慢性丙型肝炎病毒感染者对甲型肝炎的易感性:错过疫苗接种时机

作     者：Shim M. Khaykis I. Park J. Bini E.J. 张欣 

作者机构：Division of Gastroenterology VA New York Harbor Healthcare System 423 East 23rd Street New York NY 10010 United States Dr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第2期

页      面：51-51页

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 100401[医学-流行病与卫生统计学] 10[医学] 

主　　题：疫苗接种 重叠感染 甲肝疫苗 慢性肝病患者 免疫接种 急性肝功能衰竭 慢性肝脏疾病 抗体检测 临床实 

摘      要：Hepatitis A virus (HAV) superinfection is associated with a high risk of liver failure and death in patients with underlying chronic liver disease. Although HAV vaccination is recommended for all patients with chronic hepatitis C virus (HCV) infection, little is known about adherence to these recommendations in clinical practice. The aims of this study were to determine the frequency of HAV testing and vaccination among patients with chronic HCV infection. We conducted a retrospective cohort study of 1,193 patients diagnosed with chronic HCV infection over a 1-year period. During 1,646 person-years of follow-up, patients were seen by their primary care provider a median of 10.0 times (interquartile range, 4.0- 20.0). HAV antibody testing was performed in 640 subjects (53.6% ), and 317 (49.5% ) of those tested were susceptible (HAV antibody negative). Only 94 of the 1,193 patients (7.9% ) received the HAV vaccine, including 26.8% of the 317 susceptible patients, 0.9% of the 323 patients who were already immune to HAV, and 1.1% of the 553 subjects who were never tested. Among the 94 vaccinated patients, 45 received only one dose of the vaccine. Three of the unvaccinated patients developed acute HAV infection during follow-up, and 1 of them died of acute liver failure. In conclusion, despite published recommendations to vaccinate against HAV in patients with chronic HCV infection, we found that HAV testing and vaccination rates were low in clinical practice. Public health programs to increase awareness about HAV vaccination in patients with chronic liver disease are needed.