for whom a vaccination reminder was automatically generated by the EHR. Most patients who failed to get vaccination after recommendation offered no specific reason for noncompliance; insurance was a barrier in a minority. Conclusions Hepatitis vaccination rates were suboptimal even in an academic, sub-speciality setting, with wide-variability in provider adherence to vaccination guidelines.
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Vaccine induced Hepatitis A and B protection in children at risk for cystic fibrosis associated liver disease. Vaccine 2013; 31:906-11. [DOI: 10.1016/j.vaccine.2012.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/22/2012] [Accepted: 12/01/2012] [Indexed: 01/29/2023]
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de Artaza Varasa T, Sánchez Ruano JJ, García Vela A, Gómez Rodríguez R, Romero Gutiérrez M, de la Cruz Pérez G, Gómez Moreno AZ, Carrobles Jiménez JM. [Efficacy and safety of vaccination against hepatitis A and B in patients with chronic liver disease]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:483-8. [PMID: 19577338 DOI: 10.1016/j.gastrohep.2009.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 03/05/2009] [Indexed: 01/29/2023]
Abstract
UNLABELLED Vaccination to protect against hepatitis A and B should be part of the routine management of patients with chronic liver disease (CLD). OBJECTIVES To evaluate the efficacy and safety of hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination in a group of patients with CLD and to assess the presence of factors predictive of response. PATIENTS AND METHODS We performed a prospective, single-center study in 194 patients (123 men, 71 women; mean age, 48.9+/-10.7 years) with CLD: 107 with chronic hepatitis (CH) and 87 with hepatic cirrhosis (HC), all Child-Pugh class A. The most frequent causes of CLD were HCV infection and alcohol. Patients negative for anti-HAV IgG received the HAV vaccination (1440 ELISA units in two doses) and those with negative HBV serology received the HBV vaccination ( three 20 microg doses). Patients with inadequate response to the latter vaccine received an additional double dose. Thirty patients received a combination vaccine (three doses). RESULTS Sixty patients (31%) received the HAV vaccine and 150 (77%) patients received the HBV vaccine. Seroconversion was achieved by 91.6% of patients for HAV and by 57% of the patients for HBV. After the additional dose, the response increased to 74%. Efficacy was similar between CH and HC. HBV vaccination was less effective in HC than in CH and the seroconversion rate was significantly lower in patients with HC and previous decompensation. The combination vaccine (30 patients) was highly immunogenic. No adverse effects were registered. CONCLUSIONS HAV vaccination has high efficacy in patients with CLD. Patients with HC respond weakly to HBV vaccination compared with those with CH and especially if there is prior decompensation. The combination vaccine seems particularly effective in patients with CLD. The three vaccines are safe.
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Villar LM, de Melo MMM, Calado IA, de Almeida AJ, Lampe E, Gaspar AMC. Should Brazilian patients with chronic hepatitis C virus infection be vaccinated against hepatitis A virus? J Gastroenterol Hepatol 2009; 24:238-42. [PMID: 19215334 DOI: 10.1111/j.1440-1746.2008.05575.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Hepatitis A virus (HAV) superinfection is associated with a high risk of liver failure and death in patients with hepatitis C virus (HCV) infection. The aim of this study was to investigate the presence of serological and molecular HAV markers in a population of HCV-infected patients in order to determine a cost-effective strategy to vaccinate against HAV. METHODS The presence of total and immunoglobulin (Ig)M anti-HAV antibodies was investigated in 399 patients (median age, 50 years; range, 4-81) referred to the Public Health Central Laboratory of Pernambuco State who tested positive for anti-HCV antibodies and HCV RNA. HAV RNA was investigated by reverse transcription-nested polymerase chain reaction in these patients. RESULTS Three hundred and eighty-four (96%) patients were positive for anti-HAV total and negative for IgM anti-HAV antibodies (immune patients). Three patients had IgM (and total) anti-HAV antibodies, showing an acute infection, and two of them had HAV RNA detected in serum samples. HAV RNA was also found in another patient in the absence of detectable anti-HAV antibodies. By nucleotide sequencing, it was demonstrated that the HAV isolates infecting these patients belonged to subgenotype 1B. CONCLUSION This study provides valuable new data on anti-HAV prevalence among HCV carriers in Brazil. In the present study, we found a high proportion of patients with anti-HAV positivity, indicating that anti-HAV testing of HCV-infected patients is a cost-effective strategy and should be carried out before vaccination against HAV in these patients, particularly in regions such as our geographical area with high total anti-HAV prevalence.
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Affiliation(s)
- Livia M Villar
- Viral Hepatitis Laboratory, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil.
