Vaccination Strategies for Protecting Patients with Chronic Liver Disease: Focus on Hepatitis A, B, Pneumococcal, and Influenza
DOI:
https://doi.org/10.36283/ziun-pjmd15-2/016Keywords:
Chronic Liver Disease, Vaccination, Hepatitis A, Hepatitis B, Pneumococcal, InfluenzaAbstract
Background: Even in countries with far superior health resources, the immunization rate for vulnerable populations, such as those with chronic liver disease, is still below ideal despite the strong recommendations. Although the issue is worse in nations with fewer resources than ours, there is still a dearth of information regarding the immunization rate in our community. The study was designed as a result which aimed to determine the frequency of hepatitis A, B, pneumococcal and influenza vaccination among chronic liver disease patients.
Materials and methods: This cross sectional study was conducted at the department of Medicine, Khyber Teaching Hospital, Peshawar during the period 01-08-2024 to 31-01-2025. A total of 246 male and female patients aging 20 to 60 years diagnosed with chronic liver disease were enrolled and evaluated for hepatitis A and B, pneumococcal and influenza vaccination. Vaccination status was confirmed through history taking and medical record assessment.
Results: Mean age of the participants was 42.06±10.09 years, mean BMI was 24.008±2.64 kg/m2 and mean illness duration was 33.59±5.301 months. Participants aging more than 40 years were 139 (56.5%), and 157 patients (63.8%) were male. HCV and HBV constituted the most prevalent etiology of CLD recorded in 90 (36.6%), 98 (39.8%) participants. Hepatitis B vaccination was most prevalent recorded in 84 patients (34.1%) followed by hepatitis A (n = 77, 31.3%) and pneumococcal in 55 (22.4%). Influenza was least common recorded in 54 patients (22.0%).
Conclusion: Comprehensive vaccination against preventable disease in chronic liver disease patients is lacking. Vaccination against hepatitis B virus was most common followed by hepatitis A.
References
REFERENCES
1. Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020;18:2650–66.
2. Younossi ZM, Stepanova M, Younossi Y, Golabi P, Mishra A, Rafiq N, et al. Epidemiology of chronic liver diseases in the USA in the past three decades. Gut. 2020;69(3):564-8.
3. Setiawan VW, Stram DO, Porcel J, Lu SC, Le Marchand L, Noureddin M. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: the multiethnic cohort. Hepatology. 2016;64:1969–77.
4. Irvine KM, Ratnasekera I, Powell EE, Hume DA. Causes and consequences of innate immune dysfunction in cirrhosis. Front Immunol. 2019;10:818-23.
5. Rhee Y, Sha BE, Santos CAQ. Optimizing vaccination in adult patients with liver disease and liver transplantation. Clin Liver Dis (Hoboken). 2020;15:63–8.
6. Schütte A, Ciesek S, Wedemeyer H, Lange CM. Influenza virus infection as precipitating event of acute-on-chronic liver failure. J Hepatol. 2019;70:797–9.
7. Alukal JJ, Naqvi HA, Thuluvath PJ. Vaccination in Chronic Liver Disease: An Update. J Clin Exp Hepatol. 2022;12(3):937-47.
8. Reiss G, Keeffe EB. Hepatitis vaccination in patients with chronic liver disease. Alimentary pharmacology & therapeutics. 2004 Apr;19(7):715-27.
9. Alter MJ. Vaccinating patients with chronic liver disease. Gastroenterology & Hepatology. 2012 Feb;8(2):120.
10. Younossi ZM, Stepanova M. Changes in hepatitis A and B vaccination rates in adult patients with chronic liver diseases and diabetes in the US population. Hepatology. 2011 Oct;54(4):1167-78.
11. Janocha-Litwin J, Simon K. Recommended vaccinations for patients with chronic liver diseases. Clinical and Experimental Hepatology. 2025 Mar 31;11(1):1-8.
12. Leise MD, Talwalkar JA. Immunizations in chronic liver disease: what should be done and what is the evidence. Current gastroenterology reports. 2013 Jan;15:1-7.
13. Keeffe EB. Acute hepatitis A and B in patients with chronic liver disease: prevention through vaccination. The American journal of medicine. 2005 Oct 1;118(10):21-7.
14. Thudi K, Yadav D, Sweeney K, Behari J. Physicians infrequently adhere to hepatitis vaccination guidelines for chronic liver disease. PLoS One. 2013 Jul 26;8(7):e71124.
15. Yue X, Black CL, O'Halloran A, Lu PJ, Williams WW, Nelson NP. Hepatitis A and hepatitis B vaccination coverage among adults with chronic liver disease. Vaccine. 2018 Feb 21;36(9):1183-9.
16. Stroffolini T, Stroffolini G. Vaccination in Patients with Liver Cirrhosis: A Neglected Topic. Vaccines. 2024 Jun 27;12(7):715.
Published
Issue
Section
License
Copyright (c) 1970 Pakistan Journal of Medicine and Dentistry

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/