Journal of Clinical Virology 46 (2009) 206–209 Contents lists available at ScienceDirect Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv Review Why actively promote vaccination in patients with cirrhosis? Pierre Loulergue a,b,c , Stanislas Pol a,d , Vincent Mallet a,d , Philippe Sogni a,d , Odile Launay a,b,c,* , for the GEVACCIM Group 1 a Université Paris Descartes, Faculté de médecine, Paris, France b INSERM, CIC BT 505, Paris, France c Assistance Publique – Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin-Saint Vincent de Paul, CIC de Vaccinologie Cochin Pasteur, Pôle de Médecine, Paris, France d AP-HP, Groupe Hospitalier Cochin-Saint Vincent de Paul, Unité d’Hépatologie, INSERM U 567, Paris, France article info Article history: Received 24 April 2009 Accepted 1 May 2009 Keywords: Cirrhosis Vaccine Hepatitis A Hepatitis B Pneumococcal Influenza abstract Patients with cirrhosis are immunocompromised and have an increased risk of infection, with a worse outcome. Some of those infections may be prevented by vaccination. Immunization can reduce the mor- bidity and mortality associated with cirrhosis. Immunizations against hepatitis A and B viruses, influenza and pneumococcus are recommended by the French Haute Autorité de Santé since 2007. Vaccination against hepatitis A is recommended in non-immunized cirrhotic patients. Vaccination against hepatitis B is recommended in every cirrhotic patient with no serological markers, and post-vaccinal antibodies titer should be checked. Annual influenza immunization can be done in cirrhotic patients, and pneumococcal polysaccharide vaccine should be repeated after 3–5 years. Few data regarding vaccination coverage are available, but studies suggest that immunization rates are too low in this population. © 2009 Elsevier B.V. All rights reserved. Contents 1. Introduction .......................................................................................................................................... 206 2. Particularities of immunization in patients with cirrhosis .......................................................................................... 207 3. Immunization against hepatotropic viruses ......................................................................................................... 207 3.1. Natural history and epidemiology of HAV and HBV infections in patients with cirrhosis ................................................... 207 3.2. Vaccination against hepatitis A virus ........................................................................................................ 207 3.3. Vaccination against hepatitis B virus......................................................................................................... 208 4. Influenza vaccination ................................................................................................................................ 208 5. Anti-pneumococcal vaccination ..................................................................................................................... 208 6. Vaccine coverage in cirrhotic patients ............................................................................................................... 208 7. Conclusion ............................................................................................................................................ 208 References ........................................................................................................................................... 209 * Corresponding author at: 27, rue du Faubourg St Jacques, 75679 Paris Cedex 14, France. Tel.: +33 11 58 41 28 58; fax: +33 11 58 41 29 10. E-mail address: odile.launay@cch.aphp.fr (O. Launay). 1 GEVACCIM group: Groupe d’étude sur la vaccination des sujets immunodéprimés (GEVACCIM); coordination O. Launay (Hôpital Cochin, Paris), members: T. Ancelle (Hôpital Cochin, Paris), J.B. Armangaud (Hôpital Ambroise Paré, Boulogne), Y. Cal- mus (Hôpital Cochin, Paris), P.H. Consigny (Centre Médical, Institut Pasteur, Paris), C. Couzigou (Hôpital Paul Brousse, Villejuif), P. Duchet Niedziolka (Hôpital Cochin, Paris), A. Gergely (Centre Médical, Institut Pasteur, Paris), M. Goudal (Centre Médi- cal, Institut Pasteur, Paris), T. Hanslik (Hôpital Ambroise Paré, Boulogne), S. Kerneis (Hôpital Cochin, Paris), O. Launay (Hôpital Cochin, Paris), O. Lortholary (Hôpital Necker, Paris), P. Loulergue (Hôpital Cochin, Paris), M.F. Mazmer (Hôpital Necker, Paris), D. Salmon Céron (Hôpital Cochin, Paris), D. Van der Vliet (Hôpital Cochin et Centre Médical, Institut Pasteur, Paris), D. Vittecoq (Hôpital Paul Brousse, Villejuif), C. Voyer (Hôpital Paul Brousse, Villejuif), B. Wyplosz (Hôpital Paul Brousse, Villejuif). 1. Introduction Chronic liver diseases are responsible for more than 1.4 mil- lion annual deaths according to the World Health Organization, and ranking in the top 10 causes of global mortality. 1 The mortality from chronic liver diseases is declining but data are heterogeneous depending on the country. 2 Cirrhosis is a frequent disease in France with an estimated prevalence between 2000 and 3300 cases per million inhabitants, and an incidence of 150–200 new cases per year per million inhabitants. Cirrhosis is responsible for 15,000 deaths per year, mainly secondary to the occurrence of infections and hepatocellular carcinoma. 3 Cirrhosis patients are immunocom- promised and at risk of infections whose severity is correlated with 1386-6532/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.jcv.2009.05.006