Hepatitis A vaccination in chronic liver disease: Is it really required in a tropical country like India?

Abstract

Vaccination against hepatitis A virus (HAV) has been recommended in patients with chronic liver disease to prevent any decompensation due to superinfection. This may not hold good in high endemic areas for hepatitis A like India. The aim of this study was to find out the seroprevalence of anti-HAV antibodies in patients with chronic liver disease and to justify the need for vaccination against hepatitis A virus in these patients. One hundred and thirty three consecutive patients with cirrhosis of liver attending Gastroenterology department of our Institute between June 2004 and June 2005 were enrolled. Seventy-five healthy persons were taken as controls. The diagnosis of cirrhosis was based on clinical profile, biochemical, radiological (ultrasound abdomen) and endoscopic findings. The etiology of cirrhosis was based on presence of viral markers, history of significant alcohol consumption, autoimmune and metabolic workup. All patients and controls were tested for antiHAV (total) antibodies using commercially available enzyme-linked immunosorbent assay kits. Data from patients and control group were compared by unpaired 't' test and Chi square test. All subjects were in the age group 11 to 75 years. Etiology of chronic liver disease was as follows: HBV- 29.3%, HCV - 14.28%, HBV+HCV dual -1.5%, alcohol- 21.8%, Cryptogenic -23.3%, Wilson"s Disease -1.5% and Budd chiari -1.5%. The prevalence of HAV was 93.2% in patients with cirrhosis of liver and 94.6% in controls. The prevalence was almost similar irrespective of the etiology. In view of high seroprevalence of HAV antibodies among cirrhotic patients in our study and the high cost of the vaccine, the hepatitis A vaccination may not be routinely required in this part of the world.

Should Brazilian patients with chronic hepatitis C virus infection be vaccinated against hepatitis A virus?

“…In the present study, we found an increased proportion of total anti‐HAV‐positive patients, indicating that pre‐vaccination serological testing for evaluating susceptibility to HAV among HCV‐infected patients should be carried out before vaccination against HAV should be scheduled as advocated in other countries 31–34 . Nevertheless, previous studies conducted among adult patients HCV‐associated chronic liver disease from geographical areas with a high seroprevalence of anti‐HAV antibodies did not recommend hepatitis A vaccination on a routine basis 35,36 . Thus, in regions like our geographical area, with a high proportion of total anti‐HAV‐positive patients, anti‐HAV testing of HCV‐infected patients should be a cost‐effective strategy, aiming to identify susceptible individuals who might be benefitted from HAV vaccination.…”

“…[31][32][33][34] Nevertheless, previous studies conducted among adult patients HCV-associated chronic liver disease from geographical areas with a high seroprevalence of anti-HAV antibodies did not recommend hepatitis A vaccination on a routine basis. 35,36 Thus, in regions like our geographical area, with a high proportion of total anti-HAV-positive patients, anti-HAV testing of HCV-infected patients should be a cost-effective strategy, aiming to identify susceptible individuals who might be benefitted from HAV vaccination. In the light of these concerns, one should consider the ACIP's recommendations 14 concerning the vaccination of all susceptible patients with chronic liver disease such as chronic HCV infection, unless substantial shifts in the incidence of HAV infection occur in patients from regions with such a proportion of total anti-HAV positive patients.…”

“…This change in the epidemiological pattern is an important issue because patients with chronic liver disease, particularly those with hepatitis C virus (HCV)-related chronic liver disease, are at an increased risk of fulminant hepatitis or death in case of superinfection or coinfection with HAV. [7][8][9][10] Vento et al 8 reported 41.2% cases of acute liver failure associated with HAV superinfection in a population of adults with chronic HCV infection, 35.3% of whom died. As a result, in December 1996, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has recommended immunization against HAV in susceptible persons who have chronic liver disease, 11 which remained unchanged in the ACIP's 2006 recommendations.…”

Co-Occurrence of Hepatitis A Infection and Chronic Liver Disease

“…HAV vaccination seems to be effective in preventing liver failure associated with HAV in patients with or without HBV infection [ 64 , 65 , 66 , 67 ]. However, HAV vaccination may not be necessary in the case of countries in which HAV is endemic, such as India [ 68 , 69 ].…”

Medical Management of Chronic Liver Diseases (CLD) in Children (Part II)

“…Close attention must be given to vaccination status, including vaccinations against hepatitis A [107][108][109] and B, and encapsulated bacteria to optimize outcomes and the delivery of highquality pediatric healthcare. [110] …”