Vaccination for hepatitis A virus is not required for patients with chronic liver disease in India

Abstract

BACKGROUND: Hepatitis A virus (HAV) vaccination is recommended worldwide for patients with chronic liver disease to prevent decompensation due to superinfection with HAV. India being endemic for HAV, the prevalence of pre-existing antibodies against HAV due to subclinical exposure to the virus in childhood among patients with chronic liver disease may be high and, therefore, vaccination may not be needed. However, data are lacking on the prevalence of HAV antibody among patients with chronic liver disease in India. METHODS: Two hundred fifty-four patients attending the Liver Clinic at the All India Institute of Medical Sciences, New Delhi during the past 5 years and diagnosed to have either chronic hepatitis due to the hepatitis B virus (n = 76), hepatitis C virus (n = 84) or cirrhosis of the liver due to the hepatitis B (n = 47) or C (n = 47) virus were tested for the presence of IgG anti-HAV antibody in their sera (using a commercial ELISA kit). RESULTS: Two hundred forty-eight (97.6%) patients tested positive for IgG anti-HAV. The prevalence of anti-HAV positivity was similar among patients with chronic hepatitis B (74, 97.4%), chronic hepatitis C (82, 97.6%), cirrhosis of the liver due to the hepatitis B (46, 97.8%) and hepatitis C (46, 97.8%) virus. CONCLUSION: Vaccination against HAV is not required among patients with chronic liver disease in India as there is a very high prevalence of pre-existing antibodies in these patients.