Hepatitis A and B Vaccination Rates Among Patients With Chronic Liver Disease: A Phase 1 Quality Assessment Report

Abstract

Introduction: According to the US Advisory Committee on Immunization Practices, patients with chronic liver diseases are recommended vaccination against Hepatitis A and B unless already immune. To this end, the New York State Department of Health has outlined the Viral Hepatitis Strategic Plan 2016 - 2020 to ensure access and coverage for hepatitis A, B, and C. In phase 1 of this quality assessment/improvement project, we aim to investigate whether patients with chronic liver disease are receiving adequate hepatitis A and B vaccinations. Methods: A total of 4,000 patients were identified by retrospective chart review from January 2015 to January 2018 that satisfied our inclusion criteria; 200 of those patients were randomly selected as a sample population. Descriptive statistics was used to compare continuous and categorical variables. Results: Of the 200 patients randomly identified, 31% were males. The median age was 62±12 years. The majority (46%, n=92) of patients were treated for acute/chronic hepatitis C. 27.5% (n=56) were never screened for HAV or HBV infection, 0.5% (n=1) was screened for HAV only, and 5.5% (n=12) screened for HBV only. Out of those patients who were screened for both HAV and HBV (n=131), 80.1% (105/131) were already immune to HAV while 18.3% (24/131) patients were already immune to HBV. On sub-analysis, 10.7% (14/131) of patients were non-immune to both HAV and HBV, while 16% (21/131) were immune to both HAV and HBV. Additionally, 19.1% (25/131) of patients were immune to HAV but infected with HBV while 8.4% (11/131) patients were non-immune to HAV but infected with HBV. 1 patient was coinfected with HAV and HBV. Approximately 53% (105/200) of patients did not have adequate immunization status. For those patients who needed either the HAV or HBV vaccine, 34 patients were never offered vaccines, and 67 patients were offered vaccines but did not receive it. Only 16% (n=17/105) of patients who were screened and needed HAV, HBV, or both vaccines were given the vaccine (2= HAV only, 7= HBV, 8= both HAV & HBV), and of those patients, only 53% (9/17) were re-checked for immunity after the vaccine was administered. Conclusion: Phase 1 of our quality assessment has revealed that patients with chronic liver disease are not receiving adequate vaccination against HAV and HBV. Phase 2 will focus on implementing educational interventions aimed at increasing physician awareness of vaccination guidelines.