Can viral hepatitis be eliminated? That’s the key question to be addressed Monday at the annual AGA Emmet B. Keeffe Symposium, Prevention of Viral Hepatitis Through Vaccination: Done or Just Getting Started?

Viable vaccines exist for hepatitis A, B and E, but continuing disease outbreaks suggest vaccine use could be more effective. And while research continues into a vaccine for hepatitis C, a candidate has yet to gain approval for use in clinical care.

“Patients with diseases for which there are vaccines are frequently not vaccinated. And questions remain about how to assess the efficacy of vaccination, the need for boosters, and ways to accommodate or re-vaccinate someone for whom a vaccine has failed,” said Kenneth E. Sherman, MD, PhD, the Gould professor of medicine and director of digestive diseases at the University of Cincinnati College of Medicine.

Dr. Sherman will co-moderate Monday’s AGA Clinical Symposium with Jayant Talwalkar, MD, AGAF, professor of medicine and medical director of the Mayo Clinic-Optum Labs collaboration in the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.

The problems associated with viral hepatitis vaccination vary by type.

Hepatitis A vaccine has been available in the U.S. for many years. While there has been a recent effort to achieve universal childhood vaccination, Dr. Sherman said there has been no significant public health policy to catch up in populations that might have missed pediatric vaccination.

“For that reason, every year we continue to experience a variety of sporadic outbreaks of hepatitis A in various communities,” he said. “In 2016, we saw a large outbreak of hepatitis A in Hawaii associated with seafood, as well as large outbreaks associated with contaminated strawberries, and smoothies outbreaks across several other states. We have an effective vaccine, but we do not always employ effective vaccination strategies.”

The situation is similar with hepatitis B. An effective vaccine has been available in the U.S. for many years and has been widely used in pediatric and teen populations. But there has been little effort to immunize adults who missed earlier vaccination, leaving a major portion of the population unprotected.

“Risk-targeted approaches are efficient, but not always effective,” Dr. Sherman said. “We also have at-risk populations for whom alternative strategies are needed, such as individuals with HIV or underlying liver disease who simply do not respond as well to standard vaccination practices.”

Hepatitis E vaccination is linked to disease recognition. While the disease is present in up to 20 percent of some U.S. populations, vaccine development was abandoned several years ago in the U.S. A highly effective vaccine is widely used in China, Dr. Sherman noted, but no attempt has been made to bring it to the U.S.

Research and development continues for an effective vaccine for the hepatitis C virus (HCV).

“There is a large population of middle-aged and older adults who were exposed to the virus before it was recognized, as well as a new epidemic developing among injection drug users,” Dr. Sherman said. “Though HCV can be cured, an effective prevention strategy could be a critical component of HCV elimination in the U.S. and elsewhere.”

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