This blog is all about current FDA approved drugs to treat the hepatitis C virus (HCV) with a focus on treating HCV according to genotype, using information extracted from peer-reviewed journals, liver meetings/conferences, and interactive learning activities.
Risk Of Developing Liver Cancer After HCV Treatment
Read the complete article @ Gastroenterology Download PDF View Online
Severe morbidity can result from viral hepatitis co-infection, particularly in persons with existing chronic liver disease. Vaccination is the most effective way of preventing infection with the hepatitis A virus (HAV) and hepatitis B virus (HBV). Persons with chronic liver disease are currently recommended by the Advisory Committee on Immunization Practices to receive the HAV and HVB vaccines if they have not previously been vaccinated. Recently, the Advisory Committee on Immunization Practices approved language clarifying that all patients with hepatitis C virus (HCV) infection are recommended for HBV vaccination1 and that persons with HBV and HCV infections should also be specifically considered for vaccination against HAV.2, 3
Recent large outbreaks of HAV related to foodborne4, 5 and ongoing person-to-person exposures have resulted in substantial rates of morbidity and mortality5, 6, 7; these events underscored the relatively low prevalence of immunity against HAV infection among the US-born adult population.8 Poor HAV vaccine coverage among adults, combined with decreased childhood exposures to HAV since childhood vaccination initiation in 1996, have resulted in a low population immunity as measured by the prevalence of antibody to HAV (anti-HAV). Among adults age ≥18 years with chronic liver conditions participating in the 2014 and 2015 National Health Interview Survey, for example, only 19.4% reported having received 1 dose and 11.5% received 2 doses of HAV vaccine. Even among those with ≥10 provider visits, only 13.8% had received two doses of HAV vaccine, indicating missed opportunities for vaccination.9
The 1999 through 2012 National Health and Nutrition Examination Survey (NHANES) revealed that the overall anti-HAV prevalence among adults aged ≥20 years was about 25%.8 In the United States, immunity to HAV is greatest among the cohort of young people born after the 1996 recommendation for pediatric vaccination of children residing in areas of high transmission or incidence, particularly the cohort of children subject to the 2006 recommendation for universal pediatric HAV vaccination. Data from NHANES 2007 through 2012 showed 60% anti-HAV positivity among those aged 2 to 11 years in contrast with 16% to 18% among those aged 30 to 49. In earlier NHANES data from 1999 through 2006, only 21.4% of children aged 2 to 11 years had tested anti-HAV positive.8 Data from the National Immunization Survey—Child for 2012 through 2016 revealed that 82% of children 19 to 35 months had received ≥1 dose of vaccine in 2012, increasing incrementally each year to 86% in 2016.10 The increasing vaccine coverage and decreasing acute infection among children has resulted in reduced exposure to HAV for adults and consequently lower immunity among adults. This is exacerbated by poor vaccine coverage among adults, causing decreasing population immunity.
Recent data from the Chronic Hepatitis Cohort Study (CHeCS) at 4 large integrated US health care systems11 indicates that vaccination rates are far below desired public health goals. Among 3846 living chronic HBV-diagnosed and 15,471 HCV-diagnosed patients, results were available from total anti-HAV testing performed as part of routine clinical care and vaccination records from the electronic health record at any time in the patient’s past medical history through 2015. Updated vaccination records through 2016 were available for patients from 2 sites representing 35% of the cohorts. More than one-half of the HBV cohort patients had testing for anti-HAV and 60% were positive indicating immunity through either vaccination or past infection (Table 1). A similar proportion of HCV-infected patients had anti-HAV testing and 39% were positive. Among patients ever tested for anti-HAV in both HBV and HCV cohorts, significantly higher anti-HAV positivity was found among specific racial and ethnic groups. Higher numbers of patients of Asian/Pacific Islander and Hispanic race/ethnicity (70.3% and 56.3%, respectively) were immune to HAV compared with non-Hispanic black or white patients (37.7% and 38.4%, respectively; both P < .001). These differences could reflect exposure in early life among persons born in countries endemic for both HAV and HBV.
