ABSTRACT
Background & Aims: Liver injury with autoimmune features after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is increasingly reported. We investigated a large international cohort of individuals with acute hepatitis arising after SARS-CoV-2 vaccination, focusing on histological and serological features. Methods: Individuals without known pre-existing liver diseases and transaminase levels ≥5x the upper limit of normal within 3 months after any anti-SARS-CoV-2 vaccine, and available liver biopsy were included. Fifty-nine patients were recruited;35 females;median age 54 years. They were exposed to various combinations of mRNA, vectorial, inactivated and protein-based vaccines. Results: Liver histology showed predominantly lobular hepatitis in 45 (76%), predominantly portal hepatitis in 10 (17%), and other patterns in four (7%) cases;seven had fibrosis Ishak stage ≥3, associated with more severe interface hepatitis. Autoimmune serology, centrally tested in 31 cases, showed anti-antinuclear antibody in 23 (74%), anti-smooth muscle antibody in 19 (61%), anti-gastric parietal cells in eight (26%), anti-liver kidney microsomal antibody in four (13%), and anti-mitochondrial antibody in four (13%) cases. Ninety-one percent were treated with steroids ± azathioprine. Serum transaminase levels improved in all cases and were normal in 24/58 (41%) after 3 months, and in 30/46 (65%) after 6 months. One patient required liver transplantation. Of 15 patients re-exposed to SARS-CoV-2 vaccines, three relapsed. Conclusion: Acute liver injury arising after SARS-CoV-2 vaccination is frequently associated with lobular hepatitis and positive autoantibodies. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. A close follow-up is warranted to assess the long-term outcomes of this condition. Impact and implications: Cases of liver injury after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) have been published. We investigated a large international cohort of individuals with acute hepatitis after SARS-CoV-2 vaccination, focusing on liver biopsy findings and autoantibodies: liver biopsy frequently shows inflammation of the lobule, which is typical of recent injury, and autoantibodies are frequently positive. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. Close follow-up is warranted to assess the long-term outcome of this condition. © 2022 The Author(s)
ABSTRACT
Introduction: In 2016, WHO announced a plan to eliminate viral hepatitis C as a public health threat by 2030. However, for achieving this goal, not only access to highly effective drugs, but also the ability to detect hidden infections by launching national screening programs is important. Lithuanian health authorities decided as a first step of the program, to pay general practitioners (GPs) a special fee for a service of promoting and performing serological tests for hepatitis C virus (HCV) antibodies (14.3 per screened person): 1. For the population born in 1945-1994 (once per life), and;2. For persons who inject drugs and AIDS patients (annual HCV testing). The program will start in July 1st, 2022. Here we present the results of pilot study in the primary health care centre of seaport Klaipeda conducted before starting of hepatitis C screening program in Lithuania. Aims & Methods: Patients were invited to participate in the HCV screening by GPs during the visits. Additionally, regional media, social networking sites, and leaflets were used to inform about the possibility of being tested free of charge. Screening involved a blood test for the presence of antibodies to HCV (TOYO rapid test, Turklab Tibbi Malzemeler A.S., Turkey). Patients who tested positive were referred to a gastroenterologist for further examination. A case-control study was performed to identify risk factors for hepatitis C infection. All seropositive patients (case group) were invited to participate in a telephone interview, and 65 out of 81 (80.2%) responded. The control group (n=130) matched by gender and age with the cases was randomly selected from seronegative patients and interviewed by telephone using the same questionnaire as the case group. The associations of possible risk factors with HCV infection were analysed using univariable and multivariable logistic regression analysis. Result(s): From November 2020 to February 2022, 4867 patients were screened in the primary health care centre in Klaipeda. Positive test results were found in 81 (1.7%) patients. Of all screened patients, 4167 (85.6%) were born in 1945-1994, and 79 (1.9%) of them were seropositive. Seroprevalence of HCV antibodies was higher among men than women, 49 out of 2363 (2.1%) and 32 out of 2504 (1.3%) respectively (p=0.03). In men, the highest HCV seroprevalence was found in age groups of 30-39 years (3.6%) and 40-49 years (3.5%), in women - in 50-59 years (1.9%). In case-control study, injection of illegal drugs was reported by 23.8% of HCV positive patients;27.0% of seropositive patients were in prison for more than 3 months. The odds ratio (OR) of HCV infection in patients who reported blood transfusions before 1993 was 6.8 (95% CI 2.0-23.2) compared to those who did not have a blood transfusion or had it later. HCV infection was diagnosed more often among patients who were blood donors before 1993 compared to those who were not donors or were later (OR 4.6;95% CI 2.1-10.2). Having a tattoo increased the odds of HCV infection by 6.5 times (95% CI 2.8-14.8). Conclusion(s): Despite the COVID 19 pandemic, the pilot study revealed active participation of individuals in HCV screening organised by the primary health care centre. Although adults > = 18 years of age were invited to the pilot study, all serologically positive cases of hepatitis C fell into the following categories: 1) born in 1945-1994;and 2) persons who inject drugs.