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

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Efforts are needed to improve HAV vaccination rates in patients infected with HAV and HCV.

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.

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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


  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. Accessed February 7, 2018.
  4. Michigan Department of Health and Human Services. Hepatitis A southeast Michigan outbreak.,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. 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. 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.