Hepatitis A and B immunity and vaccination in chronic hepatitis B and C patients in a large United States cohort
Henkle E, Lu M, Rupp LB, Boscarino JA, Vijayadeva V, Schmidt MA, Gordon SC; for the Chronic Hepatitis Cohort Study (CHeCS) Investigators. Clin Infect Dis. 2014 Nov 3. pii: ciu879. [Epub ahead of print]
Hepatitis A and B vaccines are effective in preventing super-infection and sequelae in chronic hepatitis B or C patients. We describe immunity and vaccination against hepatitis A and B in chronic hepatitis patients from the United States Chronic Hepatitis Cohort Study (CHeCS).
We identified chronic hepatitis B and C patients with healthcare utilization 2006 to 2008 and 12 months of enrollment. We used electronic lab records to determine immunity and medical and billing records for vaccination history. Immunity against hepatitis A was defined by positive hepatitis A antibody or documented vaccination. Immunity against hepatitis B was defined as hepatitis B surface antibody level>10 mIU/ml or core antibody positive, or by documented vaccination.
Among 1635 chronic hepatitis B patients, 978 (59.8%) were immune or vaccinated against hepatitis A, 122 (7.5%) had negative hepatitis A antibody tests, and 535 (32.7%) had no testing or vaccination record. Among 5328 chronic hepatitis C patients, 2998 (56.3%) were immune or vaccinated against hepatitis A, 659 (12.4%) had negative hepatitis A antibody tests, and 1671 (31.4%) had no testing or vaccination record. Additionally, 3150 (59.1%) chronic hepatitis C patients were immune or vaccinated against hepatitis B, 1003 (18.8%) had a negative test result, and 1175 (22.1%) were neither tested nor vaccinated against hepatitis B.
Approximately 40% of chronic hepatitis B and C patients are susceptible to or have no documented immunity or vaccination against hepatitis A or hepatitis B. Clinicians should consider antibody testing and vaccination for this vulnerable population.