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104. Review of Updated Hepatitis B Vaccine Recommendations and Potential Challenges With Implementation

Author

Chitnis, Amit S. and Wong, Robert J.

Subjects
Column
Abstract

Hepatitis B virus (HBV) infection is a vaccine-preventable disease associated with substantial morbidity and mortality. Although safe and effective hepatitis B vaccines are available, an increased number of adults must receive the hepatitis B vaccine in order to reach the goal of the US Department of Health and Human Services for HBV elimination. Previous guidelines from the US Centers for Disease Control and Prevention (CDC) for hepatitis B vaccination among adults utilized a risk-based approach that may have contributed to decreased uptake of the vaccine because the recommendations were difficult to adopt into clinical practice and assumed patients would recognize and disclose their risk factors. Based on review of epidemiologic and cost-effectiveness data, the CDC now recommends that all adults 19 to 59 years old receive the hepatitis B vaccine; however, a risk-based approach to hepatitis B vaccination was retained among adults age 60 years and older because universal vaccination in this age group would not lead to substantial reductions in acute HBV cases and be cost-effective. Implementation of these expanded hepatitis B vaccination recommendations in clinical and public health practice may pose challenges, including ensuring effective HBV screening practices, quality measures to track coverage of the hepatitis B vaccine, utilization of hepatitis B vaccines that have the highest completion rates for the vaccine series in a real-world setting, and sustained efforts to vaccinate high-risk groups such as individuals experiencing incarceration, utilizing sexually transmitted disease clinics, and injecting illicit drugs.

Published
2022

113. Acute Liver Failure Guidelines.

Author

Shingina, Alexandra, Mukhtar, Nizar, Wakim-Fleming, Jamilé, Alqahtani, Saleh, Wong, Robert J., Limketkai, Berkeley N., Larson, Anne M., and Grant, Lafaine

Published
2023
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122. Simplifying Treatment Criteria in Chronic Hepatitis B: Reducing Barriers to Elimination.

Author

Wong, Robert J, Kaufman, Harvey W, Niles, Justin K, Kapoor, Hema, and Gish, Robert G

Subjects
*FIBROSIS, *ANTIVIRAL agents, *ELIGIBILITY (Social aspects), *DESCRIPTIVE statistics, *DECISION making in clinical medicine, *CHRONIC hepatitis B, *ASPARTATE aminotransferase
Abstract

Background Early, sustained hepatitis B virus (HBV) DNA suppression reduces long-term risks of hepatocellular carcinoma. Chronic hepatitis B (CHB) treatment criteria are complex. Simplifying criteria will improve timely linkage to therapy. We evaluated treatment eligibility patterns among US patients with CHB and propose stepwise simplification of CHB treatment criteria. Methods Using 2016–2020 Quest Diagnostics data, we evaluated treatment eligibility among patients with CHB (2 positive HBV tests [HBV surface antigen, HBV e antigen, or HBV DNA] ≥6 months apart) using American Association for the Study of Liver Disease (AASLD), European Association for Study of the Liver (EASL), Asian Pacific Association for Study of the Liver (APASL), and Asian American Treatment Algorithm (AATA) criteria. Results Among 84 916 patients with CHB, 6.7%, 6.2%, 5.8%, and 16.4% met AASLD, EASL, APASL, and AATA criteria, respectively. Among treatment-ineligible patients with CHB, proportion with significant fibrosis (aspartate aminotransferase platelet ratio index >0.5) were 10.4%, 10.4%, 10.8%, and 7.7% based on AASLD, EASL, APASL, and AATA, respectively. In the proposed treatment simplification, the proportion of patients with CHB eligible for therapy increased from 10.3% for step 1 (HBV DNA >20 000 IU/mL, elevated alanine aminotransferase [ALT] level) to 14.1% for step 2 (HBV >2000 IU/mL, elevated ALT level), 33.5% for step 3 (HBV DNA >2000 IU/mL, any ALT level), and 87.2% for step 4 (detectable HBV DNA, any ALT level). Conclusions A large proportion of patients with CHB not meeting established treatment criteria have significant fibrosis. Simplifying criteria to treat all patients with detectable HBV DNA will reduce complexity and heterogeneity in assessing treatment eligibility, improving treatment rates and progress toward HBV elimination. [ABSTRACT FROM AUTHOR]

Published
2023
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132. sj-docx-1-ggm-10.1177_23337214221122520 – Supplemental material for Cognitive Impairment and Cirrhosis in Older Patients: A Systematic Review

Author

Ohikere, Kabiru, Veracruz, Nicolette, and Wong, Robert J.

Subjects
FOS: Clinical medicine, 110308 Geriatrics and Gerontology
Abstract

Supplemental material, sj-docx-1-ggm-10.1177_23337214221122520 for Cognitive Impairment and Cirrhosis in Older Patients: A Systematic Review by Kabiru Ohikere, Nicolette Veracruz and Robert J. Wong in Gerontology and Geriatric Medicine

Published
2022
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147. Trends in liver transplantation in hepatitis C virus-infected persons, United States

Author

Perumpail, Ryan B., Wong, Robert J., Liu, Andy, Jayasekera, Channa R., Dieterich, Douglas T., Younossi, Zobair M., and Ahmed, Aijaz

Subjects
Health
Abstract

To the Editor: The Centers for Disease Control and Prevention and US Preventive Services Task Force recommend a one-time screening for hepatitis C virus (HCV) infection in adults born during [...]

Published
2016

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