Seroprevalence of hepatitis A virus infection in patients with chronic liver diseases: Do we need to vaccinate?

Document Type : Original article

Authors

1 Tropical Medicine and Gastroenterology dept. Faculty of Medicine, Assiut Univ., Assiut, Egypt.

2 Gastroenterology & Hepatology Unit, of Internal Medicine dept., Faculty of Medicine, Mansoura

3 Gastroenterology & Hepatology Unit, of Internal Medicine dept., Faculty of Medicine, Mansoura Univ. & Egyptian Liver Research Institute and Hospital, Mansoura, Egypt.

Abstract

Superinfection of patients with chronic liver disease (CLD) with hepatitis A virus (HAV) may have deleterious effects including hepatic decompensation and fulminant liver failure. The status of HAV infection in these patients needs to be
assessed, especially after the availability of an effective HAV vaccine. This study aimed to assess the rate of HAV serology testing in patients with CLD, and their susceptibility to HAV superinfection. Patients and Methods: A total of 638 patients
with CLD (Mean±SD age 46.2±15.8 years, 396(62.1%) males), 517(81%) of them had viral etiology were included. Total anti-HAV, which detect both IgG and IgM; and anti-HAV IgM were tested by a micro particle enzymatic assay (AxSYM
system (Abbott Diagnostics, USA). Results: HAV serology was done in 190(29.8%) patients, Mean±SD age 46.2±15.8 years 106(55.8%) were males, 119(62.6%) of them had viral etiology. Of these, 33(17%) patients had negative anti-HAV IgG. Positive anti-HAV IgM was accidentally detected in 7(3.7%) patients. Compared to IgG positive patients (immune against HAV), patients with negative anti-HAV IgG (susceptible) had no gender difference (p=0.089). Patients with nonverbal etiology were significantly more susceptible to HAV (OR: 5.2, 95% CI 2.3-11.8; p<0.001). Also, patients >20 years old, and those >40 years old had significantly more anti-HAV IgG seropositivity compared to those who are younger in age (OR: 11.4, 95% CI 4.8-27; p<0.0001 and OR: 3.8, 95% CI 1.7-8.6; p<0.01 respectively). Conclusions: Only 30% of CLD patients are tested for HAV serology, 17% of them are susceptible to HAV infection especially those who are
younger and with non-viral etiology. Detection and vaccination of these subgroups is warranted to avoid superinfection with HAV. 

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