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Carriers of hepatitis C: should they all be vaccinated for hepatitis A?
Portadores de hepatitis C: ¿Tenemos que vacunarlos a todos frente a la hepatitis A?
M. Sansa, S. Escorzaa, D. Villagrasaa, E. Comína, A. Ezpeletaa, C. Batallaa
a Specialists in Family and Community Medicine, Dr. Pujol i Capsada Basic Heath Area, El Prat de Llobregat, Costa de Ponent Family and Community Medicine Teaching Unit, Barcelona, Spain.
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    "textoCompleto" => "<p class="elsevierStylePara">Introduction</p><hr></hr><p class="elsevierStylePara">Recent years have seen a change in the epidemiological pattern of hepatitis A &#40;HA&#41;&#46; Epidemiological studies in Spain based on serological analyses carried out between 1977 and 1996 have shown a significant decrease in the prevalence of anti-HA antibodies in younger age groups&#46;</p><p class="elsevierStylePara">In persons aged 11-14 years&#44; the prevalence declined from 49&#37; in 1977 to 30&#37; in 1985&#44; and to 4&#46;6&#37; in 1996&#46; In persons aged 21-30 years the prevalence declined from 73&#37; in 1977 to 58&#46;5&#37; in 1985&#46; In 1996 the figure was 29&#46;1&#37; for persons 20-24 years old&#44; and 42&#37; for those aged 25-30 years&#46; These data reflect a reduction in the incidence of HA in younger persons&#44; and an increase in the number of persons susceptible to infection in older age groups&#44; in which the disease is known to course with more&#44; and more severe&#44; symptoms&#46;<span class="elsevierStyleSup">1-9</span></p><p class="elsevierStylePara">This change in the epidemiological pattern is also of relevance because of its implications for patients with chronic liver disease&#44; mainly that caused by hepatitis C virus &#40;HCV&#41;&#44; as in these patients&#44; superinfection or coinfection with hepatitis A virus &#40;HAV&#41; implies an increased risk of fulminant hepatitis or death&#46;<span class="elsevierStyleSup">10-13</span> In these groups of patients vaccination against HAV is recommended as a preventive measure&#44; and has been shown to be effective in preventing infection&#46;<span class="elsevierStyleSup">14-18</span></p><p class="elsevierStylePara">The aim of this study was to investigate the prevalence of immunization against HAV in persons with HCV infection&#44; in order to identify susceptible individuals who could potentially benefit from HAV vaccination&#46;</p><hr></hr><p class="elsevierStylePara">Material and methods </p><hr></hr><p class="elsevierStylePara"><img src="27v30n02-13034237tab01.gif"></img></p><p class="elsevierStylePara">The study was done at the Dr&#46; Pujol y Capsada Health Center&#44; an urban center located in El Prat de Llobregat &#40;Barcelona province&#44; Spain&#41; serving a population of 12 000&#46; The socioeconomic level of most inhabitants is low&#44; and approximately 20&#37; of the inhabitants are members of the Gypsy ethnic group&#46;</p><p class="elsevierStylePara">This descriptive&#44; cross-sectional study was done between May 1999 and March 2000 and involved the population of individuals older than 14 years who were seen at this health center&#46; Patients were initially identified from a computerized register of cases of chronic liver disease&#44; persons with human immunodeficiency virus &#40;HIV&#41; infection or intravenous drug users &#40;IVDU&#41;&#44; and from the register of serological laboratory tests ordered during the previous 2 years to detect persons positive for HCV infection&#46; The medical records of these patients were reviewed&#44; and HAV serological testing was requested for those patients who had not undergone such testing&#46; These patients were contacted in the course of a visit to the health center&#44; by telephone or in writing&#46;</p><p class="elsevierStylePara">The variables analyzed in this study were age&#44; sex&#44; presence of chronic liver disease&#44; laboratory results for hepatitis B &#40;HBcAb&#41;&#44; hepatitis A &#40;IgG&#44; classified as positive or negative on the basis of the laboratory reference