Author
Dr. Malin Fromme, Prof. Dr. Pavel Strnad, as published in Alpha1 Journal 2/2023.
Many Alpha patients receive a recommendation for vaccination against hepatitis A and B in their medical reports. To explain the background, we will briefly introduce the two infections and explain why we consider these vaccinations to be beneficial.
With approximately 350 million carriers worldwide, hepatitis B is one of the most common viral infections in humans. However, its distribution varies considerably across regions, with particularly high prevalence found in Asia, sub-Saharan Africa, South America, the South Pacific, and the Middle East (Cornberg et al. 2021). The infection is caused by the hepatitis B virus, which can be transmitted through blood and bodily fluids, and thus sexually, via needlestick injuries, contaminated blood products, and perinatally (during childbirth). However, transmission via blood transfusion is virtually impossible in Western countries due to appropriate safety precautions.
After an incubation period of usually several months, asymptomatic hepatitis develops in the vast majority of cases. Sometimes this presents with mild symptoms, but in about one-third of cases, acute, icteric hepatitis (i.e., accompanied by jaundice) can occur. This often manifests with nonspecific symptoms such as flu-like symptoms, upper abdominal pain, or fatigue. In over 90% of cases, the hepatitis resolves completely. However, in approximately 5% of cases, the infection leads to persistent, asymptomatic carrier status of the virus (Robert Koch Institute 2016). This can develop into chronic hepatitis with an increased risk of liver cirrhosis and associated complications, such as the development of liver cancer. Diagnosis is made via blood tests. Various antiviral medications are available for the treatment of the chronic form (Cornberg et al. 2021; Robert Koch Institute 2016).
A complication of hepatitis B infection can be coinfection with hepatitis D. Because the hepatitis D virus is an "incomplete virus," it can only occur together with hepatitis B. Approximately 5% of chronically hepatitis B-infected individuals also carry the hepatitis D virus and experience a significantly more severe course of the disease compared to mono-infected individuals.
Hepatitis A is frequently acquired through travel to Mediterranean, tropical, or subtropical regions. The causative agent is the hepatitis A virus, which is transmitted via the fecal-oral route, for example, through contaminated food or water (Robert Koch Institute 2023). While the infection is usually asymptomatic in children, the risk of severe symptoms and fulminant (intense) courses increases with age. In adults with hepatitis A levels above 80, acute hepatitis with jaundice (icterus) develops. Other symptoms can include fever, a rash, abdominal pain, nausea, and diarrhea. A fulminant course with liver failure is very rare overall, and the infection almost never becomes chronic (Robert Koch Institute 2023). Diagnosis is made via a blood test. Treatment is symptomatic, and the disease is usually self-limiting, meaning it resolves without external influences (Robert Koch Institute 2023).
Preventive vaccinations are available for both hepatitis B and hepatitis A.
For over 20 years, the Standing Committee on Vaccination (STIKO) has recommended hepatitis B vaccination as a standard immunization for all children (STIKO 2023). The primary immunization series consists of three doses administered within the first year of life. In addition, there is an indication-based vaccination for individuals with immunosuppression or underlying medical conditions that suggest a severe course of the disease (e.g., dialysis patients) and for individuals with an increased risk of exposure (e.g., intravenous drug use or contact with infected individuals in the household) (STIKO 2023). This is administered when the antibody titer in the blood is low, meaning that the body does not have sufficient antibodies to protect against the pathogen. Hepatitis B vaccination can also be administered as an occupational or travel vaccination (Commission on Vaccination 2021). A booster vaccination is not generally recommended. Exceptions are the aforementioned vaccinations for specific indications or occupational reasons (Commission on Vaccination 2021; STIKO 2023). Additionally, hepatitis B vaccination can protect against hepatitis D infection. In contrast, there is no general vaccination recommendation for hepatitis A vaccination. It is frequently administered for specific indications (e.g., in cases of sexual activity with an increased risk of exposure), for occupational reasons, or for travel (STIKO 2023).
Additionally, the hepatitis B vaccination can protect against hepatitis D infection.
Why do we recommend hepatitis A and B vaccinations for people with alpha-1 antitrypsin deficiency? At least those with severe alpha-1 antitrypsin deficiency (genotype Pi*ZZ) are considered to be at high risk of liver damage. Their risk of developing cirrhosis is approximately 20 times higher. For people with the heterozygous Pi*MZ genotype, the situation is less dramatic; without additional risk factors such as diabetes or obesity, we assume a risk that is only twice as high. Nevertheless, we believe it is sensible to protect these individuals from hepatitis B infection, especially since there is data suggesting that the combination of these two risk factors can be potentially dangerous. This aims to minimize a severe course of the infection and unnecessary risks. However, we also want to emphasize that the risk of hepatitis B infection is highly dependent on lifestyle and is very low for many people.
If needed, you can submit this article to your health insurance provider and request coverage of the vaccination costs. It is recommended that you apply for the corresponding support.
