Immunization Against Hepatitis A and Hepatitis B in Patients With Chronic Liver Disease: Are We Doing a Good Job?

Abstract

Introduction: Vaccination against Hepatitis A virus (HAV) and hepatitis B virus (HBV) is a cost effective and readily available intervention which can limit morbidity and mortality in patients with chronic liver disease. We aimed to determine the rates of immunization in an internal medicine resident clinic. Methods: Patient with chronic liver disease seen at University of Oklahoma Internal Medicine resident clinic between Jun, 2014 and May, 2015 were identified using the ICD-9 code 571. Demographic data, and treating physician information was extracted. Vaccination records were reviewed. Patients were considered immunized if they had documented IgG antibodies against HAV and Hepatitis B surface Antibody. Results: A total of 141 patients (mean age 54.1 years and 56% males) were identified. Hepatitis C (HCV) was the most common etiology (48%). Almost half of these patients (47.5%) were also cared for in the gastroenterology clinic. Majority (72.5% for HAV and 72.7% for HBV) of these patients were either vaccinated in the clinic or had document history of prior vaccination. However, immunity against HAV and HBV was documented by presence of anti-HAV IgG and HBsAb antibodies only in 47.5% and 47% patients respectively. A small fraction (2.7%) though vaccinated didn't develop immunity as suggested by negative serology and were not subsequently re vaccinated. Patients being seen by senior residents were more likely to be vaccinated against hepatitis A (OR 2.7, CI 1.2-5.8, p=0.009) and Hepatitis B (OR 2.1, CI 1.05-4.4, p=0.03). Patients followed in GI clinic were also more likely to be vaccinated against Hepatitis A (OR 2.1, CI 1.3-3.9, p= 0.02) and Hepatitis B (OR 2.0, CI 1.1-3.7, p=0.02). Gender of treating physician had no impact on documenting vaccination. Conclusion: Despite clear guidelines for immunization of patients with chronic liver disease, a significant number of patients have not been adequately vaccinated against Hepatitis A and B putting them at increased risk of contracting these infections. Educating resident physicians, developing vaccination protocols and referral to the Gastroenterology clinic are likely to improve vaccination status for patients with chronic liver disease. Immunity should be ensured by follow up serology after immunization.