Featured on the blog today in honor of Hepatitis Awareness Month, is a look at three common viruses that cause hepatitis, brought to you by Centers of Disease Control and Prevention (CDC), health experts, advocates, and patient bloggers, who work hard to spread information and awareness about viral hepatitis.
Hepatitis C
Lets start with the hepatitis C virus (HCV), a virus that once caused serious damage to my liver, putting me at risk for liver-related complications. The good news is after testing; it all starts with getting tested for HCV, I went on to successfully treat the virus. The bad news is close to 50% of people who have HCV have not yet been diagnosed. Why not take this opportunity to learn more about viral hepatitis, or better yet, have a long frank discussion with "yourself" about getting tested.
Young Or Not So Young - The Risk
Today we have two different groups of people that are at risk for hepatitis C, young people who have injected drugs and well, older people. We know that the hepatitis C epidemic peaked between 1940 and 1965 due in part because of hospital transmissions caused by the practice of reusing needles. So if you are at risk for HCV, rather you are young or part of the baby boomer generation; people born between 1945 and 1965, I hope you consider getting tested for HCV.
-You were born from 1945 through 1965
-Extensive surgical procedures
-Needlestick injuries in health care settings
- Recipients of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992)
-People who received a blood product for clotting problems made before 1987
-Hemodialysis patients or persons who spent many years on dialysis for kidney failure
-Other possible risk behaviors: tattoos, body piercing, living and medical care in a developing country, folk medicine, intranasal cocaine
-Sexual transmission, rare; the risk of sexual transmission to an individual is probably less than 3% when a person is in a stable monogamous relationship - Unless you also have human immunodeficiency virus (HIV).
-Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person
-Unknown--up to 5% of patients have no identifiable risk factors
May 19th is Hepatitis Testing Day!
Are You At Risk For Viral Hepatitis?
Find out if you should get tested or vaccinated by taking a quick, online Hepatitis Risk Assessment, developed by the CDC and get a personalized report.
Hepatitis C - A Few Facts
Of every 100 people infected with hepatitis C, 75 to 85 will develop chronic disease and 10-20 will go on to develop cirrhosis over a period of 20-30 years. Early on HCV doesn't always have noticeable symptoms but overtime and with certain co-factors the virus can lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer. Almost 80 percent of cases of hepatocellular carcinoma (HCC) are due to underlying chronic hepatitis B and C infection, and 80 to 90 percent of people with HCC have liver cirrhosis. According to the recent EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma;Vaccination against hepatitis B reduces the risk of HCC and is recommended for all new-borns and high-risk groups. In patients with chronic hepatitis, antiviral therapies leading to maintained HBV suppression in chronic hepatitis B and sustained viral response in hepatitis C are recommended, since they have been shown to prevent progression to cirrhosis and HCC development.
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) with the International Antiviral Society developed a living document with ever evolving guidelines to treat HCV. The guidelines break down treatment according to liver damage and HCV genotype, updated when new HCV drugs are approved, or new real world data is established.
Help - Where Do I Begin?
Talk To Someone Help‑4‑Hep is a non-profit, peer-to-peer helpline where counselors work with patients to meet the challenges of hepatitis C head-on. Callers talk one-to-one with a real person, typically someone who's had hepatitis C touch their own life. And they talk about the specifics of their particular situation. The phone call, support and information are all provided free of charge. Let us help you cut through the clutter and confusion. Call toll-free: 877‑Help‑4‑Hep (877‑435‑7443).
Begin here.......
More than 2 million Americans are chronically infected with hepatitis B virus (HBV), to learn more about HBV visit The Hepatitis B Foundation, for patients it's the best site for easy to understand information, here are a few links to get you started:
You may have questions about the hepatitis A virus (HAV) after reading about HAV outbreaks across the US; Michigan, California, Indiana, Kentucky and Utah. The outbreak began in California in 2017, this year Michigan, Utah, and Kentucky have reported outbreaks with a high number of cases. Here is a Public Service Announcement from San Diego County Health & Human Services Agency on HAV prevention.
I think I have been exposed to hepatitis A. What should I do?
