PDF(Pubmed)
Abstract：
Patients with chronic liver disease (CLD) with or without cirrhosis remain at risk of developing hepatic decompensation when infected with viral or bacterial pathogens. The Advisory Committee on Immunization Practices (ACIP) currently recommends vaccination in CLD against hepatitis A virus (HAV), hepatitis B virus (HBV), influenza, pneumococcus, herpes zoster, tetanus, diphtheria, pertussis, and SARS-CoV-2. Inactivated vaccines are preferred over live attenuated ones, especially in transplant recipients where live vaccines are contraindicated. As the severity of the liver disease progresses, vaccine efficacy declines, and therefore, vaccines should be ideally administered early in the disease course for optimal immune response. Despite the strong recommendations, overall vaccination coverage in CLD remains poor; however, it is encouraging to note that in recent years coverage against influenza and pneumococcus has shown some improvement. Inadequate access to healthcare, lack of information on vaccine safety, poor financial reimbursement for healthcare providers, and vaccine misinformation are often responsible for low immunization rates. This review summarizes the impact of vaccine-preventable illness in those with CLD, updated vaccine guidelines, seroconversion rates in the vaccinated, and barriers faced by healthcare professionals in immunizing those with liver disease.
摘要：
患有或不患有肝硬化的慢性肝病（CLD）患者在感染病毒或细菌病原体时仍有发生肝失代偿的风险。免疫实践咨询委员会（ACIP）目前建议在CLD中接种甲型肝炎病毒（HAV）疫苗，乙型肝炎病毒（HBV），流感,肺炎球菌,带状疱疹,破伤风,白喉,百日咳,和SARS-CoV-2.灭活疫苗优于减毒活疫苗，尤其是在移植受者中，活疫苗是禁忌的。随着肝脏疾病的严重程度的进展，疫苗效力下降，因此,理想情况下，疫苗应在疾病过程的早期施用，以获得最佳的免疫反应。尽管有强烈的建议，CLD的总体疫苗接种覆盖率仍然很低；然而，令人鼓舞的是，近年来，流感和肺炎球菌的覆盖率有所改善。获得医疗保健的机会不足，缺乏有关疫苗安全性的信息，医疗保健提供者的财务报销不佳，和疫苗的错误信息往往是低免疫率的原因。这篇综述总结了疫苗可预防的疾病对CLD患者的影响，更新疫苗指南，接种疫苗的血清转化率，以及医疗保健专业人员在免疫肝病患者时面临的障碍。
