[Efficacy and safety of vaccination against hepatitis A and B in patients with chronic liver disease].
Vaccination to protect against hepatitis A and B should be part of the routine management of patients with chronic liver disease (CLD).


OBJECTIVE
To evaluate the efficacy and safety of hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination in a group of patients with CLD and to assess the presence of factors predictive of response.


METHODS
We performed a prospective, single-center study in 194 patients (123 men, 71 women; mean age, 48.9+/-10.7 years) with CLD: 107 with chronic hepatitis (CH) and 87 with hepatic cirrhosis (HC), all Child-Pugh class A. The most frequent causes of CLD were HCV infection and alcohol. Patients negative for anti-HAV IgG received the HAV vaccination (1440 ELISA units in two doses) and those with negative HBV serology received the HBV vaccination ( three 20 microg doses). Patients with inadequate response to the latter vaccine received an additional double dose. Thirty patients received a combination vaccine (three doses).


RESULTS
Sixty patients (31%) received the HAV vaccine and 150 (77%) patients received the HBV vaccine. Seroconversion was achieved by 91.6% of patients for HAV and by 57% of the patients for HBV. After the additional dose, the response increased to 74%. Efficacy was similar between CH and HC. HBV vaccination was less effective in HC than in CH and the seroconversion rate was significantly lower in patients with HC and previous decompensation. The combination vaccine (30 patients) was highly immunogenic. No adverse effects were registered.


CONCLUSIONS
HAV vaccination has high efficacy in patients with CLD. Patients with HC respond weakly to HBV vaccination compared with those with CH and especially if there is prior decompensation. The combination vaccine seems particularly effective in patients with CLD. The three vaccines are safe.
de Artaza Varasa
Tomás
T
Servicio de Aparato Digestivo, Hospital Virgen de la Salud, Toledo, España. tartaza@sescam.jccm.es
Sánchez Ruano
Juan José
JJ
García Vela
Almudena
A
Gómez Rodríguez
Rafael
R
Romero Gutiérrez
Marta
M
de la Cruz Pérez
Gema
G
Gómez Moreno
Ana Zaida
AZ
Carrobles Jiménez
José María
JM
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006506:Hepatitis A / Q000150:complications / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000276:immunology*; D006509:Hepatitis B / Q000150:complications / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines