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Need for vaccination for vaccine preventable hepatitis in methadone maintenance treatment

Need for vaccination for vaccine preventable hepatitis in methadone maintenance treatment. Randy Seewald, MD 1,2,3 , Eli Kamara, BS 2 , Ruy Tio, DO 1,2 , Rashiah Elam, MD 1,2 , Sara Lorenz, MD 1,2 , Valentin Bonilla, Jr., RPA 1 , David C Perlman, MD 1,2,3

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Need for vaccination for vaccine preventable hepatitis in methadone maintenance treatment

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  1. Need for vaccination for vaccine preventable hepatitis in methadone maintenance treatment Randy Seewald, MD1,2,3, Eli Kamara, BS2, Ruy Tio, DO1,2, Rashiah Elam, MD1,2, Sara Lorenz, MD1,2 , Valentin Bonilla, Jr., RPA1, David C Perlman, MD1,2,3 1. Department of Medicine, Bronx, NY 2. Albert Einstein College of Medicine, Bronx, NY 3. Center for Drug Use and HIV Research, New York, NY APHA 10/31/2011 3232.0 Viral Hepatitis

  2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

  3. Background • Injecting and non-injecting drug users are at high risk of infection with viral hepatitis. • Hepatitis A and B are vaccine preventable diseases. • Co-infection with HCV and either HAV and HAB may lead to worsening of liver disease, fulminant hepatitis, hepatocellular carcinoma, and/or death.

  4. Aim The aim of this study was to determine the prevalence of viral hepatitis markers in a large methadone program in NYC and assess the need for vaccination.

  5. Method • The Beth Israel Medical Center MMTP serves approximately 6500 active patients at 18 clinics in NYC. • Approximately 1500 patients are admitted and leave the MMTP annually. • 8060 patients were screened between 6/2007 and 7/2009 for HAVtotAB, HBVsAg, HBVcAB), HBVsAb and HCVAb.

  6. 8060 distinct patients were screened over 2 yrs. Not all had complete screening performed because of incomplete lab requisitions. 35% of those tested were HBV susceptible. 15% had isolated HBV core Ab+. <1% were HBV surface Ag+. 27% were HBV immune by natural disease. 23% were HBV immune by vaccination. 35% were HAV susceptible Results

  7. Overall 50% were susceptible to either HAV, HBV or both. 56% were HCV Ab+. 17% of patients HCV Ab+ were HBV susceptible. 22% of patients HCV Ab+ were HAV susceptible. Overall 31% of patients HCVAb+ were susceptible to HAV and/or HBV. Results (Cont.)

  8. Of the 1029 isolated HBV core Ab+ patients who were also screened for HCV Ab, 954 (93%) were HCV Ab+. Those with HCV Ab+ were significantly more likely than those without HCV Ab+ to have isolated HBV core Ab+. (24% vs 2%, p<0.0001; OR 12.5, 95% CI: 9.8-16.0) Results (cont.)

  9. Hepatitis C

  10. Hepatitis B

  11. Hepatitis A

  12. HCV Ab and Isolated HBV Core Ab Serology N=1029

  13. 56% of MMTP patients were HCV Ab+ indicating prior infection with HCV. This rate is lower than has previously been reported in similar populations of drug users in treatment. A notably high number of patients with isolated HBV core Ab+ are HCV Ab+ (93%). Patients with HCV Ab+ were significantly more likely than those without HCV Ab+ to have isolated HBV core Ab+, possibly indicating occult HBV coinfection. Conclusions

  14. Conclusions (cont.) • Over one third of patients were HBV susceptible and HAV susceptible, with 50% susceptible to HAV and/or HBV. • Among HCV Ab+ patients, 31% were susceptible to HAV and/or HBV highlighting the need for ongoing hepatitis screening and vaccination programs for MMTP patients.

  15. Supported by: Beth Israel Medical Center NY State Office of Alcohol and Substance Abuse Services. Center for Drug Use and HIV Research Acknowledgements

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