Vaccinations: Important In Liver Disease Care

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Vaccination against disease is one of the major advances in medicine and has helped prevent disease in countless individuals. Despite the importance of vaccination, many people in our country do not get the routine vaccinations which are recommended and available. This action places them at risk of getting sick but also places those around them at risk of becoming ill.

Which vaccines am I talking about? These vaccines include, but are not limited to, the influenza vaccine, the Pneumovax or pneumonia vaccine, the meninigitis vaccine and the hepatitis A and B vaccines. Why don’t Americans get these vaccines? The answer is complex but usually comes down to several simple issues. Some of the issues are the lack of awareness of their necessity, the lack of awareness of availability and the lack of the insurance company to pay for preventive medicine. Many times, unfortunately, it is a misconception that these vaccines have side effects that can be long-lasting.

All people with liver disease should have routine vaccinations. This includes a yearly flu shot and once in a lifetime pneumococcal, meningococcal, H. flu, diphtheria and tetanus as well the hepatitis A and B vaccines.

The hepatitis A vaccine is given as a series of two injections, either six months or 12 months apart. This is important as hepatitis A is acquired via the fecal-oral route. Exposures generally occur while people are traveling or when they eat out. While hepatitis A is usually a self-limited condition with full recovery, people with liver disease who become super-infected with hepatitis A are at high risk of severe disease which can result in liver failure, death and the need for transplantation. Vaccination will prevent the disease.

What about the hepatitis B vaccine? This vaccine is given as a series of three shots over six months. It is given as an intramuscular injection in the deltoid region in adults and the thigh muscle in newborns. Injection in the buttock is associated with decreased response to the vaccine and should be avoided.

The real question is “Who should get the hepatitis B vaccine?” The current recommendations are that all newborns in the United States receive the vaccine in the first year of life. Officially, only adult high-risk groups are recommended to undergo vaccination. These high-risk groups include men having sex with men, people with multiple sexual partners, health care workers, hemodialysis staff and patients, intravenous drug users, people in institutions for the developmentally disabled, prisoners, travelers to endemic areas such as sub-Saharan Africa or the Far East, and sexual and household contacts of hepatitis B carriers. The vaccine, despite various unsubstantiated reports circulating the Internet, is safe and highly effective. Because of this, I tend to be more liberal in my hepatitis B recommendations. I would make the global recommendation that all people not previously vaccinated or exposed to hepatitis B should be vaccinated, whether they have liver disease or not. The problem is cost. Many insurers do not want to pay for this. I believe that they should and must pay for this critical piece of preventive medicine. Hepatitis B is a potentially fatal disease, especially in people over 40 years of age and it is preventable with vaccination.

This summer, do yourself a favor and consider ensuring that you and your loved ones are protected against hepatitis A and B. These are diseases which can cause considerable illness if you are not protected.

David Bernstein, MD, FAASLD,FACG, AGAF, FACP, is the chief of hepatology at Sandra Atlas Bass Center for Liver Diseases and a professor of medicine at Hofstra-Northwell School of Medicine.

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