value&#41;&#44; antecedents of vaccination for HB&#44; intravenous drug use&#44; and the results of serological testing for HIV &#40;if such testing had been done&#41;&#46;</p><p class="elsevierStylePara">The prevalence of immunization against HAV was analyzed in patients with HCV infection diagnosed at any time during their life&#46;</p><p class="elsevierStylePara">The SPSS-PC software was used to generate descriptive statistics for the variables&#44; with <span class="elsevierStyleItalic">P</span>&#60;&#46;05 used to indicate statistical significance&#46; 95&#37; confidence intervals were calculated for the main findings&#46; Chi-squared and Student&#180;s <span class="elsevierStyleItalic">t</span> tests were used for the bivariate analysis&#46;</p><hr></hr><p class="elsevierStylePara">Results  </p><hr></hr><p class="elsevierStylePara">Of the patients we studied&#44; 134 were HCV-positive&#46; Men made up 70&#46;9&#37; of this group &#40;95&#37; CI&#44; 63&#46;2&#37;-78&#46;6&#37;&#41;&#44; and 29&#46;1&#37; were women &#40;95&#37; CI&#44; 21&#46;4&#37;-36&#46;8&#37;&#41;&#46; Mean age was 41&#46;75 years &#40;SD&#44; 16&#46;55 years&#41;&#46; Chronic liver disease was present in 93&#46;3&#37; &#40;95&#37; CI&#44; 89&#37;-97&#46;5&#37;&#41;&#44; IVDU was recorded in 56&#46;7&#37; &#40;95&#37; CI&#44; 48&#46;3&#37;-65&#46;1&#37;&#41;&#44; HBcAb positivity was found in 56&#37; &#40;95&#37; CI&#44; 47&#46;6&#37;-64&#46;4&#37;&#41;&#44; and HIV positivity was found in 32&#46;8&#37; &#40;95&#37; CI&#44; 24&#46;9&#37;-40&#46;8&#37;&#41; &#40;Table 1&#41;&#46;</p><p class="elsevierStylePara">Immunity to HA was tested in 75 patients &#40;56&#37;&#41;&#46; The response to the request for testing was better in women&#44; HIV-negative persons&#44; persons with no history of IVDU&#44; and persons with chronic liver disease &#40;Table 1&#41;&#46;</p><p class="elsevierStylePara"><img src="27v30n02-13034237tab02.gif"></img></p><p class="elsevierStylePara">Of the 59 patients &#40;44&#37;&#41; in whom HA immunity could not be tested&#44; 84&#46;7&#37; &#40;95&#37; CI&#44; 75&#46;6&#37;-93&#46;9&#37;&#41; did not respond to attempts to contact them by phone or in writing&#44; 13&#46;6&#37; &#40;95&#37; CI&#44; 4&#46;8&#37;-22&#46;3&#37;&#41; were temporarily absent from their home &#40;in prison or in a detoxification center&#44; or away on holiday&#41;&#44; and 1 patient &#40;1&#46;7&#37;&#59; 95&#37; CI&#44; 0&#37;-5&#37;&#41; declined to be tested&#46;</p><p class="elsevierStylePara">Mean age of the patients who were tested for HA immunity was 48&#46;4 years &#40;SD&#44; 18 years&#41;&#59; mean age in the group who did not undergo serological testing was 33&#46;3 years &#40;SD&#44; 9&#46;3 years&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;0001&#41;&#46; Of patients with a current or previous history of IVDU&#44; or who were positive for HIV&#44; 37&#46;8&#37; agreed to be tested&#44; vs&#46; 84&#46;6&#37; of the patients with neither of these antecedents &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;0001&#41;&#46; There were no significant differences in the prevalence of HAV infection between these groups &#40;83&#46;9&#37; in the former group vs&#46; 88&#46;6&#37; in all other patients&#41;&#46;</p><p class="elsevierStylePara">Serological tests for HA were positive in 86&#46;7&#37; &#40;95&#37; CI&#44; 79&#46;0&#37;-94&#46;4&#37;&#41; and negative in 13&#46;3&#37; &#40;95&#37; CI&#44; 6&#46;0&#37;-21&#46;0&#37;&#41;&#46; Mean age in the former group was 50&#46;17 years &#40;SD&#44; 17&#46;8 years&#41;&#44; and mean age in the latter was 36&#46;6 years &#40;SD&#44; 15&#46;0 years&#59; <span class="elsevierStyleItalic"> P</span>&#61;&#46;02&#41;&#46; The prevalence of seropositivity among patients younger than 40 years was 75&#46;7&#37; &#40;95&#37; CI&#44; 61&#46;9&#37;-89&#46;5&#37;&#41;&#44; vs&#46; 97&#46;5&#37; &#40;95&#37; CI&#44; 92&#46;3&#37;-100&#37;&#41; in older patients &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;006&#41;&#46; Table 2 summarizes the characteristics in patients who were positive and negative for HAV&#59; no statistically