Screening Effectiveness for Hepatitis A and B in Chronic Hepatitis C Patients with Chronic Kidney Disease

Abstract

Purpose: The Advisory Committee on Immunization Practices (ACIP) recommends immunization of all patients with chronic liver disease (CLD) against hepatitis A (HAV) and those CLD patients with risk factors for hepatitis B (HBV) against the latter. Studies have reported underutilization of HAV and HBV vaccination in CLD patients, leading to adverse health outcomes. Screening and immunization becomes much more important in chronic hepatitis C (CHC) patients with chronic kidney disease (CKD) because CKD stage 5 patients are at high risk of acquiring HBV through dialysis. Our aim was to determine how effectively CHC patients with CKD are screened for HAV and HBV antibodies and receive vaccination at our institution. Methods: The Department of Gastroenterology at Wayne State University maintains a Hepatitis C registry, which is a database of over 3000 hepatitis C patients seen in the hepatitis clinic at Harper hospital between January 1995 and present. Retrospective chart reviews were undertaken and a final sample of 123 CHC patients with CKD was obtained. Data on demographics and immunization status was analyzed using SPSS version 17.0. Results: The mean age of patient population was 50 with a range of 26 to 83. 119 (96%) patients were African-American and 5 (4%) were Caucasians. Seventy six (61 %) patients were males. Out of 123 patients, HBV and HAV status was known for 105 and 77 patients respectively. Nineteen (15.4%) patients were infected with HBV, 23 (18.7%) had evidence of vaccination and 18 (14.6 %) had immunity as a result of previous exposure. 45 (36.6%) patients were found to be susceptible. Out of 77 patients who had been tested for HAV, 34 (44%) patients had evidence of immunization. Forty three (55.8%) patients were found to be susceptible. Conclusion: Despite multiple visits to clinic, only 62% CHC patients with CKD had been tested for anti-HAV. Out of these, 55.8 % were susceptible, most of who were referred back to the primary care because of insurance reasons. Follow-up of vaccination status was incompletely documented. Screening effectiveness was much better for HBV (85 %), half of whom were susceptible to HBV however, had incomplete follow-up of vaccination. A previous study found that patients who were susceptible to HAV and HBV were much more likely to receive vaccines if they were seen in specialist offices than the patients seen in primary care offices. Better communication between primary care personnel and specialists, with explicit understanding of which office will assume responsibility for immunization and accurate record keeping of immunization history may reduce vaccine underutilization in patients with chronic liver disease and improve health outcomes.