If you have any questions about potential exposure to hepatitis A, call your health professional or your local or state health department. If you were recently exposed to hepatitis A virus and have not been vaccinated against hepatitis A, you might benefit from an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective if given within the first 2 weeks after exposure. A health professional can decide what is best based on your age and overall health.
What is postexposure prophylaxis (PEP)?
Postexposure prophylaxis (PEP) refers to trying to prevent or treat a disease after an exposure. For hepatitis A, postexposure prophylaxis is an injection of either immune globulin or hepatitis A vaccine. However, the vaccine or immune globulin are only effective in preventing hepatitis A if given within the first 2 weeks after exposure. Begin here.......
Blog Updates: The ABCs Of Viral Hepatitis
Swedish Medical Center
What is hepatitis C, and how does it differ from hepatitis A or B?
By 2030, the World Health Organization wants to have hepatitis C eliminated from the planet. A key to reaching that goal is to create awareness of the disease among baby boomers, who suffer from it in larger numbers compared to the rest of the population, as well as those with increased lifestyle risks. But what is hepatitis C, and what can be done to reduce its numbers? Kris Kowdley, MD, director of the Liver Care Network and Organ Care Research at Swedish Medical Center in Seattle, WA, discusses hepatitis C in detail.
HEP Blogs Go-to online source for educational and social support for people living with hepatitis. The website is devoted to combating the stigma and isolation surrounding hepatitis.
What are the Different Types of Hepatitis?
May 9, 2018 • By Connie M. Welch
Viral hepatitis is a liver infection that causes inflammation and damage. There are 5 viruses that cause viral hepatitis, Hepatitis A, B, C, D, and E. Hepatitis A and E viruses can cause acute infections (infections that last less than 6 months). Hepatitis B, C, and D viruses can cause acute and chronic (lasting longer than 6 months and typically ongoing) liver infections.
So, you are hanging out with the same crowd that you always have. They’re like your family. In many ways, they are closer to you than your own family.
The Fallout Guide for Hep C: Support Network
By Rick Nash · May 2, 2018
I am lucky after my transplant, I carry that reminder on my stomach. Because when someone hears you have a condition, they may not initially understand the reality of how that affects you. This is part two of a six-part series, view part one here.
The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.
Hepatitis Awareness Month is dedicated to increasing awareness of hepatitis in the United States and to encourage high risk populations to get tested. If you’re not sure how you can get involved in the hepatitis B community this month, here are some ways you can!
The Al D. Rodriguez Liver Foundation is a 501(c)(3) non-profit organization that provides resources, education and information related to screening, the prevention of and treatment for the Hepatitis Virus and Liver Cancer.
A New York Post article about an unsafe “pizza joint manager” — who was reported to have sparked hepatitis C scare — made a few rounds on the panicked social media circuit earlier this year.
Healio features the industry’s best news reporting, dynamic multimedia, question-and-answer columns, CME and other educational activities in a variety of formats, quick reference content, blogs, and peer-reviewed journals. A quick free registration may be required.
Hepatitis Awareness Month: 10 recent reports on viral hepatitis
May 8, 2018
The Centers for Disease Control and Prevention have designated May as Hepatitis Awareness Month to raise public awareness of viral hepatitis including the most common strains: hepatitis A, hepatitis B and hepatitis C. Additionally, the CDC designated May 19th as Hepatitis Testing Day. The following recent reports, many from recent meetings including the International Liver Congress 2018, include new research data on hepatitis prevalence and outbreaks, transmission risks and treatment outcomes...
May 9, 2018
Physicians should consider administering hepatitis A vaccines to their patients with hepatitis B and those with hepatitis C, according to a…
What is the hepatitis virus? Well, the hepatitis virus invades liver cells and causes inflammation in the liver tissue. There are five known hepatitis viruses—hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E, all of which have slightly different presentations, symptoms and severity.
Do you want to know your status? If you fall under any of the above mentioned risk groups please consider getting tested.
