Hospitalists caring for patients with chronic liver disease should consider administering the hepatitis A vaccine upon discharge, says an expert from the CDC.
The recommendation is based on a new study published in Hepatology that shows the rate of hospitalizations caused by a hepatitis A virus (HAV) infection declined significantly in the U.S. from 2002 to 2011. It also reports that older patients and those with chronic liver disease are most likely to be hospitalized with HAV, says Melissa Collier, MD, MPH, a medical epidemiologist within the CDC's division of viral hepatitis.
Dr. Collier and colleagues analyzed ICD-9 codes from the National Inpatient Survey discharge data, focusing on U.S. residents hospitalized with a principal hepatitis A diagnosis and accompanying secondary diagnoses. They found that from 2002 to 2011:
- Rates of hospitalization for hepatitis A as a principal diagnosis decreased from 0.72/100,000 to 0.29/100,000 (P
- Mean age of those hospitalized increased from 37.6 years to 45.5 years (P
- Percentage of hepatitis A hospitalizations covered by Medicare increased from 12.4% to 22.7% (P
- Secondary, comorbid discharge diagnoses, including liver disease, hypertension, ischemic heart disease, disorders of lipid metabolism, and chronic liver disease, increased; and
- No changes were reported in patients’ length of stay or in-hospital deaths from hepatitis A, but persons with liver disease were hospitalized longer.
According to Dr. Collier, the drop in hospitalization rates could be explained by lower incidence of hepatitis A since the Advisory Committee on Immunization Practices (ACIP) recommended universal childhood vaccination in 2006.
Dr. Collier, who is a member of the ACIP hepatitis A working group, also points out that the ACIP recommends all patients with chronic liver disease be vaccinated. She says hospitalists should give patients with chronic liver disease the first dose of the vaccine upon discharge and ask those patients' PCPs to administer the second dose.
"Patients don't think about needing to be vaccinated, and if their physicians aren't recommending it, they aren't going to seek it," she says. Dr. Collier noted that data show only about 12% of people age 19 to 49 have received the hepatitis A vaccine. TH