Advertisement

Low Prevalence of Vaccination or Documented Immunity to Hepatitis A and Hepatitis B Viruses Among Individuals with Chronic Liver Disease

  • Robert J. Wong
    Correspondence
    Requests for reprints should be addressed to Robert J. Wong, MD, MS, Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, 3801 Miranda Ave, Palo Alto, CA 94304.
    Affiliations
    Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA

    Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA
    Search for articles by this author
  • Robert G. Gish
    Affiliations
    Hepatitis B Foundation, Doylestown, PA
    Search for articles by this author
  • Ramsey Cheung
    Affiliations
    Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA

    Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA
    Search for articles by this author
  • Amit S. Chitnis
    Affiliations
    Tuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, CA
    Search for articles by this author

      Abstract

      Background

      Despite national guidelines emphasizing the importance of vaccination or documenting immunity to hepatitis A virus and hepatitis B virus for patients with chronic liver disease, the success of adhering to these recommendations is suboptimal. We aim to evaluate the prevalence of vaccination or documented reactivity to hepatitis A antibody and hepatitis B surface antibody among US adults with chronic liver disease.

      Methods

      Using 2011-2018 National Health and Nutritional Examination Survey data, adults with nonalcoholic fatty liver disease, alcoholic liver disease, hepatitis B, and hepatitis C were evaluated to determine prevalence of vaccination (self-reported completion) and hepatitis A antibody reactivity or hepatitis B surface antibody reactivity.

      Results

      Overall prevalence of vaccination or hepatitis A antibody reactivity was lowest among individuals with nonalcoholic fatty liver disease (60.8%; 95% confidence interval [CI], 57.9-63.6) and alcoholic liver disease (61.8%; 95% CI, 59.0-64.6), and highest among individuals with hepatitis B (82.9%; 95% CI, 76.8-89.0). Prevalence of vaccination or hepatitis B surface antibody reactivity was much lower: 38.6% (95% CI, 35.7-41.4) in nonalcoholic fatty liver disease, 40.7% (95% CI, 34.4-47.0) in chronic hepatitis C virus, and 47.1% (95% CI, 44.3-49.9) in alcoholic liver disease.

