Hepatitis Vaccination in Patients With Chronic Liver Disease

[Guest guest]

MEDSCAPE

Hepatitis Vaccination in Patients With Chronic Liver Disease

Posted 04/14/2004

G. Reiss; E.B. Keeffe

Summary and Introduction

Summary

Evidence regarding the outcomes of viral super-infection in patients with

chronic liver disease and practical strategies for hepatitis A and B

vaccination of these individuals are reviewed. Patients with acute hepatitis

A and chronic hepatitis B have a more severe clinical course and a higher

death rate compared with otherwise healthy individuals with hepatitis A, and

these differences are most pronounced in older patients and those with

histological evidence of chronic hepatitis or cirrhosis, rather than in

asymptomatic hepatitis B carriers. Patients with acute hepatitis A

super-infection and chronic hepatitis C have an increased risk of fulminant

hepatitis and death. In addition, patients with other chronic liver diseases

also appear to be at increased risk for more severe disease with

superimposed hepatitis A. Patients with chronic hepatitis B and hepatitis C

virus co-infection have more severe laboratory abnormalities, more severe

histological disease, a greater frequency of cirrhosis and complications of

cirrhosis, and a higher incidence of hepatocellular carcinoma. Vaccines for

both hepatitis A and B are safe and effective if used early in the course of

chronic liver disease. Hepatitis A and B vaccination should be part of the

routine management of patients with chronic liver disease, preferably as

early as possible in the natural course of their disease.

Introduction

Since at least 400 bc, when Hippocrates described epidemic jaundice, viral

hepatitis has been a relentless public health problem. Despite a declining

incidence of acute viral hepatitis in recent years, it remains the most

common cause of chronic liver disease world-wide.[1] Globally, chronic

hepatitis B virus (HBV) infection affects over 350 million people, and up to

40% of these individuals may progress to cirrhosis, liver failure or

hepatocellular carcinoma.[2] Chronic hepatitis C virus (HCV) infection

affects roughly half as many people. Many of the estimated 170 million

people with chronic HCV infection may also progress to cirrhosis, end-stage

liver disease and hepatocellular carcinoma.[3] Industrialized countries,

whilst benefiting from sanitation and vaccination programmes, are not spared

from endemic viral hepatitis or its long-term morbidity and mortality.

Chronic liver disease and cirrhosis account for approximately 400 000

hospitalizations and nearly 30 000 deaths annually.[4,5] Of the total number

of patients with chronic liver disease, over 17 000 were listed for liver

transplantation in 2003, and more than 10% of these individuals were

expected to die before undergoing transplantation.[6]

As the pool of patients with chronic liver disease grows, and acute viral

hepatitis continues to occur with only a slightly reduced incidence, it is

inevitable that a greater number of individuals with chronic liver disease

will be at risk for superimposed acute and chronic hepatitis. To minimize

the occurrence of acute hepatitis in patients with chronic liver disease, a

variety of organizations have recommended hepatitis A and B vaccination of

these patients. The Centers for Disease Control and Prevention, the National

Institutes of Health, the Veteran's Health Administration and the American

Liver Foundation are among the organizations endorsing vaccination of

patients with chronic liver disease.[7,8] The purpose of this article is to

review vaccination in patients with chronic liver disease, specifically the

evidence for worse outcomes associated with the occurrence of viral

super-infection, and practical strategies for the vaccination of these

individuals.

[Guest guest]

MEDSCAPE

Hepatitis Vaccination in Patients With Chronic Liver Disease

Posted 04/14/2004

G. Reiss; E.B. Keeffe

Summary and Introduction

Summary

Evidence regarding the outcomes of viral super-infection in patients with

chronic liver disease and practical strategies for hepatitis A and B

vaccination of these individuals are reviewed. Patients with acute hepatitis

A and chronic hepatitis B have a more severe clinical course and a higher

death rate compared with otherwise healthy individuals with hepatitis A, and

these differences are most pronounced in older patients and those with

histological evidence of chronic hepatitis or cirrhosis, rather than in

asymptomatic hepatitis B carriers. Patients with acute hepatitis A

super-infection and chronic hepatitis C have an increased risk of fulminant

hepatitis and death. In addition, patients with other chronic liver diseases

also appear to be at increased risk for more severe disease with

superimposed hepatitis A. Patients with chronic hepatitis B and hepatitis C

virus co-infection have more severe laboratory abnormalities, more severe

histological disease, a greater frequency of cirrhosis and complications of

cirrhosis, and a higher incidence of hepatocellular carcinoma. Vaccines for

both hepatitis A and B are safe and effective if used early in the course of

chronic liver disease. Hepatitis A and B vaccination should be part of the

routine management of patients with chronic liver disease, preferably as

early as possible in the natural course of their disease.

