Implementation of a hepatitis A prevention policy in haemophiliacs: results from the French cohort

Abstract

In the early nineties, the occurrence of hepatitis A outbreaks in some patients with haemophilia in some countries led French health authorities to recommend hepatitis A virus (HAV) vaccination in HAV-seronegative haemophiliacs. The French 'Suivi thérapeutique National des Hémophiles' cohort permitted to assess the implementation of this recommendation by the analysis of the vaccinal process, i.e. HAV seropositivity assessment and vaccination of HAV-seronegative patients, in a survival approach. In a subgroup of 812 patients diagnosed earlier than 1990 (prevalent cohort), the implementation of vaccinal process increased quickly from 0% in 1993 to 41.8% in 1994 and to 71.2% in 1996, suggesting a 'notification effect'. The vaccinal process was associated to three cofactors in a Cox model analysis (age, severity of haemophilia, centre of treatment). No infection was observed during the survey in this group. In another subgroup of 201 boys born since 1993 (incident cohort), 27.5% and 15.4% patients remained exposed to the risk at 3 and 5 years from diagnosis respectively, again with a 'centre effect', which might be linked to various factors such as regain in confidence for products or economic reasons. Only five infectious seroconversions were assessed over the 7-year survey, which represents 14.5 cases per 1000 person-year incidence without any relationship with products. Our data combined with the contemporary hepatitis A epidemiology and the current safety of anti-haemophilic concentrates, should lead to a new assessment of the risk of hepatitis A in haemophiliacs. We suggest that among patients with bleeding disorder, as well as in other populations, HAV prevention policy might be stressed on those who already suffer from chronic liver disease and/or travel in endemic countries.

Vaccination Against Hepatitis A for Hemophilic Patients: Is It Necessary?

“…The outcome of the positivity rate for anti-HAV concerning region (51.4% in urban areas and 91.5% in rural areas) is completely in favor of the findings of Taghavi and his colleagues in Shiraz showing the high frequency of HAV-positive individuals living in rural areas (95.9% of rural people in comparison with 85.1% of the urban population) ( 28 ). In another study, the overall seroprevalence of HAV in the general population of three provinces of Iran (Tehran, Golestan and Hormozgan) was 86%, with no variation between the two genders ( 22 ).…”

“…In Hayashi’s study, the infection incidence in the age range of 10 – 19 years was 21.4 %, and 30.8% of hemophilic patients were 40 - 49 years old ( 20 ). In Chambost’s investigation, 20% of people were 30 to 35 years old, and almost 49% of infected patients were over 50 years ( 28 ).…”

The Seroprevalence of Entrically Transmitted Viral Hepatitis in HCV Infected Thalassemia and Hemophilia Patients in Iran

“…The patients receiving clotting factor concentrate, particularly products inactivated by solvent-detergent which was ineffective against nonlipid enveloped viruses such as HAV (25)(26)(27)(28)(29)(30). In developed countries, hepatitis A vaccine is recommended for HAV seronegative people with clotting disorders, and those with CLD (31,32). On the other hand, some effective examinations such as blood-donor screening, viral inactivation of plasma-derived products, and development of recombinant clotting factors are used to reduce viral exposure (31).…”