      Conclusion

      Among US adults with chronic liver disease, prevalence of vaccination or documented reactivity to hepatitis A antibody and hepatitis B surface antibody was alarmingly low. These observations are particularly concerning given that underlying chronic liver disease increases risks of severe liver injury and decompensation from acute hepatitis A or hepatitis B infections.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Koff RS
        Risks associated with hepatitis A and hepatitis B in patients with hepatitis C.
        J Clin Gastroenterol. 2001; 33: 20-26
        • Keeffe EB
        Acute hepatitis A and B in patients with chronic liver disease: prevention through vaccination.
        Am J Med. 2005; 118: 21S-27S
        • Reiss G
        • Keeffe EB
        Review article: hepatitis vaccination in patients with chronic liver disease.
        Aliment Pharmacol Ther. 2004; 19: 715-727
        • Vento S
        • Garofano T
        • Renzini C
        • et al.
        Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C.
        N Engl J Med. 1998; 338: 286-290
        • Nelson NP
        • 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.
        MMWR Recomm Rep. 2020; 69: 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.
        MMWR Recomm Rep. 2018; 67: 1-31
        • Koepke R
        • Sill DN
        • Akhtar WZ
        • et al.
        Hepatitis A and hepatitis B vaccination coverage among persons who inject drugs and have evidence of hepatitis C infection.
        Public Health Rep. 2019; 134: 651-659
        • Tenner CT
        • Herzog K
        • Chaudhari S
        • Bini EJ
        • Weinshel EH
        Knowledge, attitudes and barriers regarding vaccination against hepatitis A and B in patients with chronic hepatitis C virus infection: a survey of family medicine and internal medicine physicians in the United States.
        Int J Clin Pract. 2012; 66: 1009-1013
        • Kramer JR
        • Hachem CY
        • Kanwal F
        • Mei M
        • El-Serag HB
        Meeting vaccination quality measures for hepatitis A and B virus in patients with chronic hepatitis C infection.
        Hepatology. 2011; 53: 42-52
        • Felsen UR
        • Fishbein DA
        • Litwin AH
        Low rates of hepatitis A and B vaccination in patients with chronic hepatitis C at an urban methadone maintenance program.
        J Addict Dis. 2010; 29: 461-465
        • Koenig A
        • Stepanova M
        • Felix S
        • Kalwaney S
        • Clement S
        • Younossi ZM
        Vaccination against hepatitis A and B in patients with chronic liver disease and type 2 diabetes: has anything changed?.
        Liver Int. 2016; 36: 1096-1100
        • Younossi ZM
        • Stepanova M
        Changes in hepatitis A and B vaccination rates in adult patients with chronic liver diseases and diabetes in the U.S. population.
        Hepatology. 2011; 54: 1167-1178
        • Henkle E
        • Lu M
        • Rupp LB
        • et al.
        Hepatitis A and B immunity and vaccination in chronic hepatitis B and C patients in a large United States cohort.
        Clin Infect Dis. 2015; 60: 514-522
        • Yue X
        • Black CL
        • O'Halloran A
        • Lu PJ
        • Williams WW
        • Nelson NP
        Hepatitis A and hepatitis B vaccination coverage among adults with chronic liver disease.
        Vaccine. 2018; 36: 1183-1189
        • Kaplan DE
        • Medvedeva E
        • Serper M
        Care quality and outcomes among US veterans with chronic hepatitis B in the hepatitis C direct-acting antiviral era.
        J Viral Hep. 2020; 27: 1082-1092
        • Moorman AC
        • Xing J
        • Nelson NP
        • Investigators CH
        Need for increasing hepatitis A virus vaccination among patients infected with hepatitis B virus and hepatitis C virus.
        Gastroenterology. 2018; 154: 2015-2017
        • Rinella ME
        Nonalcoholic fatty liver disease: a systematic review.
        JAMA. 2015; 313: 2263-2273
        • Dang K
        • Hirode G
        • Singal AK
        • Sundaram V
        • Wong RJ
        Alcoholic liver disease epidemiology in the United States: a retrospective analysis of 3 US databases.
        Am J Gastroenterol. 2020; 115: 96-104
        • Wong T
        • Dang K
        • Ladhani S
        • Singal AK
        • Wong RJ
        Prevalence of alcoholic fatty liver disease among adults in the United States, 2001-2016.
        JAMA. 2019; 321: 1723-1725
        • Wong RJ
        • Liu B
        • Bhuket T
        Significant burden of nonalcoholic fatty liver disease with advanced fibrosis in the US: a cross-sectional analysis of 2011-2014 National Health and Nutrition Examination Survey.
        Aliment Pharmacol Ther. 2017; 46: 974-980
        • Younossi ZM
        • Otgonsuren M
        • Venkatesan C
        • Mishra A
        In patients with non-alcoholic fatty liver disease, metabolically abnormal individuals are at a higher risk for mortality while metabolically normal individuals are not.
        Metabolism. 2013; 62: 352-360
        • Younossi ZM
        • Stepanova M
        • Afendy M
        • et al.
        Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008.
        Clin Gastroenterol Hepatol. 2011; 9 (e1; quiz e60): 524-530
        • Hofmeister MG
        • Xing J
        • Foster MA
        • et al.
        Hepatitis A person-to-person outbreaks: epidemiology, morbidity burden, and factors associated with hospitalization - Multiple States, 2016-2019.
        J Infect Dis. 2021; 223: 426-434
        • Jacobson Vann JC
        • Jacobson RM
