title: Incidence of HAV and HBV infections and vaccination rates in patients with autoimmune liver diseases.
abstract: OBJECTIVE
  Hepatitis A virus (HAV) or hepatitis B virus (HBV) superinfection is associated with an increased mortality in patients with chronic liver diseases (CLD). Despite official recommendations, it was reported that the vaccination rate against HAV is low in patients with chronic hepatitis C infection. To evaluate the situation in patients with autoimmune liver diseases, we conducted a retrospective cohort study.
  
  
  METHODS
  Susceptibility to HAV and HBV infections, course of HAV and HBV infections, vaccination rates against HAV and HBV, and efficacy of hepatitis A/B vaccines were evaluated by antibody testing in 225 patients with autoimmune liver diseases during 1,677 person-years.
  
  
  RESULTS
  Susceptibility to HAV/HBV infection was 51/86%. Incidence of HAV/HBV infection was 1.3/1.4 per 1,000 person-years. One HAV infection occurred, but the patient recovered spontaneously. Two patients were HBV-infected after receiving an anti-HBc-positive (antibody to hepatitis B core antigen) donor graft during orthotopic liver transplantation, and one of them developed chronic HBV infection. Vaccination rates were 11% (HBV) and 13% (HAV), respectively. Seventy-six percent of the vaccinated patients (HBV vaccine) developed anti-HBs (antibody to hepatitis surface antigen) >or=10 UI/L. Ten out of 13 vaccinated patients, showing a low or nonresponse to hepatitis B vaccine, had concomitant immunosuppressive therapy. Anti-HAV was detectable in all patients after administration of HAV vaccine.
  
  
  CONCLUSIONS
  Patients with autoimmune liver diseases have a high susceptibility to HAV and HBV infections. Vaccination rates are low in this patient cohort and efficacy of hepatitis B vaccine is reduced due to immunosuppressive therapy. Improving adherence to vaccine recommendations is essential to prevent HAV and HBV infections in patients with autoimmune liver diseases.
authors.affiliation: Department of Internal Medicine I, Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Marcus A
authors.initials: MA
authors.lastname: Wörns
authors.forename: Andreas
authors.initials: A
authors.lastname: Teufel
authors.forename: Stephan
authors.initials: S
authors.lastname: Kanzler
authors.forename: Annette
authors.initials: A
authors.lastname: Shrestha
authors.forename: Anja
authors.initials: A
authors.lastname: Victor
authors.forename: Gerd
authors.initials: G
authors.lastname: Otto
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.forename: Thomas
authors.initials: T
authors.lastname: Höhler
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000276:immunology; D004279:DNA, Viral / Q000032:analysis; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006506:Hepatitis A / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D035922:Hepatitis A Antibodies / Q000276:immunology; D022362:Hepatitis A Vaccines / Q000627:therapeutic use; D030041:Hepatitis A virus / Q000235:genetics / Q000276:immunology; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000627:therapeutic use; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000276:immunology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014611:Vaccination / Q000379:methods*
chemical_list: D000974:Antibodies, Antinuclear; D004279:DNA, Viral; D035922:Hepatitis A Antibodies; D022362:Hepatitis A Vaccines; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines