Vaccination Against Hepatitis A for Hemophilic Patients: Is It Necessary?

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Abstract

Background

Hemophilic patients require long-life intravenous infusion of factor concentrates to treat bleedings. This could increase the risk of transmission of blood-borne infections like hepatitis C.

Objectives

The current study was aimed at investigating the immunity status against hepatitis A in hemophilic patients in south Khorasan and evaluating the necessity of hepatitis A vaccination for this population.

Patients and Methods

A cross-sectional descriptive study was conducted between 2014 and 2015 on all hemophilic patients of south Khorasan province, Iran (n = 108) for anti-HAV total, anti- HCV, HBs-Ag, anti-HIV, and anti-HTLV-I /II. Note that no one had already received a hepatitis A vaccine.

Results

As our results show, 77.8% of the participants (59% under 20 and 88.4% above 20 years old) were seropositive for anti-HAV total; 20.4% and 2.8% (three patients) of the cases were anti-HCV positive and anti-HTLV-1 positive, respectively, while none of the subjects were HBS-Ag or HIV-Ab positive. Seventeen of the patients (15.75%) showed a co-infection of HAV with HCV, and five HCV-infected patients (22.73%) had no immunity against hepatitis A. There was a significant relationship between age, rural life, and anti-HAV positive state in our patients (P < 0.001). No significant relationship between positive anti-HAV status and sex (P = 0.16), severity of hemophilia (P = 0.23), and infection with HIV, HCV, HTLV-1, and hepatitis B (P > 0.05) was detected.

Conclusions

More than 40% of the hemophilic patients under 20 years of age in the present study had no immunity against hepatitis A, and 23% of hepatitis C patients had not had a hepatitis A co-infection yet. Since hepatitis A can show a fulminant course in hepatitis C patients, vaccination against hepatitis A seems necessary in hemophilic patients in the region.

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Most cited references 37

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Hepatitis A: old and new.

Bonnie J. Cuthbert (2000)

The hepatitis A virus (HAV), a picornavirus, is a common cause of hepatitis worldwide. Spread of infection is generally person to person or by oral intake after fecal contamination of skin or mucous membranes; less commonly, there is fecal contamination of food or water. Hepatitis A is endemic in developing countries, and most residents are exposed in childhood. In contrast, the adult population in developed countries demonstrates falling rates of exposure with improvements in hygiene and sanitation. The export of food that cannot be sterilized, from countries of high endemicity to areas with low rates of infection, is a potentially important source of infection. After ingestion and uptake from the gastrointestinal tract, the virus replicates in the liver and is excreted into the bile. Cellular immune responses to the virus lead to destruction of infected hepatocytes with consequent development of symptoms and signs of disease. Humoral immune responses are the basis for diagnostic serologic assays. Acute HAV infection is clinically indistinguishable from other causes of acute viral hepatitis. In young children the disease is often asymptomatic, whereas in older children and adults there may be a range of clinical manifestations from mild, anicteric infection to fulminant hepatic failure. Clinical variants include prolonged, relapsing, and cholestatic forms. Management of the acute illness is supportive, and complete recovery without sequelae is the usual outcome. Research efforts during World War II led to the development of passive immunoprophylaxis. Pooled immune serum globulin is efficacious in the prevention and attenuation of disease in exposed individuals. More recently, active immunoprophylaxis by vaccination has been accomplished. Future eradication of this disease can now be contemplated.

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Hepatitis A shifting epidemiology in Latin America.

Jorge Tanaka (2000)

In the past, Latin America was considered to be an area of high endemicity for hepatitis A virus (HAV) infection, with most people infected in early childhood. A seroepidemiological study was recently undertaken in six countries to determine whether this pattern has changed. The highest seroprevalence of antibodies to HAV (anti-HAV) was found in Mexico and the Dominican Republic. Analysis of the different age groups showed that at age 6-10 years, 30% of children in Chile and 54-55% in Brazil, Venezuela and Argentina had been infected, compared with almost 70% in Mexico and 80% in the Dominican Republic. At age 11-15 years, nearly 90% in Mexico and 91% in the Dominican Republic had been infected, compared with 54% in Argentina, 62% in Venezuela, 60% in Brazil and 70% in Chile. By age 31-40 years, over 80% of the populations in all six countries had been exposed to HAV. In all of the countries except Brazil and Venezuela, the seroprevalence of anti-HAV was significantly higher in females than in males. In Mexico, Argentina and Brazil, anti-HAV seroprevalence was significantly higher in the low socioeconomic groups than in the middle/high socioeconomic groups. The results show that there has been a shift from high to medium endemicity of HAV infection throughout Latin America, which may result in more clinical cases in adolescents and adults and a greater potential for outbreaks. The vaccination strategy for hepatitis A should thus be reviewed.

