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Learning Objectives for this Presentation:
By the end of the presentation, participants will be able to:
1. Identify factors that could reduce hepatitis A and/or B
vaccine response in HCV-infected patients
2. Develop strategies to improve referral and response to
hepatitis A and/or B vaccination in targeted HCV-infected
patient populations
Background:
Coinfection with hepatitis A virus (HAV) and/or hepatitis B virus (HBV) in patients with chronic hepatitis C virus (HCV) can increase morbidity and mortality. The NIH Consensus panel recommends vaccinating against HAV and HBV in chronic HCV-infected patients who lack immunity. However, limited data exist on HAV/HBV screening practices and vaccine efficacy in this population. The aims of this study were to determine the proportion of chronic HCV-infected veterans that: 1) were tested for HAV and/or HBV immunity, and appropriately referred for vaccination; and 2) developed antibody response to the vaccine.
Methods:
Data were collected using the Veterans Health Information Systems at the Veterans Affairs Medical Center, San Francisco (VASF). All subjects had confirmed HCV and were accessing outpatient services. Data were reviewed from January 1, 1997 to December 31, 2003 in patients tested for HAV and/or HBV immunity, and appropriately referred for vaccination. Response was evaluated in patients who completed vaccination and had antibody results.
Results:
In 2,317 patients with chronic HCV, over 75% were tested for HAV antibody (HAVAb) and/or hepatitis B surface antibody (HBsAb). In HAVAb negative and/or HBsAb negative patients, approximately 50% were referred for vaccination. In those completing vaccination, 74.8% developed HAVAb and 50.4% developed HBsAb. Liver disease severity did not appear to influence vaccine response.
Conclusions:
Improved efforts should be made to refer high-risk patients for vaccination against HAV and/or HBV. Vaccine response appears reduced by 25-50% in patients with chronic HCV. Further studies are needed to determine the actual benefit of universal vaccination in HCV-infected patients.
See more of F3 - Clinical and Educational Tools for Managing Chronic Hepatitis C VIrus Infection
See more of The 2005 National Viral Hepatitis Prevention Conference