Clinical Guidelines |5 December 2017 Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention
Winston E. Abara, MD, PhD; Amir Qaseem, MD, PhD, MHA; Sarah Schillie, MD, MPH, MBA; Brian J. McMahon, MD; Aaron M. Harris, MD, MPH (*); for the High Value Care Task Force of the American College of Physicians and the Centers for Disease Control and Prevention
Background: Vaccination, screening, and linkage to care can reduce the burden of chronic hepatitis B virus (HBV) infection. However, recommendations vary among organizations, and their implementation has been suboptimal. The American College of Physicians' High Value Care Task Force and the Centers for Disease Control and Prevention developed this article to present best practice statements for hepatitis B vaccination, screening, and linkage to care.
Methods: A narrative literature review of clinical guidelines, systematic reviews, randomized trials, and intervention studies on hepatitis B vaccination, screening, and linkage to care published between January 2005 and June 2017 was conducted.
Best Practice Advice 1: Clinicians should vaccinate against hepatitis B virus (HBV) in all unvaccinated adults (including pregnant women) at risk for infection due to sexual, percutaneous, or mucosal exposure; health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease (including hemodialysis patients), or HIV infection; travelers to HBV-endemic regions; and adults seeking protection from HBV infection.
Best Practice Advice 2: Clinicians should screen (hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease (including hemodialysis patients), blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels (≥19 IU/L for women and ≥30 IU/L for men), incarcerated persons, pregnant women, and infants born to HBV-infected mothers.
Best Practice Advice 3: Clinicians should provide or refer all patients identified with HBV (HBsAg-positive) for posttest counseling and hepatitis B–directed care.
Review Article
COST-EFFECTIVE OPTIONS FOR THE PREVENTION AND MANAGEMENT OF GASTROINTESTINAL AND LIVER DISEASE IN THE ASIA-PACIFIC REGION
Authors
Ian C Roberts-Thomson,
Thomas Lung
Accepted manuscript online: 17 August 2017
Full publication history
DOI: 10.1111/jgh.13925
Abstract
The Asia-Pacific region contains more than half of the world's population and is markedly heterogeneous in relation to income levels and the provision of public and private health services. For low-income countries, the major health priorities are child and maternal health. In contrast, priorities for high-income countries include vascular disease, cancer, diabetes, dementia and mental health disorders as well as chronic inflammatory disorders such as hepatitis B and hepatitis C. Cost-effectiveness analyses are methods for assessing the gains in health relative to the costs of different health interventions. Methods for measuring health outcomes include years of life saved [or lost], quality-adjusted life years [QALYs] and disability-adjusted life years [DALYs]. The incremental cost-effectiveness ratio [ICER] measures the cost [usually in US dollars] per life year saved, QALY gained or DALY averted of one intervention relative to another. In low-income countries, approximately 50% of infant deaths [<5years] are caused by gastroenteritis, the major pathogen being rotavirus infection. Rotavirus vaccines appear to be cost-effective but, thus far, have not been widely adopted. In contrast, infant vaccination for hepatitis B is promoted in most countries with a striking reduction in the prevalence of infection in vaccinated individuals. Cost-effectiveness analyses have also been applied to newer and more expensive drugs for hepatitis B and C and to government-sponsored programs for the early detection of hepatocellular, gastric and colorectal cancer. Most of these studies reveal that newer drugs and surveillance programs for cancer are only marginally cost-effective in the setting of a high-income country.
Why do we continue to put our children at unnecessary risk of liver cancer? On International Children’s Day (1June), the World Hepatitis Alliance calls for widespread coverage of the hepatitis B birth dose vaccine to protect our children’s futures.
Children are our future. It’s an utter cliché, but it’s true. Children are our future adults, leaders, carers. And so, we have a duty to provide children with the best start in life possible, and that means ensuring their health and wellbeing from day one. A no-brainer, right?
Worldwide, almost two out three babies are being denied access to the hepatitis B birth dose vaccine, a simple measure which can avert a virus that can cause cirrhosis and liver cancer and accounts for over 880,000 deaths a year, globally.
Despite the alarming figures, inexplicably not all children are receiving this life-saving intervention. Across the globe 84% of infants receive three doses of the hepatitis B vaccine. It’s a good start but to ensure full protection, the vaccine must be given shortly after birth to prevent both infection that may occur early in life and to protect against potential mother-to-child transmission if the mother is living with hepatitis B.