significant differences were found&#46;</p><p class="elsevierStylePara"><img src="27v30n02-13034237tab03.gif"></img></p><hr></hr><p class="elsevierStylePara">Discussion  </p><hr></hr><p class="elsevierStylePara">La prevalencia de inmunizaci&#243;n frente al VHA en pacientes infectados por el VHC es de un 86&#44;5&#37; en la muestra The prevalence of immunization against HAV in patients with HCV infection was 86&#46;5&#37; in the sample of persons we studied&#46; This figure is similar to that reported in 1998 by Diago et al for a Valencian population&#46; These authors studied patients hospitalized with chronic liver disease caused by HBV and HCV&#44; who were similar in age to the population we studied&#46; The prevalence of HAV infection in their study ranged from 75&#37; to 90&#37;<span class="elsevierStyleSup">1</span>&#46;</p><p class="elsevierStylePara">Our sample did not differ in terms of sex&#44; age or seroprevalence of HB in comparison to other studies<span class="elsevierStyleSup">1&#44;10</span>&#44; although the percentage of patients with a history of IVDU was higher in our sample than in the study by Diago et al&#46;<span class="elsevierStyleSup">1</span> Coinfection with HIV could not be compared with earlier studies&#44; as we found none that had investigated this factor&#46;</p><p class="elsevierStylePara">In the present study&#44; most of the patients who declined HAV testing were HIV carriers or had a history of IVDU &#40;62&#46;2&#37; of these patients refused testing&#41;&#44; as compared to a refusal rate of 15&#46;4&#37; among all remaining patients&#46; This response may reflect problems in locating the patients&#44; and the tendency of these patients to reject preventive health interventions&#46;</p><p class="elsevierStylePara">The population we studied contained a high percentage of persons who were positive for HIV infection or who had a current or prior history of IVDU&#44; and the prevalence of HAV infection might be expected to be higher in this group&#46; However&#44; we found no difference in the rate of HAV infection between the patients with these two antecedents and those without them&#46;</p><p class="elsevierStylePara">Vaccination against HA is indicated for patients with chronic liver disease&#44; and vaccination should be given systematically if the patient is seronegative&#46;<span class="elsevierStyleSup">14-19</span></p><p class="elsevierStylePara">In the present study we found a higher proportion of HAV seronegative patients among those younger than 40 years&#44; in whom seroprevalence was similar to that reported for patients aged 30-39 years in the general population &#40;77&#46;3&#37;&#59; 95&#37; CI&#44; 72&#46;9&#37;-81&#46;8&#37;&#41;&#46;<span class="elsevierStyleSup">4&#44;5</span> These figures mean that vaccination against HA should be recommended for all HCV-positive patients younger than 40 years&#44; and for patients of any age with chronic liver disease who are seronegative&#46;</p><p class="elsevierStylePara">Cost-benefit studies will be needed to determine whether serological testing should be done before vaccination in different age groups&#46;</p><p class="elsevierStylePara"><img src="27v30n02-13034237tab04.gif"></img></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Correspondence&#58; Alicia Ezpeleta&#46; ABS Dr&#46; Pujol i Capsada&#46; C&#47; Riu Anoia&#44; 19&#46; 08820 El Prat de Llobregat &#40;Barcelona&#41;&#46; Espa&#241;a&#46; E-mail&#58; pcapsada&#64;baixll&#46;scs&#46;es</p>"
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            0 => "Hepatitis C"
            1 => "Hepatitis A"
            2 => "Vaccination"
