Changes in Hepatitis A and B Vaccination Rates in Adult Patients With Chronic Liver Diseases and Diabetes in the US Population

Professional societies recommend hepatitis A and hepatitis B immunization for individuals with chronic liver disease (CLD), but the degree of implementation is unknown. Data were obtained from the National Health and Nutrition Examination Surveys (NHANES) 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 seroprevalence of hepatitis A antibody and anti-HB surface antibody. In total, 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 nonalcoholic fatty liver disease (NAFLD), whereas HepB vaccination increased for patients with hepatitis C and nonalcoholic fatty liver disease. In the 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 quality measure (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 subcohorts. On the other hand, QM for HepB increased from 31.7% +/- 0.9% to 40.7% +/- 1.0% in the population, whereas 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. (HEPATOLOGY 2011;54:1167-1178)