Impact of the mandatory Hepatitis A immunization program: before and after the vaccine in Ankara, Central of Turkey
TURKISH JOURNAL OF PEDIATRICS
Authors: Yuksek, Saliha Kanik; Tezer, Hasan; Parlakay, Aslinur Ozkaya; Gulhan, Belgin; Kara, Ates; Ciftci, Ergin; Tapisiz, Anil; Celik, Melda; Ozdemir, Halil; Aykac, Kubra; Demirdag, Tugba Bedir; Kara, Tugce Tural; Hayran, Gamze; Ince, Erdal
Abstract
In Turkey Hepatitis A virus (HAV) infection is considered to be moderate-endemic. Hepatitis A vaccine was included in the mandatory vaccination schedule of Turkey on November 2012. We aimed to evaluate the cases of HAV infection followed in Ankara, which is located in the center of Central Anatolia, retrospectively according to the date of the administration of the mandatory hepatitis A vaccine. A total of 272 children followed-up between January 2008 and December 2015 for HAV infection in five separate hospitals were enrolled to the study. There were 200 (68.2%) cases in the pre-vaccination group, 72 (31.74%) cases in the post-vaccination group, and 55.1% were male in total. The immunization status were as follow; 89.7% (n = 244) unvaccinated, 0.4% (n = 1) vaccinated and 9.9% (n = 27) with unknown immune status. There was a statistically significant difference between the groups in hospitalization rates, but no statistically significant differences in hospitalization indications, length of hospital stay, complication types and proportions, and normalization period of transaminases. The national hepatitis A immunization program in Turkey has had a significant impact when the targeted population is considered, with suggestive herd protection effects.
Care quality and outcomes among US veterans with chronic hepatitis B in the hepatitis C direct-acting antiviral era
JOURNAL OF VIRAL HEPATITIS
Authors: Kaplan, David E.; Medvedeva, Elina; Serper, Marina
Abstract
Adherence to guideline-recommended hepatitis B virus (HBV) care is suboptimal. We hypothesized that national hepatitis C eradication efforts during the era from 2015 to 2017 would improve the quality of care for cHBV given increased recognition and specialty referrals for liver disease. The study described herein is a retrospective cohort study of veterans with at least one positive HBsAg (HBsAg+) result from 1 January 2003 to 31 December 2017 using the VA Corporate Data Warehouse (CDW) analysed by era (2003-2004, 2005-2009, 2010-2014, 2015-2017). Relevant covariates such as HCV co-infection, demographics, cirrhosis and baseline laboratory testing were obtained through previously validated approaches. We evaluated completion of process measures within 2 years of the index HBsAg + result: specialty care referral; testing of ALT, HBV-DNA, HBeAg and anti-HBe; testing for co-infection and/or vaccination for HAV, HCV, HDV and HIV; and hepatocellular carcinoma (HCC) surveillance among those meeting criteria. We also measured use of antiviral therapy in appropriate candidates (ALT >= 2 x ULN, HBV-DNA >= 2000 IU/mL). Of the 16 673 individuals with HBsAg + test results, 9,521 were confirmed as chronic HBV. Era-related (Era 3:2010-2014 vs Era 4:2015-2017) increases in guideline-recommended process measures included the following: outpatient visits with GI/ID specialists (78%-89%), HBV-DNA testing (73%-79%), HDV testing (27%-35%), appropriate HBV antiviral utilization (55%-70%) and HCC surveillance (40%-43%); allP < .0001. In the subset of HBV/HCV-co-infected patients, HCV DAA therapy was associated with a trend towards improved overall survival. In conclusion, the overall quality of care for HBV has significantly improved in the era of widespread HCV DAA therapy in an integrated health system possibly due to increased recognition and referral for liver disease.