In the South-East Asia region only 34% receive the birth dose vaccine; in the Eastern Mediterranean region just 23% of babies are vaccinated and in the African region as few as just 10% receive the birth dose. There are many reasons for this: vaccines are unavailable, health services are poorly provided or inaccessible, populations live in remote locations, or because families are uninformed about the importance of vaccination.
As a mother myself, I know it might be hard to imagine putting a newborn baby through the pain of a shot but this small prick is a crucial first step to protecting a child against a deadly disease for life. What’s more, where vaccination has been implemented, it has already proven a success. The proportion of children under 5 years of age who are chronically infected with hepatitis B has fallen from 4.7% in the pre-vaccine era to 1.3% now. The fact that the majority of those living with hepatitis B are adults born before the hepatitis B was available and that the prevalence of hepatitis B among children under 5 is still at 3% in the African region shows just how crucial vaccination is in protecting children’s futures.
The 257 million people currently living with chronic hepatitis B infection were denied this protection, but we cannot deny our children protection. In May 2016, 194 governments committed to increasing coverage of the hepatitis B birth dose vaccine to 90% by 2030.
Today on International Children’s Day, we call on all governments to uphold their commitment by implementing vaccination programme for infants from day one. Let’s join together and raise our voices to ensure that every baby across the world gets the best possible start in life. Now, that’s a no-brainer.
Mumbai, February 17, 2017: Cipla Ltd, a global pharmaceutical company, which uses cutting edge technology and innovation to meet the everyday needs of all patients, today announced that it has launched adult Hepatitis B vaccine in India. Under a co-exclusive agreement with Serum Institute of India Private Limited (SII), Cipla will market the vaccine for adults while SII will market it for adults and children.
Umang Vohra, MD and Global CEO Cipla Ltd. said: “This agreement will enable Cipla to provide affordable vaccines for a chronic disease like Hepatitis B. Cipla’s strong marketing network and reach will ensure maximum accessibility of the vaccines in India.”
In India, around 40 million people are chronically infected with hepatitis B. This infection is responsible for 70% of chronic hepatitis and 80% of liver cirrhosis. Hepatitis B is spread through contact with an infected person’s blood and body fluids. At risk are all those who are not vaccinated against the infection. Since 2002 the Hepatitis B vaccine has been a part of India’s Universal Immunization Programme. This vaccine is able to protect 95% of recipients from developing chronic Hepatitis B. The vaccine is given in three doses that include one after the first month of the first dose and the second after 6 months post the first dose. The vaccine can protect the recipient from this infection for decades. In addition, it is expected to bring down the number of cases of liver cirrhosis and liver cancer.
About Serum Institute of India Private Limited (SII): Serum Institute of India Private Limited is the world's second largest vaccine manufacturer in number of doses manufactured and supplied to more than 140 countries. The vaccines include Diphtheria, Tetanus, Pertussis, Hib, BCG, r-Hepatitis B, Measles, Mumps, Rubella, Meningitis A, Influenza and Polio vaccines. One of every two children born in the world receive a vaccine manufactured by Serum Institute.
About Cipla Ltd.: Cipla is a global pharmaceutical company which uses cutting edge technology and innovation to meet the everyday needs of all patients. For over 80 years, Cipla has emerged as one of the most respected pharmaceutical names in India as well as across more than 100 countries. Our portfolio includes over 1000 products across wide range of therapeutic categories with one quality standard globally. Whilst delivering a long-term sustainable business, Cipla recognizes its duty to provide affordable medicines. Cipla’s emphasis on access for patients was recognized globally for the pioneering role played in HIV/AIDS treatment as the first pharmaceutical company to provide a triple combination anti-retroviral (ARV) in Africa at less than a dollar a day and thereby treating many millions of patients since 2001. Cipla's research and development focuses on developing innovative products and drug delivery systems. http://corporates.bseindia.com/xml-data/corpfiling/AttachLive/A9E925B8_85D1_4A9D_9CCB_4CD23F3E1512_131653.pdf
Changes in the 2017 adult immunization schedule from the previous year's schedule include new or revised ACIP recommendations on influenza, human papillomavirus, hepatitis B, and meningococcal vaccinations.