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        "resumen" => "Aim&#46; To investigate the prevalence of immunization against hepatitis A virus &#40;HAV&#41; in persons with hepatitis C virus &#40;HCV&#41; infection&#44; in order to determine who should be vaccinated for the former&#46; Design&#46; Descriptive&#44; cross-sectional study&#46; Setting&#46; Urban health center serving 12 000 inhabitants&#46; Participants&#46; Patients older than 14 years positive for HCV infection&#46; Main measures&#46; Variables&#58; presence of chronic liver disease&#44; serological indications of hepatitis B&#44; A&#44; and immune deficiency virus &#40;HIV&#41; infection&#44; vaccination for hepatitis B&#46; Results&#46; A total of 134 persons &#40;70&#46;9&#37; men and 29&#46;1&#37; women&#41; comprised the sample of patients positive for HCV infection&#46; Mean age was 41&#46;75 years &#40;SD&#44; 16&#46;55 years&#41;&#46; Nearly all patients &#40;93&#46;3&#37;&#41; had chronic liver disease&#44; 56&#46;7&#37; were intravenous drug users&#44; 56&#37; were positive for Hbc antibodies and 32&#46;8&#37; were positive for HIV&#46; Serological testing for HAV was done in 75 patients &#40;56&#37;&#41;&#59; the result was positive in 86&#46;7&#37;&#46; Mean age in this subgroup was 50&#46;4 years &#40;SD&#44; 17&#46;8 years&#41;&#46; In the HAV-negative subgroup&#44; mean age was 36&#46;6 years &#40;SD&#44; 15 years&#59; P&#61;&#46;02&#41;&#46; Serological testing for HAV could not be done in 44&#37; of the patients&#58; 33&#46;6&#37; did not respond to attempts to contact them by telephone or in writing&#44; 6&#37; were temporarily away from home&#44; and 1 patient declined to be tested&#46; The response to requests to obtain blood samples was better in women &#40;66&#46;7&#37;&#41;&#44; HIV-negative patients &#40;34&#46;7&#37;&#41;&#44; persons who were not intravenous drug users &#40;43&#46;3&#37;&#41; and persons with chronic liver disease &#40;60&#37;&#41;&#46; Conclusions&#46; In persons younger than 40 years&#44; the proportion of seronegative individuals is similar to that in the general population&#46; Vaccination should be considered for all patients positive for HCV infection&#46; In persons older than 40 years with chronic liver disease&#44; the decision to vaccinate for HAV should be made in the light of serological findings&#46;"
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        "resumen" => "Objetivo&#46; Estudiar la prevalencia de inmunizaci&#243;n frente al virus de la hepatitis A &#40;VHA&#41; en personas infectadas por el virus de la hepatitis C &#40;VHC&#41;&#44; con el fin de indicar la vacunaci&#243;n&#46; Dise&#241;o&#46; Estudio descriptivo transversal&#46; Emplazamiento&#46; Centro urbano &#40;12&#46;000 habitantes&#41;&#46; Participantes&#46; Pacientes positivos para el VHC mayores de 14 a&#241;os&#46; Mediciones principales&#46; Variables&#58; presencia de hepatopat&#237;a cr&#243;nica&#44; serolog&#237;as de hepatitis B y A e inmunodeficiencia humana &#40;VIH&#41;&#44; vacunaci&#243;n de hepatitis B&#46; Resultados&#46; La muestra de pacientes positivos para el VHC se compon&#237;a de 134 personas&#44; el 70&#44;9&#37; varones y el 29&#44;1&#37; mujeres&#46; Edad media&#58; 41&#44;75 &#40;DE&#44; 16&#44;55&#41; a&#241;os&#46; El 93&#44;3&#37; presentaba hepatopat&#237;a cr&#243;nica&#44; el 56&#44;7&#37; era usuario de drogas por v&#237;a parenteral &#40;UDVP&#41;&#44; el 56&#37; era HBcAc positivo y el 32&#44;8&#37; VIH positivo&#46; La serolog&#237;a del VHA se realiz&#243; a 75 pacientes &#40;56&#37;&#41;&#44; y fue positiva en el 86&#44;7&#37;&#46; La edad media en los pacientes VHA&#43; era de 50&#44;4 &#40;DE&#44; 17&#44;8&#41; a&#241;os&#44; y en VHA- de 36&#44;6 &#40;DE&#44; 15&#41; a&#241;os &#40;p &#61; 0&#44;02&#41;&#46; Al 44&#37; de los pacientes no se pudo determinar la serolog&#237;a VHA&#58; un 33&#44;6&#37; no respondi&#243; a los mensajes telef&#243;nicos ni a las cartas enviadas&#44; un 6&#37; estaba ausente temporalmente y un caso no acept&#243; hacerse la anal&#237;tica&#46; La respuesta a la realizaci&#243;n de la prueba fue mejor en las mujeres &#40;66&#44;7&#37;&#41;&#44; en pacientes VIH-&#40;34&#44;7&#37;&#41;&#44; en no UDVP &#40;43&#44;3&#37;&#41; y en hepat&#243;patas cr&#243;nicos &#40;60&#37;&#41;&#46; Conclusiones&#46; En menores de 40 a&#241;os&#44; la proporci&#243;n de seronegativos es similar a la de la poblaci&#243;n general y se deber&#237;a considerar la vacunaci&#243;n en todos los pacientes VHC&#43;&#46;"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos