Haemophilia A patients are not at increased risk of hepatitis A virus infection: An Egyptian experience

Abstract

Background: Hepatitis A virus (HAV) infection is endemic in Egypt. Haemophiliacs are at risk of transmission through exposure to blood products. We evaluated the seroprevalence of hepatitis A in Egyptian patients with haemophilia A as well as the safety and immunogenicity of subcutaneous hepatitis A vaccine in haemophiliacs.
Methods: 182 male children and adolescents were studied (82 patients with moderate and severe haemophilia A and 100 healthy controls). Screening for anti-HAV antibody was done and seronegative subjects received hepatitis A vaccine (Havrix™) at a dose of 720 Elisa Units at 0 and 6 months, given subcutaneously in haemophiliacs and intramuscularly for controls. Seroconversion was assessed 2 months after the second vaccine dose by anti-HAV IgG.
Results: Seroprevalence of HAV antibodies was 87.6% among haemophiliacs and 90% among the control group. Seronegative children (mean age 4.4± 3.71 years) were significantly younger than seropositive children (mean age 10.2 ± 3.86 years). Hepatitis A vaccine was given to 10 non immune haemophilia patients and 10 controls. The vaccine was well tolerated with local side effects including pain in 40% and erythema in 20% of haemophiliacs versus 20% for pain and erythema in the control group. All patients and controls developed seroconversion 2 months after the second dose; with no significant difference as regards the titre of anti-HAV IgG (351.4± 65.0 IU/L for haemophiliacs and 367.0 ±132.3 IU/L for controls).
Conclusion: HAV infection occurs early in life in Egyptian children, necessitating hepatitis A vaccination in early life. The vaccine is safe and effective when given subcutaneous in haemophiliacs.

Keywords: Hepatitis A virus; Haemophilia A; Hepatitis A vaccine