The updated changes include people with HCV;
The ACIP updated chronic liver disease conditions for which a hepatitis B vaccine (HepB) series is recommended. This change is described in the 2017 adult immunization schedule as: Adults with chronic liver disease, including, but not limited to, hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level greater than twice the upper limit of normal, should receive a HepB series.
Listen to key changes in this podcast available at Medscape;
Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2017 February 7, 2017
In October 2016, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger—United States, 2017. Changes in the 2017 immunization schedules for children and adolescents aged 18 years or younger include new or revised ACIP recommendations for influenza; human papillomavirus; hepatitis B; Haemophilus influenzae type B; pneumococcal; meningococcal; and diphtheria and tetanus toxoids and acellular pertussis vaccines.
In The Media What you need know about the CDC's updated vaccine guidelines
Roll up your sleeves, America. A national advisory panel of the U.S. Centers for Disease Control and Prevention has released its 2017 advisory for recommended shots affecting adults.
Too few U.S. teens getting flu and cancer vaccines (Reuters Health) - Less than half of U.S. adolescents get vaccinated to protect against seasonal influenza, and even fewer teens receive shots to help prevent cancers of the cervix and throat, new research suggests.
TUESDAY, Sept. 3 (HealthDay News) -- Taiwanese researchers report a 90 percent reduction in deaths from complications of hepatitis B since the country began its infant vaccination program in 1984.
Vaccinations have also decreased the spread of hepatitis B, which can cause liver damage, liver cancer and a deadly reaction in babies called infant fulminant hepatitis, the researchers said.
"Immunization has provided 30-year protection against acute hepatitis and end-stage chronic liver diseases, including cirrhosis and liver cancer," said lead researcher Chien-Jen Chen, a vice president at the Genomics Research Center at Academia Sinica in Taipei.
The implications of the findings are global.
Chen said there are 350 million chronic carriers of hepatitis B in the world, with the highest prevalence in the Asia-Pacific region and sub-Saharan Africa. The infection can be spread from mothers to newborns.
"All newborns in high-prevalence areas should be vaccinated to reduce the liver disease burden and health care costs," he said.
The report was published in the Sept. 4 issue of the Journal of the American Medical Association.
According to the Hepatitis B Foundation, 12 million Americans have been infected with the disease -- one out of every 20 people. In addition, more than 1 million people are chronically infected and up to 100,000 new infections occur each year.
The foundation estimates that 5,000 people in the United States die each year from hepatitis B and its complications.
The new findings add even more support for the need for vaccination, a U.S. expert said.
"This is an exclamation point of what we already knew -- that infants should be vaccinated against hepatitis B," said Dr. Marc Siegel, an associate professor of medicine at the NYU Langone Medical Center in New York City. "Vaccination of infants with hepatitis B vaccine, which is highly effective, leads to a dramatic decrease in chronic infection and liver cancer, which are outcomes for up to 50 percent of those with hepatitis B."
In addition, vaccination builds herd immunity as fewer people are infected, thus reducing the spread of the disease in the population, Siegel said. "Everybody should be vaccinated against this virus -- everybody," he said. "Infants and all adults should be vaccinated."
The hepatitis B vaccine is safe, Siegel said. "The disease is scary-- the vaccine is not," he said.
For the study, Chen's team looked at the 30-year outcomes of the immunization program in Taiwan. For the first two years, the immunization program covered only newborns of mothers who carried the disease. Then it expanded to all newborns.
In July 1987, vaccinations were extended to cover preschoolers. Between 1988 and 1999, the program was extended to cover all elementary school children.
The rate of vaccinations for those born from 1984 to 2010 was about 89 percent to 97 percent, the researchers found.
For those born between 1977 and 2004, a more than 90 percent reduction occurred in deaths from chronic liver disease and liver cancer, and there were 80 percent fewer cases of liver cancer overall.
Deaths from infant fulminant hepatitis B also decreased 90 percent.
Hepatitis B is spread when blood, semen or other body fluids infected with the virus enters the body of an uninfected person, according to the U.S. Centers for Disease Control and Prevention.
