1/22/2024 0 Comments Hepatitis b vaccine after effects![]() ![]() 11 One study that looked at 96 hospitalized patients with influenza found that underlying cirrhosis was associated with nearly four times higher risk of death. Rather it causes collateral damage in which a pulmonary infection triggers an immune response resulting in recruitment of CD8 +T cells to the liver resulting in clinically significant hepatitis. 10, 11, 12, 13 Based on available evidence, it appears that influenza, an extrahepatic respiratory virus, may not cause direct damage to the liver parenchyma. Patients with cirrhosis infected with the influenza virus are not only at increased risk of developing severe illness but also have higher mortality compared to those without liver disease. In this review, we discuss the current guidelines on vaccinations, seroconversion rates in the vaccinated, challenges faced by the healthcare professionals in immunizing those with liver disease, and the potential solutions to overcome these shortfalls. ![]() Despite these strong recommendations, the vaccination rate in this vulnerable population remains suboptimal. Ideally, inactivated vaccines are preferred over live attenuated ones, especially in immunocompromised (transplant recipients) where live vaccines are contraindicated. The CDC, Advisory committees on immunization practices (ACIP), and the AASLD recommend vaccination in CLD against hepatitis A virus (HAV), HBV, influenza, pneumococcus, and herpes zoster early in the disease course for optimal immune response. Moreover, coinfection with hepatitis B virus (HBV) in CLD also increases the risk of hepatocellular cancer (HCC). As a result, patients with CLD, especially those with cirrhosis, remain at risk of developing hepatic decompensation when infected with vaccine-preventable viral infections such as hepatitis A and B, pneumococcal disease, influenza, or coronavirus disease-19 (COVID-19). 5, 6 Defects in adaptive immunity may also perhaps explain hypo-responsiveness to vaccines in this patient population. 4Ĭirrhosis-related immune dysfunction characterized by alterations in innate (decreased complement activity, reduced chemotaxis, and phagocytosis) and adaptive immunity (decreased memory cells, CD4 helper cells, T cell exhaustion) leads to an inadequate immune response against a wide range of pathogens. The etiology of CLD varies considerably by race and ethnicity, with ALD being the predominant cause in Caucasians and HCV in African Americans, while NAFLD stemming from the obesity epidemic is the leading cause of cirrhosis in Hispanics, Native Americans, Hawaiians, and Japanese Americans. In the era of direct-acting antiviral drugs (DAA), the etiology of CLD has shifted from Hepatitis C virus (HCV) infection to one primarily driven by nonalcoholic fatty liver disease (NAFLD) and alcohol-related liver disease (ALD). 3 CLD was responsible for 44,358 deaths in the United States in 2019, with a crude death rate of 13.5 per 100,000. 1, 2 According to the CDC, nearly 4.5 million Americans were diagnosed with CLD and cirrhosis in 2018, corresponding to approximately 1.8% of the total adult population. The prevalence of CLD in the United States has consistently increased over the last three decades from 12% in the early 1990s to ∼15% in 2008. This review summarizes the impact of vaccine-preventable illness in those with CLD, updated vaccine guidelines, seroconversion rates in the vaccinated, and barriers faced by healthcare professionals in immunizing those with liver disease.Ĭhronic liver disease (CLD) and cirrhosis are important causes of morbidity and mortality in the western world. Inadequate access to healthcare, lack of information on vaccine safety, poor financial reimbursement for healthcare providers, and vaccine misinformation are often responsible for low immunization rates. Despite the strong recommendations, overall vaccination coverage in CLD remains poor however, it is encouraging to note that in recent years coverage against influenza and pneumococcus has shown some improvement. As the severity of the liver disease progresses, vaccine efficacy declines, and therefore, vaccines should be ideally administered early in the disease course for optimal immune response. Inactivated vaccines are preferred over live attenuated ones, especially in transplant recipients where live vaccines are contraindicated. The Advisory Committee on Immunization Practices (ACIP) currently recommends vaccination in CLD against hepatitis A virus (HAV), hepatitis B virus (HBV), influenza, pneumococcus, herpes zoster, tetanus, diphtheria, pertussis, and SARS-CoV-2. Patients with chronic liver disease (CLD) with or without cirrhosis remain at risk of developing hepatic decompensation when infected with viral or bacterial pathogens. ![]()
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