Skip to main content

Advertisement

SpringerLink
Log in

Immunization Needs of Chronic Liver Disease Patients Seen in Primary Care Versus Specialist Settings

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Chronic liver disease patients may benefit from certain vaccines, but their immunization coverage levels have not been widely studied. We examined the serologic and vaccination status of 693 chronic liver disease patients from 37 primary care and specialist centers. Patients in primary care had more often received influenza (47 versus 32%; P < .001) and pneumococcal (39 versus 19%; P < .001) vaccines. Among patients without documented prior exposure, those seeing specialists had more often completed hepatitis A (28 versus 5%; P < .001) and hepatitis B (29 versus 14%; P < .001) vaccination. Coverage was higher in centers with a policy of vaccinating on-site, among non-Hispanic whites, and among patients with hepatitis C and cirrhosis. In summary, most patients were unprotected against one or more vaccine preventable diseases. The higher coverage rates evident in centers vaccinating on-site suggests a breakdown may occur when patients are referred to alternative vaccination venues.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Centers for Disease Control: Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 48(RR12):1–37, 1999

    Google Scholar 

  2. National Institutes of Health: Consensus Development Conference Statement: Management of hepatitis C. Available at: http://www.liverfoundation.org/images/advocacy/1015/nih.final.rev.pdf. Accessed January 2004

  3. American College of Gastroenterology: Chronic liver disease: a primer for vaccination. Available at: http://www.acg.gi.org/physicianforum/publications/CLDPrimer/cld.pdf. Accessed January 2004

  4. Centers for Disease Control: Prevention of pneumococcal disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 46(RR 8):1–32, 1997

    Google Scholar 

  5. Vento S, Garofano T, Renzini C, Cainelli F, Casali F, Ghironzi G, Ferraro T, Concia E: Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med 338:286–290, 1998

    Article  PubMed  Google Scholar 

  6. Datta D, Williams I, Culver D, Bloom SC, Bell BP: Association between deaths due to hepatitis A and chronic liver disease, United States, 1981–1997. Antiviral Ther 5(Suppl 1):79–80, 2000 (abstract)

    Google Scholar 

  7. Benvegnu L, Fattovich G, Noventa F, Tremolada F, Chemello L, Cecchetto A, Alberti A: Concurrent hepatitis B and C virus infection and risk of hepatocellular carcinoma in cirrhosis. A prospective study. Cancer 74:2442–2448, 1994

    PubMed  Google Scholar 

  8. Kew MC, Yu MC, Kedda MA, Coppin A, Sarkin A, Hodkinson J: The relative roles of hepatitis B and C viruses in the etiology of hepatocellular carcinoma in Southern African blacks. Gastroenterology 112:184–187, 1997

    PubMed  Google Scholar 

  9. Alberti A, Pontisso P, Chemello L, Fattovich G, Benvegnu L, Belussi F, De Mitri MS: The interaction between hepatitis B virus and hepatitis C virus in acute and chronic liver disease. J Hepatol 22(Suppl 1):38–41, 1995

    PubMed  Google Scholar 

  10. Keeffe EB: Vaccination against hepatitis A and B in chronic liver disease. Viral Hepatitis Rev 5:77–88, 1999

    Google Scholar 

  11. Ramos RJM, Cuenca EM, Fernandez GML: Retrospective and comparative study of pneumococcal bacteremia in patients with chronic hepatopathy. An Med Intera 13:313–316, 1996

    Google Scholar 

  12. Centers for Disease Control: Prevention of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 49(RR-3):1–38, 2000

    Google Scholar 

  13. Arguedas, MR, McGuire BM, Fallon MB: Implementation of vaccination in patients with cirrhosis. Dig Dis Sci 47:384–387, 2002

    PubMed  Google Scholar 

  14. Rothstein KD: Hepatitis A vaccination in patients with chronic liver disease: to screen or not to screen? Am J Gastroenterol 97:1590–1593, 2002

    PubMed  Google Scholar 

  15. Sjögren MH: Preventing acute liver disease in patients with chronic liver disease. Hepatology 27:887–888, 1998

    PubMed  Google Scholar 

  16. Duncan M, Hirota WK, Tsuchida A: Prescreening versus empirical immunization for hepatitis A in patients with chronic liver disease: a prospective cost analysis. Am J Gastroenterol 97:1792–1795, 2002

    PubMed  Google Scholar 

  17. Siddiqui F, Mutchnick M, Kinzie J, Peleman R, Naylor P, Ehrinpreis M: Prevalence of hepatitis A virus and hepatitis B virus immunity in patients with polymerase chain reaction-confirmed hepatitis C: implications for vaccination strategy. Am J Gastroenterol 96:858–863, 2001

    PubMed  Google Scholar 

  18. Stokes ME, Davis CS, Koch GG. Categorical data analysis using the SAS system. Cary NC, SAS Institute, 1995, pp 172–175

  19. Pirovino M, Lydick E, Grob PJ, Arrenbrecht S, Altorfer J, Schmid M: Pneumococcal vaccination: the response of patients with alcoholic liver cirrhosis. Hepatology 4:946–949, 1984

