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Incidence of HAV and HBV Infections and Vaccination Rates in Patients With Autoimmune Liver Diseases

Wörns, Marcus A., M.D.1; Teufel, Andreas, M.D.1; Kanzler, Stephan, M.D.1; Shrestha, Annette1; Victor, Anja, Ph.D.2; Otto, Gerd, M.D.3; Lohse, Ansgar W., M.D.4; Galle, Peter R., M.D.1; Höhler, Thomas, M.D.5

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 138–146

OBJECTIVES Hepatitis A virus (HAV) or hepatitis B virus (HBV) superinfection is associated with an increased mortality in patients with chronic liver diseases (CLD). Despite official recommendations, it was reported that the vaccination rate against HAV is low in patients with chronic hepatitis C infection. To evaluate the situation in patients with autoimmune liver diseases, we conducted a retrospective cohort study.

METHODS Susceptibility to HAV and HBV infections, course of HAV and HBV infections, vaccination rates against HAV and HBV, and efficacy of hepatitis A/B vaccines were evaluated by antibody testing in 225 patients with autoimmune liver diseases during 1,677 person-years.

RESULTS Susceptibility to HAV/HBV infection was 51/86%. Incidence of HAV/HBV infection was 1.3/1.4 per 1,000 person-years. One HAV infection occurred, but the patient recovered spontaneously. Two patients were HBV-infected after receiving an anti-HBc-positive (antibody to hepatitis B core antigen) donor graft during orthotopic liver transplantation, and one of them developed chronic HBV infection. Vaccination rates were 11% (HBV) and 13% (HAV), respectively. Seventy-six percent of the vaccinated patients (HBV vaccine) developed anti-HBs (antibody to hepatitis surface antigen) ≥10 UI/L. Ten out of 13 vaccinated patients, showing a low or nonresponse to hepatitis B vaccine, had concomitant immunosuppressive therapy. Anti-HAV was detectable in all patients after administration of HAV vaccine.

CONCLUSIONS Patients with autoimmune liver diseases have a high susceptibility to HAV and HBV infections. Vaccination rates are low in this patient cohort and efficacy of hepatitis B vaccine is reduced due to immunosuppressive therapy. Improving adherence to vaccine recommendations is essential to prevent HAV and HBV infections in patients with autoimmune liver diseases.

1Department of Internal Medicine I, Johannes Gutenberg-University, Mainz, Germany; 2Institute for Medical Biometry, Epidemiology and Informatics, Johannes Gutenberg-University, Mainz, Germany; 3Department of Transplantation and Hepatobiliopancreatic Surgery, Johannes Gutenberg-University, Mainz, Germany; 4Department of Internal Medicine I, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; and 5Department of Internal Medicine I, Prosper Hospital, Recklinghausen, Germany

Reprint requests and correspondence: Marcus A. Wörns, M.D., Department of Internal Medicine I, Johannes Gutenberg-University, Langenbeckstrasse 1, 55101 Mainz, Germany.

Received February 4, 2007; accepted May 29, 2007.

CONFLICT OF INTERESTGuarantor of the article: Marcus A. Wörns, M.D.

Specific author contributions: Marcus A. Wörns and Thomas Höhler designed the study and interpreted the data. Annette Shrestha performed the analysis of serum probes. Anja Victor was responsible for the statistical analysis. Andreas Teufel, Stephan Kanzler, Gerd Otto, Angsar W. Lohse, and Peter R. Galle made substantial contributions to the conception and realization of the study and the interpretation of data. All authors read and approved to the final draft manuscript.

Financial support: We hereby disclose any funding sources for this publication.

Potential competing interests: None.

© The American College of Gastroenterology 2008. All Rights Reserved.
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