Increased HAV Vaccination Needed in Patients With Chronic HBV, HCV Infections

Hepatitis A virus (HAV) immunization in adults in the United States remains poor and increased vaccination of patients with chronic viral hepatitis is needed, according to a commentary published in Gastroenterology.¹

Recent large outbreaks of HAV infection have resulted in substantial rates of morbidity and mortality, indicating a low prevalence of HAV immunity in the United States.^1-6 Current recommendations by the Advisory Committee on Immunization Practices for patients with chronic liver disease include immunization with HAV and hepatitis B virus (HBV) vaccines.^1,7-9 Also, all patients with hepatitis C virus (HCV) infection should receive HBV vaccination and individuals with HBV and HCV infections should receive HAV vaccination.

The Chronic Hepatitis Cohort Study (CHeCS), which includes data from 3846 HBV-diagnosed patients and 15,471 HCV-diagnosed patients from 4 large US healthcare systems, indicates that vaccination rates are far below desired public health goals.^1,10 In HBV-diagnosed patients, 67.4% had been tested for anti-HAV and 58.9% were positive, indicating immunity through either vaccination or past infection. In a similar fashion, 66.4% of HCV-diagnosed patients had anti-HAV testing and 39.2% were positive.

This study also found that Asian/Pacific Islanders and Hispanic race/ethnicity had higher rates of HAV immunity (70.3% and 56.3%, respectively) compared with non-Hispanic black or white patients (37.7% and 38.4%, respectively; both P <.001), possibly from exposure earlier in life from countries endemic for both HAV and HBV.

The CHeCS study found that a total of 44% of HBV-diagnosed patients and 54% of HCV-diagnosed patients had neither HAV vaccination nor a positive anti-HAV test.^1,10

“These findings, from multiple populations, support current guideline⁸ efforts to improve rates of screening for immunity to HAV and subsequent vaccination of vulnerable populations of patients with chronic viral hepatitis” concluded the investigators.¹

References

1. Moorman AC, Xing J, Nelson NP, for the CHeCS Investigators. Need for increasing hepatitis A virus vaccination among patients infected with hepatitis B virus and hepatitis C virus. Gastroenterology. 2018;1-3. doi:10.1053/j.gastro.2018.04.031
2. Collier MG, Khudyakov YE, Selvage D, et al, Hepatitis A Outbreak Investigation Team. Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study. Lancet Infect Dis. 2014;14:976-981.
3. Centers for Disease Control and Prevention (CDC), Division of Viral Hepatitis. Viral Hepatitis. Hepatitis A outbreaks. www.cdc.gov/hepatitis/outbreaks/. Accessed February 7, 2018.
4. Michigan Department of Health and Human Services. Hepatitis A southeast Michigan outbreak. www.michigan.gov/mdhhs/0,5885,7-339-71550_2955_2976_82305_82310-447907–,00.html. Accessed February 7, 2018.
5. California Department of Public Health. Hepatitis A outbreak in California. www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Hepatitis-AOutbreak.aspx. Accessed February 7, 2018.
6. Klevens RM, Denniston MM, Jiles-Chapman RB, et al. Decreasing immunity to hepatitis A virus infection among U.S. adults: findings from the National Health and Nutrition Examination Survey (NHANES), 1999-2012. Vaccine. 2015;46:6192–6198.
7. 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. Morbid Mortal Weekly Rep. 2018;67:1-31.
8. Prevention of hepatitis A though active or passive immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbid Mortal Wkly Rep. 2006;55:1.
9. Department of Health and Human Services, Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP). Summary Report, October 19-20, 2016, Atlanta, Georgia. www.cdc.gov/vaccines/acip/meetings/downloads/min-archive/min-2016-10.pdf. Accessed February 7, 2018.
10. Moorman AC, Gordon SC, Rupp LB, et al. Baseline characteristics and mortality among people in care for chronic viral hepatitis: the Chronic Hepatitis Cohort Study. Clin Infect Dis. 2013;56:40-50.