    PubMed  Google Scholar 

  20. Keeffe EB, Iwarson S, McMahon BJ, Lindsay KL, Koff RS, Manns M, Baumgarten R, Wiese M, Fourneau M, Safary A, Clemens R, Krause DS: Safety and immunogenicity of hepatitis A vaccine in patients with chronic liver disease. Hepatology 27:881–886, 1998

    PubMed  Google Scholar 

  21. Arguedas MR, Johnson A, Eloubeidi MA, Fallon MB: Immunogenicity of hepatitis A vaccination in decompensated cirrhotic patients. Hepatology 34:28–31, 2001

    PubMed  Google Scholar 

  22. Keeffe EB, Krause DS: Hepatitis B vaccination of patients with chronic liver disease. Liver Transpl Surg 4:437–439, 1998

    Google Scholar 

  23. Lee SD, Chan CY, Yu MI, Lu RH, Chang FY, Lo KJ: Hepatitis B vaccination in patients with chronic hepatitis C. J Med Virol 59:463–468, 1999

    PubMed  Google Scholar 

  24. Rosman AS, Basu P, Galvin K, Lieber CS: Efficacy of a high and accelerated dose of hepatitis B vaccine in alcoholic patients: a randomized clinical trial. Am J Med 103:217–222, 1997

    PubMed  Google Scholar 

  25. Dumot JA, Barnes DS, Younossi Z, Gordon SM, Avery RK, Domen RE, Henderson JM, Carey WD: Immunogenicity of hepatitis A vaccine in decompensated liver disease. Am J Gastroenterol 94:1601–1604, 1999

    PubMed  Google Scholar 

  26. Van Thiel DH, el-Ashmawy L, Love K, Gavaler JS, Starzl TE: Response to hepatitis B vaccination by liver transplant candidates. Dig Dis Sci 37:1245–1249, 1992

    PubMed  Google Scholar 

  27. Patrick KM, Woolley FR: A cost-benefit analysis of immunization for pneumococcal pneumonia. JAMA 245:473–477, 1981

    PubMed  Google Scholar 

  28. Turner D, Wailoo A, Nicholson K, Cooper N, Sutton A, Abrams K: Systematic review and economic decision modelling for the prevention and treatment of influenza A and B. Health Technol Assess 7:1–170, 2003

    Google Scholar 

  29. Myers RP, Gregor JC, Marotta PJ: The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C. Hepatology 31:834–839, 2000

    PubMed  Google Scholar 

  30. Jacobs RJ, Koff RS, Meyerhoff AS: The cost effectiveness of vaccinating chronic hepatitis C patients against hepatitis A. Am J Gastroenterol 97:427–434, 2002

    PubMed  Google Scholar 

  31. Arguedas MR, Heudebert GR, Fallon MB, Stinnett AA: The cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C viral infection in the United States. Am J Gastroenterol 97:721–728, 2002

    PubMed  Google Scholar 

  32. Jacobs RJ, Koff RS: Cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C. Hepatology 32:873–874, 2000 (letter)

    Google Scholar 

  33. Margolis HS, Coleman PJ, Brown RE, Mast EE, Sheingold SH, Arevalo JA: Prevention of hepatitis B virus transmission by immunization. An economic analysis of current recommendations. JAMA 274:1201–1208, 1995

    PubMed  Google Scholar 

  34. Jacobs RJ, Saab S, Meyerhoff AS: The cost effectiveness of hepatitis immunization for US college students. J Am Coll Health 51:227–236, 2003

    PubMed  Google Scholar 

  35. Armstrong GL, Bell BP: Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization. Pediatrics 109:839–845, 2002

    PubMed  Google Scholar 

  36. Coleman PJ, McQuillan GM, Moyer LA, Lambert SB, Margolis HS: Incidence of hepatitis B virus infection in the United States, 1976–1994: estimates from the National Health and Nutrition Examination Surveys. J Infect Dis 178:954–959, 1998

    PubMed  Google Scholar 

  37. Blostein J, Clark PA: Cost-effectiveness of pre-immunization hepatitis B screening in high risk adults. Public Health Rep 116:165–168, 2001

    PubMed  Google Scholar 

  38. Jacobs RJ, Saab S, Meyerhoff AS, Koff RS: An economic assessment of pre-vaccination screening for hepatitis A and B. Public Health Rep 118:550–558, 2003

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From Capitol Outcomes Research, Inc., Alexandria, Virginia, USA

    R. Jake Jacobs MPA, Allen S Meyerhoff MS & Sammy Saab MD, MPH

  2. Capitol Outcomes Research, Inc., 6188 Old Franconia Road, Suite 204, Alexandria, Virginia, 22310, USA

    R. Jake Jacobs MPA

Authors
  1. R. Jake Jacobs MPA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allen S Meyerhoff MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sammy Saab MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Jake Jacobs MPA.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jacobs, R.J., Meyerhoff, A.S. & Saab, S. Immunization Needs of Chronic Liver Disease Patients Seen in Primary Care Versus Specialist Settings. Dig Dis Sci 50, 1525–1531 (2005). https://doi.org/10.1007/s10620-005-2873-5

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-005-2873-5

Key Words

Search

Navigation