Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu.
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights “Low Prevalence of Vaccination or Documented Immunity to Hepatitis A and Hepatitis B Viruses among Individuals with Chronic Liver Disease.” Authored by Wong RJ, Gish RG, Cheung R, Chitnis AS. American Journal of Medicine 2021; vol 134(7): 882-892.
What question(s) does this study address?
Persons with underlying chronic liver disease (whether due to viral or non-viral causes) who become infected with Hepatitis A or Hepatitis B virus have worse outcomes and higher mortality than previously healthy individuals who are newly infected with these viruses. For this reason, the Centers for Disease Control and Prevention (CDC) recommends that all persons with chronic liver disease be vaccinated against Hepatitis A and Hepatitis B virus.
This study sought to determine the prevalence of vaccination for (self-reported) and documented immunity to (based on laboratory testing) Hepatitis A and Hepatitis B virus among adults with chronic liver disease, using 2011-2018 data from the National Health and Nutrition Examination Survey (NHANES). The study population consisted of 3,097 adults with chronic liver disease due to one of the following causes: alcoholic liver disease, non-alcoholic fatty liver disease, chronic hepatitis C infection or chronic Hepatitis B infection. Prior vaccination was determined by self-reported NHANES data. The presence of immunity to Hepatitis A and Hepatitis B virus was determined by assessing Hepatitis A virus total antibody and Hepatitis B surface antibody.
What are the major findings of this report/article?
- The prevalence of self-reported Hepatitis A vaccination or Hepatitis A antibody reactivity ranged from 61% to 83% and was lowest among persons with nonalcoholic fatty liver disease.
- The prevalence of vaccination or Hepatitis B surface antibody reactivity was much lower, ranging from 39% to 47%. The lowest levels of immunity to Hepatitis B were observed among persons with nonalcoholic fatty liver disease.
- This study found low levels of documented immunity or vaccination to Hepatitis A or Hepatitis B among persons with chronic liver disease.
What are the implications for the prevention and control of viral hepatitis?
- Persons with underlying chronic liver disease have worse outcomes if infected with Hepatitis A or Hepatitis B virus (including an increased risk of death) and both of these infections are preventable by vaccination.
- Although it is important to educate persons with chronic liver disease about the recommendation to receive Hepatitis A and Hepatitis B vaccinations, improving provider education may have a greater impact on improving vaccine coverage.
- Increasing the uptake of Hepatitis A and Hepatitis B vaccine is one of the key objectives named in the National Strategic Plan to eliminate viral hepatitis in the US.
- Keeffe EB. Acute Hepatitis A and B in patients with chronic liver disease: prevention through vaccination. American Journal of Medicine 2005; vol 118 (10A): 21S—27S.
- Nelson N, Weng MK, Hofmeister MG et al. Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020. Morbidity and Mortality Weekly Report 2020; vol 69 (5): 1—38.
- Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report 2018; vol 67 (1):1—31.
- Thudi K, Yadav D, Sweeney K, Behari J. Physicians infrequently adhere to hepatitis vaccination guidelines for chronic liver disease. PLoS One 2013; 8(7): e71124
- Viral Hepatitis National Strategic Plan: A Roadmap to Elimination. DHHS 2021.