Waghray Abhijeet, Waghray Nisheet, Khallafi Hicham, Menon K V Narayanan
Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH 44109, USA.
Division of Gastroenterology/Hepatology, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH 44109, USA.
Gastroenterol Res Pract. 2016;2016:5795712. doi: 10.1155/2016/5795712. Epub 2016 Apr 30.
Introduction. The progression of chronic liver disease to cirrhosis involves both innate and adaptive immune system dysfunction resulting in increased risk of infectious complications. Vaccinations against pneumococcus, hepatitis A virus (HAV), and hepatitis B virus (HBV) are well tolerated and effective in disease prevention and reduction in morbidity and mortality. Prior studies assessing vaccination rates in patients with cirrhosis have specific limitations and to date no study has provided a comprehensive evaluation of vaccination rates in patients with cirrhosis in the United States. Aim. This study assessed vaccination rates for pneumococcus, HAV, and HBV in patients with cirrhosis. Results. Overall 59.7% of patients with cirrhosis received at least 1 vaccination during the study period. Vaccination rates within the same or following year of cirrhosis diagnosis were 19.9%, 7.7%, and 11.0% against pneumococcus, HAV, and HBV, respectively. Trend analysis revealed significant increases in vaccination rates for pneumococcus in all patients with cirrhosis and within subgroups based on age, gender, and presence of concomitant diabetes. Conclusion. The study demonstrated that vaccination rates in patients with cirrhosis remain suboptimal. Ultimately, the use of electronic medical record (EMR) reminders improved communication between healthcare professionals and public health programs to increase awareness are fundamental to reducing morbidity, mortality, and health-care related costs of vaccine preventable diseases in patients with cirrhosis.
引言。慢性肝病发展为肝硬化涉及先天性和适应性免疫系统功能障碍，导致感染并发症风险增加。针对肺炎球菌、甲型肝炎病毒（HAV）和乙型肝炎病毒（HBV）的疫苗耐受性良好，在疾病预防以及降低发病率和死亡率方面有效。先前评估肝硬化患者疫苗接种率的研究存在特定局限性，迄今为止，尚无研究对美国肝硬化患者的疫苗接种率进行全面评估。目的。本研究评估了肝硬化患者肺炎球菌、HAV和HBV的疫苗接种率。结果。在研究期间，总体上59.7%的肝硬化患者接受了至少1次疫苗接种。在肝硬化诊断的同一年或之后，肺炎球菌、HAV和HBV的疫苗接种率分别为19.9%、7.7%和11.0%。趋势分析显示，所有肝硬化患者以及基于年龄、性别和是否伴有糖尿病的亚组中，肺炎球菌疫苗接种率均显著增加。结论。该研究表明，肝硬化患者的疫苗接种率仍不理想。最终，使用电子病历（EMR）提醒改善医疗保健专业人员与公共卫生项目之间的沟通以提高认识，对于降低肝硬化患者疫苗可预防疾病的发病率、死亡率和医疗保健相关成本至关重要。