The infection can be transmitted from an infected mother to her newborn. The hepatitis B virus also can be transmitted during sex with an infected person or by sharing needles, syringes or other drug-injection equipment.
Sharing razors or toothbrushes with an infected person also can transmit the disease, as can direct contact with blood or open sores of an infected person, according to the CDC.
Source Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
Abstract BACKGROUND AND GOALS: Hepatitis A (HAV) and hepatitis B (HBV) vaccination in patients with chronic liver disease is an accepted standard of care. We determined HAV and HBV vaccination rates in a tertiary care referral hepatology clinic and the impact of electronic health record (EHR)-based reminders on adherence to vaccination guidelines.
METHODS: We reviewed the records of 705 patients with chronic liver disease referred to our liver clinic in 2008 with at least two follow-up visits during the subsequent year. Demographics, referral source, etiology, and hepatitis serology were recorded. We determined whether eligible patients were offered vaccination and whether patients received vaccination. Barriers to vaccination were determined by a follow-up telephone interview.
RESULTS: HAV and HBV serologic testing prior to referral and at the liver clinic were performed in 14.5% and 17.7%; and 76.7% and 74% patients, respectively. Hepatologists recommended vaccination for HAV in 63% and for HBV in 59.7% of eligible patients. Patient demographics or disease etiology did not influence recommendation rates. Significant variability was observed in vaccination recommendation amongst individual providers (30-98.6%), which did not correlate with the number of patients seen by each physician. Vaccination recommendation rates were not different for Medicare patients with hepatitis C infection for whom a vaccination reminder was automatically generated by the EHR. Most patients who failed to get vaccination after recommendation offered no specific reason for noncompliance; insurance was a barrier in a minority.
CONCLUSIONS: Hepatitis vaccination rates were suboptimal even in an academic, sub-speciality setting, with wide-variability in provider adherence to vaccination guidelines.
Introduction Hepatitis A and hepatitis B are amongst the most common infectious diseases worldwide [1], [2]. Superinfection with hepatitis A virus (HAV) or hepatitis B virus (HBV) in patients with underlying chronic liver disease is associated with a higher risk of morbidity and mortality [3], [4], [5]. Both HAV and HBV infections are preventable by highly effective and safe vaccines [6], [7], [8], [9]. Experts have recommended screening for susceptibility to HAV and HBV infection and vaccination against them for all patients with chronic liver disease [10], [11]. The CDC and several professional societies have also recommended vaccination against HAV and HBV for susceptible patients with chronic liver disease. In 2008, Centers for Medicare and Medicaid Services (CMS) proposed HAV and HBV vaccination for eligible patients with chronic hepatitis C infection (HCV) as a quality measure [12], [13], [14], [15].
Prior studies have demonstrated shortcomings in adherence to vaccination guidelines in specific subgroups of patients with chronic liver disease in the United States and around the world. In a study of patients with chronic hepatitis C infection in a Veterans Administration Healthy System in California, an adherence rate of 71% for HAV and 70% for HBV and 62% for both vaccination was found [16]. Similarly, in a large cohort of HCV patients from the Department of Veterans Affairs quality measure of HAV and HBV vaccination or documentation of immunity were met in just 57% and 45.5% patients, respectively [17]. A study of patients with autoimmune hepatitis from Germany found vaccination rates of just 11% for HBV and 13% for HAV [18].
Given the increased focus on preventive care and advent of pay for performance models of health care delivery, it likely that adherence to vaccination guideline will be emphasized as a quality measure. Low adherence to vaccination guidelines in primary care settings has been documented [19]. However, limited data are available on whether specialists that care for chronic liver disease patients perform better on these quality measures than community physicians [19]. Furthermore, it is also unknown whether adoption of electronic health records (EHR) and introduction of CMS-mandated quality measures reporting has affected physician practice patterns in terms of adhering to hepatitis vaccination guidelines.
Therefore, the objectives of this study were: (1) To evaluate adherence to hepatitis vaccination guidelines in patients with chronic liver disease at a tertiary care hepatology clinic, (2) to identify barriers to vaccinations in patients with chronic liver disease, and (3) to determine physician variability in adherence to vaccination guidelines......
