Patients with a hepatitis C infection can be readily vaccinated against hepatitis A and B with a combined vaccine administered at short intervals within a period of three weeks. A study by the Heidelberg University Hospital for Internal Medicine, in collaboration with the university hospitals of Dresden and Regensburg, has established that the vaccine Twinrix Adult(r) is safe, effective and provides a high degree of protection.
This is however only true with regard to patients whose liver is not entirely infiltrated by connective tissue (cirrhosis). The study team was headed by Privatdozentin Dr. Birgit Kallinowski, senior consultant at the Gastroenterology and Infectious Diseases department (medical director: Prof. Dr. Wolfgang Stremmel).
In Germany there are some 500,000 patients with hepatitis C. The virus is transmitted primarily by blood transfusions, intravenous drug use and rarely sexual intercourse. As the virus was only identified in 1989 and accordingly no protective measures could be taken against its transmission before then, most of these infections date back over a number of decades. In about 80% of the patients the acute infection leads to a chronic disorder that can totally destroy their liver tissue. Unlike hepatitis A and B, there has so far been no effective vaccination protection against hepatitis C.
Additional infection with other hepatitis viruses is a threat to the functioning of the liver
For patients with chronic inflammation of the liver due to hepatitis C, additional infection by hepatitis A and B viruses can be dangerous. Their liver would be damaged even more severely. Accordingly, protective vaccination is considered imperative by the Standing Committee on Vaccination of the Robert Koch Institute (Berlin). Frequently, however, such vaccination is not effective in the case of advanced liver disorders or in patients with cirrhosis of the liver. Also, the third vaccination completing the basic protection regimen and administered six months after the first vaccination is frequently forgotten.
In the prospective study, Dr. Kallinowski investigated how hepatitis C patients without cirrhosis responded to a new combination vaccine against hepatitis A and B. A total of 82 hepatitis C patients and 95 healthy participants were immunised against both liver viruses with a combined preparation, in accordance either with the normal regimen (second and third vaccination after one month and six months) or with an accelerated regimen (second and third vaccination after 7 days and 21 days).
In all groups the protection against both viruses was equally good. Almost 90% of the hepatitis C patients were immunised against hepatitis A, about 80% against hepatitis B, regardless of the regimen used. No severe side-effects were identified in any of the participants in the study.
Vaccination after liver transplants usually not successful
"So patients with a hepatitis C infection should, if possible, be vaccinated before the liver is completely infiltrated by connective tissue and the immune system has been thrown out of kilter," Dr. Kallinowski explains. Under these conditions, vaccination, including accelerated vaccination, against hepatitis A and B is very successful in hepatitis C patients, with results that are almost as good as those achieved in persons without a liver disorder.
Less positive were the vaccination results in patients who had already developed cirrhosis and were waiting for a liver transplant. Here, only 25% developed adequate immunisation against the hepatitis B virus. The results were even less successful in patients vaccinated against hepatitis A and B after having undergone a liver transplant. The medication designed to prevent rejection of the new organ by the suppression of immune defence has a detrimental effect on the formation of antibodies.
PD Dr. Birgit Kallinowski
Liver Outpatient Dept.
University Hospital for Internal Medicine
Kallinowski B, Jilg W, Buchholz L, Stremmel W, Engler S:
Immunogenicity of an accelerated vaccination regime with a combined hepatitis a/b vaccine in patients with chronic hepatitis C
Gastronenterol. 2003 Oct; 41(10):983-90.
(The original article can be obtained from the Press Department of Heidelberg University Hospital Complex by applying to firstname.lastname@example.org).
For further information on hepatitis and on therapy provided at the Heidelberg University Hospital for Internal Medicine go to http://www.gastroenterologie.uni-hd.de/leber/
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