NEW YORK (Reuters Health) Aug 30 - Although guidelines recommend hepatitis A vaccination for all patients with chronic hepatitis C virus (HCV) infection, new research indicates that in practice this seldom occurs. "Public health efforts aimed at raising awareness about HAV vaccination in patients with chronic liver disease should be strongly encouraged," the researchers emphasize.

Superinfection with hepatitis A virus (HAV) greatly increases the risk of liver failure and death in patients with underlying chronic liver disease, according to the report in the September issue of Hepatology. As such, HAV vaccination has been recommended for patients with such disease, including disease arising from HCV infection.

To investigate adherence with HAV vaccination guidelines, Dr. Edmund J. Bini and colleagues, from VA New York Harbor Healthcare System, analyzed data from 1193 patients who were diagnosed with chronic HCV infection over a 1-year period. Nearly 1700 person-years of follow-up were included in the analysis.

The subjects visited their primary care provider a median of 10 times, the report indicates. HAV antibody testing was performed in 640 subjects (53.6%) and 317 of them (49.5%) tested negative and were considered susceptible to the pathogen.

Only 94 patients were given the HAV vaccine, including 85 who were susceptible to HAV, 3 who were immune, and 6 who were not tested for HAV antibodies. Moreover, 45 of the vaccinated patients received just one dose.

During follow-up, three unvaccinated patients developed acute HAV infection and one of the cases proved to be fatal, the report shows.

"Further studies to evaluate patient and provider barriers to HAV vaccination are needed to prevent future missed opportunities for vaccination," Dr. Bini and colleagues conclude.

Hepatology 2005;42:688-695.

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