Merck & Co., said Wednesday that it was recalling one lot of its hepatitis B vaccine Recombivax HB that was made in West Point, Montgomery County, because of fears that some of the vials could have cracked.
The U.S. Food and Drug Administration posted a notice of the voluntary recall on its website. The medication is delivered via injection.
"Merck's investigation concluded that for certain vials in the affected lot, the potential exists for a crack to have occurred in the vial," the FDA said in its statement. "If the vial was cracked, the integrity of the vial and the sterility of any product remaining in the vial could not be assured."
Merck's facilities in West Point handle some of the company's research and development of medicine, along with some manufacturing.
(Reuters Health) - Vaccination against hepatitis B seems to protect against the virus for 25 years, suggesting booster shots are unnecessary, according to a new study from Taiwan.
"Universal vaccination in infancy provides long-term protection," Dr. Yen-Hsuan Ni, the study's lead author from the National Taiwan University in Taipei, wrote in an e-mail.
Taiwan mandated hepatitis B virus (HBV) immunization for all infants in 1984, in response to extremely high rates of infection. Hepatitis B infection is a prime cause of liver cancer, the second most common cancer type in Taiwan.
In 2009, study participants younger than age 25 were far less likely to be infected than those between the ages of 26 and 30 -- who were born before universal vaccination, the researchers found.
"It's efficacy in young adults is clear," Ni told Reuters Health, explaining that medical experts had questions about how long the vaccine's protective effect would last. Booster shots, which are generally not recommended for hepatitis B, were not given to subjects in the study.
The findings reinforce five previous surveys -- done at five-yearly intervals since 1984 -- which also found lower infections among those born after the mandate.
Under the Taiwanese program, infants born to infected mothers also get a shot of a protein to fight against the virus known as an antibody within 24 hours of birth, but this did not completely eliminate the spread of the virus from mother to child, the study noted.
"Mother-to-infant transmission remains the key route of vaccine failure that needs to be overcome," Ni said.
The study, published in the Journal of Hepatology, suggests that other countries may benefit from including compulsory hepatitis B vaccination for infants.
Hepatitis B is a viral infection that attacks the liver. The virus is spread by contact with the blood or other bodily fluids of an infected person.
An estimated 350 million people worldwide have the hepatitis B virus. Almost 100,000 new people are infected each year in the United States, according to the non-profit Hepatitis B Foundation.
The World Health Organization recommends hepatitis B shots for all babies. The three-part vaccine series usually costs $75 to $165, and is available often free of charge from health clinics. Common side effects include soreness, swelling and redness where the shot is injected.
BOOSTER SHOTS UNNECESSARY
For the new study, funded by the National Taiwan University Hospital, Ni and his colleagues enrolled more than 3,300 participants under 30. Of these subjects, more than 2,900 -- born after the mandate -- received at least three doses of vaccine in their first year. Approximately 370 subjects, born before 1984, were not universally vaccinated.
When they collected blood samples from January to December 2009, Ni's team found that less than one percent of the universally vaccinated group carried the virus and were infectious to others, compared with 10 percent of those who weren't universally vaccinated.
Among subjects over age 20, the infection rate did not increase significantly from 1989 to 2009, making universal booster doses unnecessary, the study noted.
Fifty-six percent of those born after universal vaccination developed immunity to the disease, versus 24 percent in the group born before it began. Seven percent of the group that was universally vaccinated had an infection in their history but possibly had recovered, compared with 28 percent of the group that was not.
Most cases of vaccine failure were related to the mother's status, the study found. Of the 25 subjects who developed an infection despite getting immunized, 86 percent had mothers who carried the virus.
Globally, gaps in treatment -- including spread of the virus from mother to baby -- need to be plugged to eliminate hepatitis B, said Dr. Solomon Chen, a visiting fellow in global health at the Harvard School of Public Health.
"The issue of vaccine failure due to intrauterine transmission should be overcome," Chen, who was not involved in this study but studied under its authors in Taiwan, told Reuters Health.
SOURCE: bit.ly/NU4fKa Journal of Hepatology, online June 4, 2012.
