Hepatitis A and Hepatitis B Vaccination Responses in Persons with Chronic Hepatitis C Infections: A Review of the Evidence and Current Recommendations

Abstract

In persons with chronic hepatitis C virus (HCV) infections, superinfection by hepatitis A virus (HAV) or hepatitis B virus (HBV) can cause serious complications, including fulminating hepatitis or increased severity of hepatitis. Therefore, it is important to adequately protect persons with chronic HCV infections by immunization. Suboptimal response to vaccines has been reported in patients with chronic liver disease. The present article reviews HAV and HBV vaccine responses reported in the literature when administered to individuals with chronic HCV infection, and reviews current national and international recommendations.RESULTS: Persons with chronic HCV respond well to HAV vaccine, but studies exploring HBV vaccine efficacy in this population have equivocal results. Vaccine schedules and participant characteristics differ among studies, and most do not adjust for confounders. Some studies found no difference in HBV vaccine response between patients with chronic HCV and controls. However, HBV vaccine response was generally reduced in those with cirrhosis and HCV genotype 1. Organizations recommend HAV and HBV vaccines for persons with chronic HCV, but do not suggest alterations in schedule or dose.RECOMMENDATIONS: Because HAV vaccine response is good and routine laboratory testing may not detect lower levels of vaccine-induced anti-HAV, the standard HAV vaccine schedule is recommended without postimmunization testing. HBV vaccine should be administered early in the course of chronic HCV infection because response may be lower in patients with cirrhosis. Reflex testing of anti-HCV reactive sera for anti-HAV and hepatitis B surface antibody can facilitate appropriate follow-up and timely immunization. Determination of postimmunization hepatitis B surface antibody, especially in patients with cirrhosis or genotype 1, will allow HBV vaccine boosters to be offered.

Efficacy of Hepatitis B Virus Vaccination and Antibody Response to Reactivation Dose Among Adult Non-Responders to Primary Hepatitis B Vaccination in Chronic Hepatitis C Egyptian Patients

“…Our results are in agree with [13] who stated that "Antibody response to HBV vaccination was generally lower in patients with chronic HCV infection compared with controls, indicating some degree of immune compromise in individuals with chronic HCV".…”

Hepatitis C Virus Suppresses C9 Complement Synthesis and Impairs Membrane Attack Complex Function

“…Systemic autoimmune diseases also occur in patients with HCV infection (37). Further, HAV or HBV vaccination response rates are reduced in patients with chronic HCV infection (38)(39)(40). These observations suggest that chronic HCV infection may generate an overall state of immune suppression.…”

Viral Hepatitis Among Drug Users in Methadone Maintenance: Associated Factors, Vaccination Outcomes, and Interventions

“…1, 41 Those with HCV Ab seropositivity had poorer responses to HBV vaccination as has been seen in some series, but in other series the association lost significance when smoking, which is associated with poorer responses to HBV vaccination, was included in analyses. 7 HBV vaccination is recommended specifically for those with HCV and further, non-responders may respond to double dose vaccination. 7, 23 …”

“…7 HBV vaccination is recommended specifically for those with HCV and further, non-responders may respond to double dose vaccination. 7, 23 …”