Source Center for Liver Diseases at Inova Fairfax Hospital; Betty and Guy Beatty Center for Integrated Research, Inova Health System Falls Church, VA, USA. zobair.younossi@inova.org.

BACKGROUND: Professional societies recommend hepatitis A and hepatitis B immunization for individuals with chronic liver disease (CLD), but the degree of implementation is unknown.

METHODS: Data were obtained from the National Health and Nutrition Examination Surveys conducted in 1999-2008. For the entire study population and for those with CLD and diabetes, we determined the rates and independent predictors of history of hepatitis A and hepatitis B (HepA and HepB) vaccinations, of their effectiveness, and of sero-prevalence of anti-hepatitis A antibody and anti-HBsurface antibody.

RESULTS: 24,871 participants from NHANES were included: 14,886 (1999-2004), and 9,985 (2005-2008). Of these individuals, 14.0% had CLD and 8.6% had diabetes. During the study period, HepA vaccination in CLD increased from 13.3±1.0% to 20.0±1.5%, HepB vaccination increased from 23.4±1.2% to 32.1±1.5%. Of subtypes of CLD, HepA vaccination rates increased only in NAFLD, whereas HepB vaccination increased for hepatitis C and non-alcoholic fatty liver disease. In diabetic cohort, HepA vaccination rates increased from 9.3±1.1% to 15.4±1.7% and HepB rates increased from 15.2±1.5% to 22.4±1.7%. All changes were similar to those observed in the general population. The QM for HepA in the general population decreased from 44.4±1.2% in 1999-2004 to 41.7±1.9% in 2005-2008, and similar changes were noted for all sub-cohorts. On the other hand, QM for HepB increased from 31.7±0.9% to 40.7±1.0% in the population while no changes in QM were noted in any diagnostic cohort except for NAFLD.

CONCLUSIONS: Although vaccination rates in CLD and diabetic cohorts are increasing, they remain low. Given the public health implications of acute hepatitis A and hepatitis B in patients with CLD, better implementation of the vaccination recommendations for these populations is warranted.