Vaccination against hepatitis A and B in patients with chronic liver disease and type 2 diabetes: has anything changed?
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Aaron Koenig1, Maria Stepanova1, Sean Felix1,2
1Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
Insights
Hepatitis A (HAV) and B (HBV) vaccination rates increased in the general US population but remain low in patients with chronic liver disease (CLD) and type 2 diabetes (DM). Improved vaccination strategies are needed for these high-risk groups.
Area of Science:
- Hepatology
- Immunology
- Public Health
Background:
- Patients with chronic liver disease (CLD) and type 2 diabetes (DM) face severe risks from acute hepatitis.
- Vaccination against Hepatitis A (HAV) and Hepatitis B (HBV) is recommended for these high-risk populations.
Purpose of the Study:
- To assess recent trends in HAV and HBV vaccination rates.
- To analyze vaccination coverage in US patients with CLD and DM using population data.
Main Methods:
- Utilized National Health and Nutrition Examination Surveys (NHANES) data from 1999-2014.
- Compared vaccination rates across different population subgroups and time periods.
Main Results:
- HBV vaccination rates increased from 24.4% to 41.3% and HAV vaccination rates from 12.0% to 33.4% in the general US population (1999-2014).
- Significant increases in HBV vaccination were observed in CLD patients (22.7% to 51.1%).
- Vaccination rates in DM patients showed similar increases to the general population, despite recommendations.
Conclusions:
- HAV and HBV vaccination coverage remains suboptimal in patients with CLD and DM.
- There is a critical need for enhanced vaccination strategies targeting these vulnerable populations.
Background & Aims:
Given the severity of acute hepatitis in patients with chronic liver diseases (CLD) and patients with type 2 diabetes (DM), most of these patients are recommended to be vaccinated. The aim is to assess the recent changes in HAV and HBV vaccination rates in patients with CLD and DM in the U.S. using the most recent population data.
Methods:
We used the National Health and Nutrition Examination Surveys (NHANES) cycles 2009-2012 and 2013-2014, and compared those to previous cycles (1999-2004 and 2005-2008).
Results:
In general U.S. population, the rates of quality measure (QM, serologic immunity or history of vaccination) for HBV increased from 31.9% in 1999-2004 to 49.5% in 2013-2014 (P < 0.0001), synchronously with an increase in self-reported HBV vaccination: from 24.4% to 41.3% (P < 0.0001). A similar increase was noted for HAV: 12.0% in 1999-2004 to 33.4% in 2013-2014 in vaccination, 44.0% to 52.4% in HAV QM (all P < 0.0001). Greater recent increases in HBV QM were noted in non-HBV CLD patients: 34.7% to 56.8% in HBV QM and 22.7% to 51.1% in HBV vaccination (all P < 0.0001), while the changes in patients with diabetes were similar to those in general U.S. population despite the recent CDC recommendation (for the age 19-59): 31.0% to 45.1% (P = 0.007) in HBV QM, and 22.3% to 39.0% (P = 0.0004) in HBV vaccination.
Conclusions:
Despite recommendations, HAV and HBV vaccination rates in patients with CLD and DM remain relatively low. Better vaccination strategies for these high risk patients should be undertaken.
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