Susceptibility to hepatitis a in patients with chronic liver disease due to hepatitis C virus infection: Missed opportunities for vaccination
Susceptibility to hepatitis a in patients with chronic liver disease due to hepatitis C virus infection: Missed opportunities for vaccination
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DOI：
10.1002/hep.20830
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发表时间：
2005-09-01
期刊：
影响因子：
13.5
通讯作者：
Bini, EJ
中科院分区：
文献类型：
--
作者：
Shim, M;Khaykis, I;Bini, EJ
甲型肝炎病毒(HAV)重叠感染与潜在慢性肝病患者发生肝功能衰竭和死亡的高风险相关。尽管建议所有慢性丙型肝炎病毒(丙型肝炎病毒)感染的患者接种甲型肝炎疫苗，但在临床实践中遵守这些建议的情况知之甚少。这项研究的目的是确定慢性丙型肝炎患者进行甲型肝炎病毒检测和接种疫苗的频率。我们对1193名被诊断为慢性丙型肝炎病毒感染的患者进行了一项为期一年的回顾性队列研究。在1646人年的随访中，他们的初级保健提供者看过患者的中位数为10.0次(四分位数范围为4.0-20.0)。有640人(53.6%)进行了甲型肝炎病毒抗体检测，其中317人(49.5%)为甲型肝炎病毒抗体阴性。在1193名患者中只有94名(7.9%)接受了甲型肝炎疫苗接种，包括317名易感患者中的26.8%，已经对甲型肝炎免疫的323名患者中的0.9%，以及从未接受过测试的553名受试者中的1.1%。在94名接种疫苗的患者中，45人只接种了一剂疫苗。其中三名未接种疫苗的患者在随访期间发生了急性甲型肝炎病毒感染，其中一人死于急性肝功能衰竭。总而言之，尽管发表了对慢性丙型肝炎患者接种甲型肝炎疫苗的建议，但我们发现甲型肝炎检测和疫苗接种率在临床实践中很低。需要公共卫生项目来提高慢性肝病患者对甲型肝炎疫苗接种的认识。
Hepatitis A virus (HAV) superinfection is associated with a high risk of liver failure and death in patients with underlying chronic liver disease. Although HAV vaccination is recommended for all patients with chronic hepatitis C virus (HCV) infection, little is known about adherence to these recommendations in clinical practice. The aims of this study were to determine the frequency of HAV testing and vaccination among patients with chronic HCV infection. We conducted a retrospective cohort study of 1,193 patients diagnosed with chronic HCV infection over a 1-year period. During 1,646 person-years of follow-up, patients were seen by their primary care provider a median of 10.0 times (interquartile range, 4.0-20.0). HAV antibody testing was performed in 640 subjects (53.6%), and 317 (49.5%) of those tested were susceptible (HAV antibody negative). Only 94 of the 1,193 patients (7.9%) received the HAV vaccine, including 26.8% of the 317 susceptible patients, 0.9% of the 323 patients who were already immune to HAV, and 1.1% of the 553 subjects who were never tested. Among the 94 vaccinated patients, 45 received only one dose of the vaccine. Three of the unvaccinated patients developed acute HAV infection during follow-up, and I of them died of acute liver failure. In conclusion, despite published recommendations to vaccinate against HAV in patients with chronic HCV infection, we found that HAV testing and vaccination rates were low in clinical practice. Public health programs to increase awareness about HAV vaccination in patients with chronic liver disease are needed.