        • Coyne-Beasley T
        • Asafu-Adjei JK
        • Szilagyi PG
        Patient reminder and recall interventions to improve immunization rates.
        Cochrane Database Syst Rev. 2018; 1CD003941
        • Thudi K
        • Yadav D
        • Sweeney K
        • Behari J
        Physicians infrequently adhere to hepatitis vaccination guidelines for chronic liver disease.
        PLoS One. 2013; 8: e71124
        • Burman BE
        • Mukhtar NA
        • Toy BC
        • et al.
        Hepatitis B management in vulnerable populations: gaps in disease monitoring and opportunities for improved care.
        Dig Dis Sci. 2014; 59: 46-56
        • Mukhtar NA
        • Kathpalia P
        • Hilton JF
        • et al.
        Provider, patient, and practice factors shape hepatitis B prevention and management by primary care providers.
        J Clin Gastroenterol. 2017; 51: 626-631
        • Hernandez B
        • Hasson NK
        • Cheung R
        Hepatitis C performance measure on hepatitis A and B vaccination: missed opportunities?.
        Am J Gastroenterol. 2009; 104: 1961-1967
        • Harris AM
        • Link-Gelles R
        • Kim K
        • et al.
        Community-based services to improve testing and linkage to care among non-U.S.-born persons with chronic hepatitis B virus infection - three U.S. programs, October 2014-September 2017.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 541-546
        • Bruce MG
        • Bruden D
        • Hurlburt D
        • et al.
        Antibody levels and protection after hepatitis B vaccine: results of a 30-year follow-up study and response to a booster dose.
        J Infect Dis. 2016; 214: 16-22
        • Lin AW
        • Wong KH
        Long-term protection of neonatal hepatitis B vaccination in a 30-year cohort in Hong Kong.
        J Hepatol. 2013; 59: 1363-1364
        • Simons BC
        • Spradling PR
        • Bruden DJ
        • et al.
        A longitudinal hepatitis B vaccine cohort demonstrates long-lasting hepatitis B virus (HBV) cellular immunity despite loss of antibody against HBV surface antigen.
        J Infect Dis. 2016; 214: 273-280
        • Gabbuti A
        • Romano L
        • Blanc P
        • et al.
        Long-term immunogenicity of hepatitis B vaccination in a cohort of Italian healthy adolescents.
        Vaccine. 2007; 25: 3129-3132
        • Van Damme P
        • Moiseeva A
        • Marichev I
        • et al.
        Five years follow-up following two or three doses of a hepatitis B vaccine in adolescents aged 11-15 years: a randomised controlled study.
        BMC Infect Dis. 2010; 10: 357
        • McMahon BJ
        • Dentinger CM
        • Bruden D
        • et al.
        Antibody levels and protection after hepatitis B vaccine: results of a 22-year follow-up study and response to a booster dose.
        J Infect Dis. 2009; 200: 1390-1396
        • Spradling PR
        • Bulkow LR
        • Negus SE
        • Homan C
        • Bruce MG
        • McMahon BJ
        Persistence of seropositivity among persons vaccinated for hepatitis A during infancy by maternal antibody status: 15-year follow-up.
        Hepatology. 2016; 63: 703-711
        • Plumb ID
        • Bulkow LR
        • Bruce MG
        • et al.
        Persistence of antibody to hepatitis A virus 20 years after receipt of hepatitis A vaccine in Alaska.
        J Viral Hepat. 2017; 24: 608-612
        • Mosites E
        • Gounder P
        • Snowball M
        • et al.
        Hepatitis A vaccine immune response 22 years after vaccination.
        J Med Virol. 2018; 90: 1418-1422
        • Sempere L
        • Almenta I
        • Barrenengoa J
        • et al.
        Factors predicting response to hepatitis B vaccination in patients with inflammatory bowel disease.
        Vaccine. 2013; 31: 3065-3071
        • Chonwattana W
        • Raengsakulrach B
        • Holtz TH
        • et al.
        Hepatitis B vaccination uptake and correlates of serologic response among HIV-infected and uninfected men who have sex with men (MSM) in Bangkok, Thailand.
        Vaccine. 2016; 34: 2044-2050
        • da Silva EN
        • Baker A
        • Alshekaili J
        • Karpe K
        • Cook MC
        A randomized trial of serological and cellular responses to hepatitis B vaccination in chronic kidney disease.
        PLoS One. 2018; 13e0204477
        • Yeo YH
        • Le MH
        • Chang ET
        • Henry L
        • Nguyen MH
        Prevalence of undetectable vaccine-induced immunity against hepatitis B virus in US adults at high risk for infection.
        Hepatology. 2019; 69: 1385-1397
        • Ashhab AA
        • Rodin H
        • Campos M
        • et al.
        Response to hepatitis B virus vaccination in individuals with chronic hepatitis C virus infection.
        PLoS One. 2020; 15e0237398
        • Aggeletopoulou I
        • Davoulou P
        • Konstantakis C
        • Thomopoulos K
        • Triantos C
        Response to hepatitis B vaccination in patients with liver cirrhosis.
        Rev Med Virol. 2017; 27https://doi.org/10.1002/rmv.1942
        • Amjad W
        • Alukal J
        • Zhang T
        • Maheshwari A
        • Thuluvath PJ
        Two-dose hepatitis B vaccine (Heplisav-B) results in better seroconversion than three-dose vaccine (Engerix-B) in chronic liver disease [online ahead of print].
        Dig Dis Sci. 2020; (Jul 20)https://doi.org/10.1007/s10620-020-06437-6
        • U.S. Department of Health and Human Services
        Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021–2025).
        U.S. Department of Health and Human Services, Washington, DC2020