237717 Need for vaccination for vaccine preventable hepatitis in methadone maintenance treatment

Monday, October 31, 2011: 12:35 PM

Randy M. Seewald, MD , Department of Medicine, Beth Israel Medical Center, New York, NY
Eli Kamara, BS , Albert Einstein College of Medicine, Bronx, NY
Ruy Tio, DO , Department of Medicine, Beth Israel Medical Center, New York, NY
Rashiah Elam, MD , Department of Medicine, Beth Israel Medical Center, New York, NY
Sara Lorenz, MD , Department of Medicine, Beth Israel Medical Center, New York, NY
Valentin Bonilla Jr., RPA , Department of Medicine, Beth Israel Medical Center, New York, NY
David C. Perlman, MD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
  
     
Background: Drug users are at risk of infection with viral hepatitis. Hepatitis A (HAV) and B (HBV) virus infections are vaccine preventable diseases. Hepatitis C co-infection with hepatitis A and/or B may lead to worsening liver disease, fulminant hepatitis, hepatocellular carcinoma, and/or death.

Aim: To determine the prevalence of viral hepatitis markers and assess the need for vaccination.

Method: The MMTP serves 6500 patients at 18 clinics in NYC. Approximately 1500 patients are admitted/discharged annually. 8060 patients were screened between 6/2007 until 7/2009 for HAVTotal Antibody (HAVtotAB), HBVSurface Antigen (HBVsAg), HBVCore Antibody (HBVcAb), HBVSurface Antibody (HBVsAb) and HCVAntibody (HCVAb).

Results:35% were HBV susceptible, 15% had isolated HBVcAb+, 1% were HBVsAg+, 27% were HBV immune by natural disease, 23% were HBV immune by vaccination, and 35% were HAV susceptible. Overall, 50% were susceptible to HAV, HBV or both. 56% were HCVAb+, of these 17% were HBV susceptible, and 22% were HAV susceptible, 31% HCVAb+ were susceptible to HAV and/or HBV. Of the 1029 HBVcAb+ who were also screened for HCVAb, 954 (93%) were HCVAb+. 24% of the HCV+ patients had isolated HBVcAb+. (24% vs 2%, p < 0.0001; OR 12.5, 95% CI: 9.8-16.0)

Conclusion: Patients HCVAb+ were more likely than those without HCVAb+ to have isolated HBVcAb+ suggesting a role for HCV on HBV antibody responses. One third were HBV susceptible and 50% were susceptible to HAV and/or HBV, needing vaccination. Among those HCVAb+, 31% were susceptible to HAV and/or HBV highlighting the need for ongoing hepatitis screening and vaccination programs for MMTP patients.

Learning Areas:
Planning of health education strategies, interventions, and programs

Learning Objectives:
1. Learners will be able to describe the prevalence of viral hepatitis in a large methadone maintenance treatment program in New York City. 2. Learners will be able to assess the need for vaccination against vaccine preventable hepatitis A and B in methadone maintenance treatment.

Keywords: Methadone Maintenance, Primary Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Medical Director of the Beth Israel Medical Center Methadone Maintenance Treatment Program (MMTP), the oldest and largest hospital based MMTP in the US, with 18 clinics in New York City serving over 8000 opioid dependent patients annually.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Viral hepatitis
See more of: Epidemiology