Immune Profiles of Hepatitis A in Patients with Chronic Liver Disease across Three Major Hospitals in Sri Lanka

Introduction: Viral hepatitis remains a major global public health concern. Among the various types, hepatitis A, B, and D are preventable through effective vaccination. Patients with chronic liver disease (CLD) are particularly vulnerable to severe complications if they contract hepatitis A. Therefore, protecting this high-risk group through immunization is crucial. However, in Sri Lanka, there is limited information available on how many CLD patients are already immune to hepatitis A and how many have been vaccinated. This study was conducted to assess both the immunity levels and vaccination status of CLD patients attending three major government hospitals in Sri Lanka. Methods: A descriptive cross-sectional study was carried out from February to June 2022 among 151 newly registered patients with CLD attending gastroenterology clinics at three tertiary care hospitals. Information on age, gender, and hepatitis A vaccination history was collected through interviewer-administered questionnaires. Blood samples were tested for the presence of hepatitis A-specific IgG antibodies using a commercial Chemiluminescence Immunoassay to determine immunity status. Results: The ages of the study participants ranged from 10 to 81 years, with an average age of 59.5 years (Standard Deviation: 10.66 years). The majority of patients (54.9%) were over the age of 61, and 58.9% were male. Hepatitis A immunity was detected in 79.4% of participants, suggesting past natural infection or previous vaccination. However, only one participant (0.66%) reported receiving the hepatitis A vaccine, indicating extremely low vaccination coverage among this group. Conclusion: The findings show that a significant proportion (79.4%) of CLD patients in the study were already immune to hepatitis A, likely due to past natural infection. Vaccination rates, however, were remarkably low. These results suggest that instead of offering the hepatitis A vaccine to all CLD patients, it may be more practical and cost-effective to first screen for immunity and then selectively vaccinate only those who are not already protected. This targeted approach could help optimize resource use and provide better protection for vulnerable patients in Sri Lanka.