Hepatitis B Virus, Pneumococcal, Diphtheria, and Tetanus Vaccination Responses in Compensated Cirrhosis

Cirrhosis favours infections that can lead to liver decompensation and death. Some of these infections can be prevented by vaccination. This study aimed to evaluate the immune response after HBV, pneumococcal, diphtheria, and tetanus vaccination in cirrhotic patients.

Patients with cirrhosis were prescribed 3 doses of hepatitis B vaccine, a tetanus-diphtheria booster and/or a 13-valent pneumococcal conjugate vaccine followed by a 23-valent polysaccharide vaccine. HBs seroconversion was assessed 6 months after the last booster dose. Antibody concentrations for seven pneumococcal serotypes, tetanus and diphtheria were measured by ELISA before (V0) and 4 to 6 months after vaccination (V1).

Of the 125 patients enrolled, 83 were analysed for HBs seroconversion, 119 for pneumococcal vaccine response and 117 for tetanus and diphtheria vaccine response. The anti-HBs seroconversion rate was 31%. A doubling of the antibody was observed in 19% of cases for tetanus and in 26% of cases for diphtheria. For the pneumococcal vaccine, the global protection (at least 5 antibodies with a concentration ≥ 1.3 mg/L against the 7 serotypes of pneumococcus tested) increased from 39% before vaccination to 80% after vaccination. However, only 48% of patients had a 2-fold increase in IgG antibody for at least five of the seven serotypes tested.

Our study highlights a weak response to the hepatitis B, tetanus, and diphtheria vaccines and an acceptable immunological response to the pneumococcal vaccine, although lower than in healthy subjects. There is a real need to optimise vaccination in cirrhotics.