Public Health

Contrary to recommendation, hepatitis A vaccine not required in Indian cirrhotics

Last Updated: 2003-05-05 18:06:53 -0400 (Reuters Health)

INDIA (Reuters Health) - The great majority of patients in India with cirrhosis of the liver have protective antibodies against hepatitis A and hence do not require hepatitis A vaccine prophylaxis, Indian researchers report in the March-April issue of Indian Journal of Gastroenterology.

Dr. Saju Xavier from Al Shifa Hospital and Dr. K. Anish from Moulana Hospital in Perintalmanna town of Kerala note that hepatitis A vaccination has been routinely recommended in western countries for patients with cirrhosis. To evaluate the validity of this recommendation in a country like India where hepatitis A is endemic, the investigators studied the seroprevalence of anti-hepatitis A antibodies in 52 adult patients with cirrhosis of the liver and 50 healthy controls from rural areas.

The researchers observed that alcoholic hepatitis was responsible for 25% and hepatitis B for 13% of cases of cirrhosis, while the etiology could not be identified in the rest.

Antibodies to hepatitis A were present in 51 (98%) of patients with cirrhosis and in 100% of the controls, the Drs. Xavier and Anish report.

While previous studies from India have shown contrasting results, the authors postulate that the high prevalence of anti-hepatitis A antibodies they observed could be due to older patient age or regional differences in seroconversion.

"Vaccination would be justified only if acute hepatitis A were common in patients with liver cirrhosis," the researchers explain. However, most Indian adults have protective antibodies due to prior subclinical infections.

"Our results suggest that neither routine vaccination nor testing all patients with chronic liver disease for hepatitis A serology in an endemic country like India is worthwhile," Drs. Xavier and Anish conclude.

Indian J Gastroenterol 2003;22:54-55.