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Is Open Access

Distribution of Hepatitis C Virus Genotypes in Iranian Chronic Infected Patients

Fatemeh Jahanbakhsh Sefidi, Hossein Keyvani, Seyed Hamidreza Monavari … (2013)

Background Hepatitis C virus (HCV) has different genotypes throughout the world. Since the determination of which antiviral treatment to be applied is related to HCV genotypes, identification of an individual’s HCV genotypes prior to antiviral therapy is critical. Objectives The purpose of this study was to investigate the distribution of HCV genotypes in a large population of Iranian HCV infected patients. Patients and Methods Eleven thousand, five hundred and sixty one patients with chronic HCV infection which referred to hospitals related to the Tehran University of Medical Sciences and Tehran Hepatitis Center-Clinical Department of Baqiyatallah Research Center for Gastroeneterology and Liver Disease from March 2003 to December 2011 were enrolled. Following extraction of viral RNA of the serum, HCV-RNA was detected using reverse transcriptase-nested polymerase chain reaction (RT-nested PCR) and then HCV genotypes analyzed by restriction fragment length polymorphism (RFLP) assay. Results The mean age of patients was 37.6 ± 14.2 years (range: 1-87). The highest frequency was noted for subtype 1a (44.9%) followed by subtype 3a (39.6%), and 1b (11.3%). Mixed HCV genotypes were also found in 2.5% of the total cases. Subtype 1a was the most frequent genotype in patients over 40 years of age (46.1% versus 42.4%) and subtype 3a was the most frequent in patients under 40 years old (41.5% versus 38.9%). Conclusions This study suggested that the dominant HCV subtype among Iranian patients was 1a followed by subtype 3a.

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Author and article information

Journal

Journal ID (nlm-ta): Hepat Mon

Journal ID (iso-abbrev): Hepat Mon

Journal ID (doi): 10.5812/hepatmon

Journal ID (publisher-id): Kowsar

Title: Hepatitis Monthly

Publisher: Kowsar

ISSN (Print): 1735-143X

ISSN (Electronic): 1735-3408

Publication date (Electronic): 05 April 2016

Publication date Collection: April 2016

Volume: 16

Issue: 4

Electronic Location Identifier: e37447

Affiliations

[1 ]Infectious Disease Research Center, AJA University of Medical Sciences, Tehran, IR Iran

[2 ]Hepatitis Research Center, Birjand University of Medical Sciences, Birjand, IR Iran

[3 ]Asthma, Allergy and Immunology Research Center, Birjand University of Medical Sciences, Birjand, IR Iran

[4 ]Diabetes Research center, Department of Internal Medicine, Birjand University of Medical Sciences, Birjand, IR Iran

Author notes

[* ]Corresponding Author: Masood Ziaee, Hepatitis Research Center, Birjand University of Medical Sciences, Birjand, IR Iran. Tel: +98-5632443243; +98-9151613942, E-mail: dr.m.ziaee@ 123456Gmail.com

Article

DOI: 10.5812/hepatmon.37447

PMC ID: 4888500

PubMed ID: 27257430

SO-VID: 338055dd-9f1e-4b04-8d52-88a2f1b012ab

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Vaccination Against Hepatitis A for Hemophilic Patients: Is It Necessary?

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Abstract

Background

Objectives

Patients and Methods

Results

Conclusions

Related collections

Point-Of-Care Testing for Hepatitis

Most cited references 37

Hepatitis A: old and new.

Hepatitis A shifting epidemiology in Latin America.

Distribution of Hepatitis C Virus Genotypes in Iranian Chronic Infected Patients

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