Introduction

Since at least 400 bc, when Hippocrates described epidemic jaundice, viral

hepatitis has been a relentless public health problem. Despite a declining

incidence of acute viral hepatitis in recent years, it remains the most

common cause of chronic liver disease world-wide.[1] Globally, chronic

hepatitis B virus (HBV) infection affects over 350 million people, and up to

40% of these individuals may progress to cirrhosis, liver failure or

hepatocellular carcinoma.[2] Chronic hepatitis C virus (HCV) infection

affects roughly half as many people. Many of the estimated 170 million

people with chronic HCV infection may also progress to cirrhosis, end-stage

liver disease and hepatocellular carcinoma.[3] Industrialized countries,

whilst benefiting from sanitation and vaccination programmes, are not spared

from endemic viral hepatitis or its long-term morbidity and mortality.

Chronic liver disease and cirrhosis account for approximately 400 000

hospitalizations and nearly 30 000 deaths annually.[4,5] Of the total number

of patients with chronic liver disease, over 17 000 were listed for liver

transplantation in 2003, and more than 10% of these individuals were

expected to die before undergoing transplantation.[6]

As the pool of patients with chronic liver disease grows, and acute viral

hepatitis continues to occur with only a slightly reduced incidence, it is

inevitable that a greater number of individuals with chronic liver disease

will be at risk for superimposed acute and chronic hepatitis. To minimize

the occurrence of acute hepatitis in patients with chronic liver disease, a

variety of organizations have recommended hepatitis A and B vaccination of

these patients. The Centers for Disease Control and Prevention, the National

Institutes of Health, the Veteran's Health Administration and the American

Liver Foundation are among the organizations endorsing vaccination of

patients with chronic liver disease.[7,8] The purpose of this article is to

review vaccination in patients with chronic liver disease, specifically the

evidence for worse outcomes associated with the occurrence of viral

super-infection, and practical strategies for the vaccination of these

individuals.

[Guest guest]

MEDSCAPE

Hepatitis Vaccination in Patients With Chronic Liver Disease

Posted 04/14/2004

G. Reiss; E.B. Keeffe

Summary and Introduction

Summary

Evidence regarding the outcomes of viral super-infection in patients with

chronic liver disease and practical strategies for hepatitis A and B

vaccination of these individuals are reviewed. Patients with acute hepatitis

A and chronic hepatitis B have a more severe clinical course and a higher

death rate compared with otherwise healthy individuals with hepatitis A, and

these differences are most pronounced in older patients and those with

histological evidence of chronic hepatitis or cirrhosis, rather than in

asymptomatic hepatitis B carriers. Patients with acute hepatitis A

super-infection and chronic hepatitis C have an increased risk of fulminant

hepatitis and death. In addition, patients with other chronic liver diseases

also appear to be at increased risk for more severe disease with

superimposed hepatitis A. Patients with chronic hepatitis B and hepatitis C

virus co-infection have more severe laboratory abnormalities, more severe

histological disease, a greater frequency of cirrhosis and complications of

cirrhosis, and a higher incidence of hepatocellular carcinoma. Vaccines for

both hepatitis A and B are safe and effective if used early in the course of

chronic liver disease. Hepatitis A and B vaccination should be part of the

routine management of patients with chronic liver disease, preferably as

early as possible in the natural course of their disease.

Introduction

Since at least 400 bc, when Hippocrates described epidemic jaundice, viral

hepatitis has been a relentless public health problem. Despite a declining

incidence of acute viral hepatitis in recent years, it remains the most

common cause of chronic liver disease world-wide.[1] Globally, chronic

hepatitis B virus (HBV) infection affects over 350 million people, and up to

40% of these individuals may progress to cirrhosis, liver failure or

hepatocellular carcinoma.[2] Chronic hepatitis C virus (HCV) infection

affects roughly half as many people. Many of the estimated 170 million

people with chronic HCV infection may also progress to cirrhosis, end-stage

liver disease and hepatocellular carcinoma.[3] Industrialized countries,

whilst benefiting from sanitation and vaccination programmes, are not spared

from endemic viral hepatitis or its long-term morbidity and mortality.

