The occurrence of an acute episode of viral hepatitis A or B in a patient with chronic liver disease is associated with increased morbidity and mortality. A patient with chronic liver disease (CLD) should be vaccinated against viral hepatitis A and B if nonimmune.


Immunization should be performed as soon as chronic liver disease has been diagnosed. Vaccine protection is reduced in a patient who has:

(1) advanced liver disease

(2) had a liver transplant (due to immunosuppression)


Vaccination is particularly important in patients at risk for exposure to viral hepatitis such as:

(1) traveler

(2) day care worker

(3) healthcare worker


The patient should be evaluated for:

(1) serologic evidence of immunity

(2) history of previous vaccination


Vaccination is not indicated if the patient has protective antibodies.


Following vaccination the patient should be tested for serologic response. A booster shot may be indicated for a patient who does not show seroconversion.


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