Hepatitis a and B Vaccination of Patients with Hepatitis C in Internal Medicine Residency Clinics

Abstract

Purpose: The primary aims of this study were to evaluate and improve adherence of medical residents to guideline recommendations by the Advisory Committee on Immunization Practices of CDC, AASLD and NIH for administration of hepatitis A and B vaccines to patients with hepatitis C. Methods: This investigation consisted of a retrospective review with a prospective intervention arm performed at two university affiliated teaching hospital internal medicine residency clinics. Patients with ICD-9 code for hepatitis C (70.51) for the time period of January 2001 to June 2006 were identified. Demographic and clinical data including reasons for non-vaccination were abstracted from clinical charts and electronic medical records. Patients were excluded from vaccination if they were seropositive for hepatitis A and B. In a prospective phase, contact of patients with hepatitis C not vaccinated for hepatitis A and B was attempted by both mail and telephone to encourage them to return for free vaccinations. Results: A total of 230 patients were found to be hepatitis C antibody positive over 5 years in the two residency clinics. Vaccination practices were equivalent at both clinics: 80.8% and 82.9% of patients were not vaccinated for hepatitis A and 75.0% and 87.4% of patients were not vaccinated against hepatitis B. No reason for non-vaccination was recorded for 62% and 73% patients in the 2 clinics for hepatitis A and B. Hepatitis vaccination was mentioned in another 20% of cases but was not performed. Multivariate analysis of patient characteristics associated with vaccination identified only white ethnicity as a significant risk factor (OR 0.33, CI 0.12–0.91). Attempts to contact 186 patients non-vaccinated were made: 30% of patients were reached, 11% made appointments for vaccination clinic but only 7% attended. Conclusion: Adherence to hepatitis A and B vaccination guidelines in patients with hepatitis C followed in residency clinics was very low. The major reason for non-vaccination appeared to be that the option was not discussed with or offered to patients. Patients not vaccinated are difficult to reach and recall for vaccination. A significant opportunity exists to improve hepatitis vaccination practices in residency clinics serving high risk patients.