Chronic liver disease and cirrhosis account for approximately 400 000

hospitalizations and nearly 30 000 deaths annually.[4,5] Of the total number

of patients with chronic liver disease, over 17 000 were listed for liver

transplantation in 2003, and more than 10% of these individuals were

expected to die before undergoing transplantation.[6]

As the pool of patients with chronic liver disease grows, and acute viral

hepatitis continues to occur with only a slightly reduced incidence, it is

inevitable that a greater number of individuals with chronic liver disease

will be at risk for superimposed acute and chronic hepatitis. To minimize

the occurrence of acute hepatitis in patients with chronic liver disease, a

variety of organizations have recommended hepatitis A and B vaccination of

these patients. The Centers for Disease Control and Prevention, the National

Institutes of Health, the Veteran's Health Administration and the American

Liver Foundation are among the organizations endorsing vaccination of

patients with chronic liver disease.[7,8] The purpose of this article is to

review vaccination in patients with chronic liver disease, specifically the

evidence for worse outcomes associated with the occurrence of viral

super-infection, and practical strategies for the vaccination of these

individuals.

[Guest guest]

MEDSCAPE

Hepatitis Vaccination in Patients With Chronic Liver Disease

Posted 04/14/2004

G. Reiss; E.B. Keeffe

Summary and Introduction

Summary

Evidence regarding the outcomes of viral super-infection in patients with

chronic liver disease and practical strategies for hepatitis A and B

vaccination of these individuals are reviewed. Patients with acute hepatitis

A and chronic hepatitis B have a more severe clinical course and a higher

death rate compared with otherwise healthy individuals with hepatitis A, and

these differences are most pronounced in older patients and those with

histological evidence of chronic hepatitis or cirrhosis, rather than in

asymptomatic hepatitis B carriers. Patients with acute hepatitis A

super-infection and chronic hepatitis C have an increased risk of fulminant

hepatitis and death. In addition, patients with other chronic liver diseases

also appear to be at increased risk for more severe disease with

superimposed hepatitis A. Patients with chronic hepatitis B and hepatitis C

virus co-infection have more severe laboratory abnormalities, more severe

histological disease, a greater frequency of cirrhosis and complications of

cirrhosis, and a higher incidence of hepatocellular carcinoma. Vaccines for

both hepatitis A and B are safe and effective if used early in the course of

chronic liver disease. Hepatitis A and B vaccination should be part of the

routine management of patients with chronic liver disease, preferably as

early as possible in the natural course of their disease.

Introduction

Since at least 400 bc, when Hippocrates described epidemic jaundice, viral

hepatitis has been a relentless public health problem. Despite a declining

incidence of acute viral hepatitis in recent years, it remains the most

common cause of chronic liver disease world-wide.[1] Globally, chronic

hepatitis B virus (HBV) infection affects over 350 million people, and up to

40% of these individuals may progress to cirrhosis, liver failure or

hepatocellular carcinoma.[2] Chronic hepatitis C virus (HCV) infection

affects roughly half as many people. Many of the estimated 170 million

people with chronic HCV infection may also progress to cirrhosis, end-stage

liver disease and hepatocellular carcinoma.[3] Industrialized countries,

whilst benefiting from sanitation and vaccination programmes, are not spared

from endemic viral hepatitis or its long-term morbidity and mortality.

Chronic liver disease and cirrhosis account for approximately 400 000

hospitalizations and nearly 30 000 deaths annually.[4,5] Of the total number

of patients with chronic liver disease, over 17 000 were listed for liver

transplantation in 2003, and more than 10% of these individuals were

expected to die before undergoing transplantation.[6]

As the pool of patients with chronic liver disease grows, and acute viral

hepatitis continues to occur with only a slightly reduced incidence, it is

inevitable that a greater number of individuals with chronic liver disease

will be at risk for superimposed acute and chronic hepatitis. To minimize

the occurrence of acute hepatitis in patients with chronic liver disease, a

variety of organizations have recommended hepatitis A and B vaccination of

these patients. The Centers for Disease Control and Prevention, the National

Institutes of Health, the Veteran's Health Administration and the American

Liver Foundation are among the organizations endorsing vaccination of

patients with chronic liver disease.[7,8] The purpose of this article is to

review vaccination in patients with chronic liver disease, specifically the

evidence for worse outcomes associated with the occurrence of viral

super-infection, and practical strategies for the vaccination of these

individuals.