Hepatitis A in patients with chronic liver disease - severity of illness and prevention with vaccination.

Acute hepatitis A in patients with pre-existing chronic liver disease (CLD) may theoretically predispose such patients to a more severe outcome of infection. The results of reports covering epidemics and case series suggest but do not universally support this possibility. An analysis of the larger case series support the suggestion that acute hepatitis A superimposed on chronic hepatitis B infection is associated with higher peak laboratory abnormalities, more severe disease and a higher fatality rate. The safety and immunogenicity of an inactivated hepatitis A vaccination was evaluated in patients with CLD and found to be satisfactory for the protection of this group of patients.