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Abstract
Most care of liver disease is in the ambulatory setting, and therefore the clinical needs of patients represent those of any other chronic illness. Emphasis must be given to preventative strategies such that liver lifetime (including pre-emptive strategies related to potential allograft survival) is maximised through timely intervention and avoidance of side effects. This review addresses the pertinent practical clinical concerns faced by clinicians as they manage adult patients with chronic liver disease, with an emphasis on preventing and managing symptoms and complications directly and indirectly related to the underlying disease.
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Affiliation(s)
- Gideon M Hirschfield
- Toronto Western Hospital, University Health Network, University of Toronto, ON, Canada.
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Abstract
Immunization is the most effective way to prevent transmission of HBV and, hence, the development of acute or chronic hepatitis B. The national strategy to eliminate transmission of the virus in the United States includes vaccination of all newborn infants, children, adolescents, and high-risk adults. Postexposure prophylaxis is also advocated, depending on the vaccination and anti-HBs status of the exposed person. Seroprotection after vaccination, defined as anti-HBs > or = 10 mIU/mL, is achieved in over 95% of all vaccinees. The hepatitis B vaccines are very well tolerated with usually minimal adverse effects. Predictors of non-response include increasing age, male gender, obesity, tobacco smoking, and immunocompromising chronic dis-ease. For those who remain nonresponders after the second series of vaccination, adjuvants such as GM-CSF may be considered, but their results are variable.
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Affiliation(s)
- Andy S Yu
- Pacific Gastroenterology, 2101 Forest Avenue, Suite 106, San Jose, CA 95128, USA
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Ramsay DB, Friedman M, Borum ML. Does the race or gender of hepatitis C infected patients influence physicians' assessment of hepatitis A and hepatitis B serologic status? South Med J 2007; 100:683-5. [PMID: 17639747 DOI: 10.1097/smj.0b013e318063ecc5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HCV infection with concurrent or superinfection with HAV or HBV has the potential to worsen the liver status of HCV-infected individuals. This study evaluates if patients' race or gender influenced whether HAV or HBV serologic status was determined for the purpose of providing immunization. METHODS Medical records of consecutive African-American and white patients referred for management of HCV were evaluated to determine whether the referring physicians had obtained HAV and HBV serology. RESULTS Race and gender analysis revealed a statistically significant difference (P < 0.0001) in HAV testing of African-American and white patients, a statistically significant difference in HAV (P < 0.0001) and HBV (P < 0.0001) testing of African-American and white men, and a statistically significant difference (P = 0.0026) in HBV testing of African-American and white women. CONCLUSION HCV-infected individuals were inconsistently tested for HAV and HBV. Patients' race, but not gender, had a significant impact upon whether HCV-infected individuals were tested for HAV and HBV.
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Affiliation(s)
- David B Ramsay
- Division of Gastroenterology and Liver Disease, George Washington University Medical Center, Washington, DC 20037, USA.
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Song HJ, Kim TH, Song JH, Oh HJ, Ryu KH, Yeom HJ, Kim SE, Jung HK, Shim KN, Jung SA, Yoo K, Moon IH, Chung KW. Emerging need for vaccination against hepatitis A virus in patients with chronic liver disease in Korea. J Korean Med Sci 2007; 22:218-22. [PMID: 17449927 PMCID: PMC2693585 DOI: 10.3346/jkms.2007.22.2.218] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Vaccination against hepatitis A virus (HAV) is recommended for patients with chronic liver disease (CLD), but this has been deemed unnecessary in Korea since the immunity against HAV was almost universal in adults. However, this practice has never been reevaluated with respect to the changing incidence of adult acute hepatitis A. We retrospectively reviewed the medical records of 278 patients with acute hepatitis A diagnosed from January 1995 to November 2005 and prospectively tested 419 consecutive CLD patients from July to December 2005 for the presence of IgG anti-HAV. The number of patients with acute hepatitis A has markedly increased recently, and the proportion of adult patients older than 30 yr has been growing from 15.2% during 1995-1999, to 28.4% during 2000-2005 (p=0.019). Among 419 CLD patients, the seroprevalences of IgG anti-HAV were 23.1% for those between 26 and 30 yr, 64% between 31 and 35 yr, and 85.0% between 36 and 40 yr. These data demonstrate that immunity against HAV is no more universal in adult and substantial proportion of adult CLD patients are now at risk of HAV infection in Korea. Therefore, further study on seeking proper strategy of active immunization against HAV is warranted in these populations.
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Affiliation(s)
- Hyun Joo Song
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae Hun Kim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Hyun Song
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hee Jung Oh
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kum Hei Ryu
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hye Jung Yeom
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kwon Yoo
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Il-Hwan Moon
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyu Won Chung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
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