Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitis
Background and aims: Coronavirus disease 2019 (COVID-19) vaccines were rapidly implemented globally and vaccine-associated immune-related hepatitis was recently reported. We aim to investigate its impact in regions endemic of chronic hepatitis B (CHB). Methods: We retrospectively collected patients...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664623002358 |
| _version_ | 1797348662111633408 |
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| author | Hsin-Yun Wu Tung-Hung Su Chun-Jen Liu Hung-Chih Yang Jia-Huei Tsai Ming-Han Wei Chieh-Chang Chen Chien-Chih Tung Jia-Horng Kao Pei-Jer Chen |
| author_facet | Hsin-Yun Wu Tung-Hung Su Chun-Jen Liu Hung-Chih Yang Jia-Huei Tsai Ming-Han Wei Chieh-Chang Chen Chien-Chih Tung Jia-Horng Kao Pei-Jer Chen |
| author_sort | Hsin-Yun Wu |
| collection | DOAJ |
| description | Background and aims: Coronavirus disease 2019 (COVID-19) vaccines were rapidly implemented globally and vaccine-associated immune-related hepatitis was recently reported. We aim to investigate its impact in regions endemic of chronic hepatitis B (CHB). Methods: We retrospectively collected patients who developed hepatitis within 90 days after COVID-19 vaccination in Taiwan. The mechanisms of hepatitis included vaccine induced liver injury (VILI) and immune-related hepatitis, which are direct liver injuries defined as aspartate or alanine aminotransferase (AST or ALT) increased ≥ 5-fold upper limit of normal (ULN) and/or AST or ALT ≥ 3-fold of ULN with concurrent total bilirubin ≥ 2-fold of ULN. Indirect liver injury due to HBV reactivation was defined as HBsAg reverse seroconversion or significant rise in HBV DNA level. The demographics, clinical data, and course of hepatitis were compared statistically. Results: Twenty-five patients were included with a median age of 54. The culprit vaccines were ChAdOx1 nCoV-19 (n = 9), mRNA-1273 (n = 12), and BNT162b2 (n = 4). The characteristics of hepatitis were comparable regardless of vaccine subtypes. The median onset of hepatitis was 25 days post vaccination, with a peak of 10-fold ALT-increase. The etiologies included HBV reactivation (n = 10), VILI (n = 10), and immune-related hepatitis (n = 5). HBV reactivation accounts for 90% of vaccine-induced hepatitis in patients of CHB (n = 10), and two patients died. Patients with initial AST levels >500 U/L increased 27-fold risks of liver injury greater than moderate severity compared with those without. Conclusion: COVID-19 vaccine induced hepatitis is a clinical significant complication, and HBV reactivation may account for a possible mechanism. |
| first_indexed | 2024-03-08T12:09:08Z |
| format | Article |
| id | doaj.art-d9660f192670472da0db06e0aabeb2a2 |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-03-08T12:09:08Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-d9660f192670472da0db06e0aabeb2a22024-01-23T04:14:56ZengElsevierJournal of the Formosan Medical Association0929-66462024-01-0112318897Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitisHsin-Yun Wu0Tung-Hung Su1Chun-Jen Liu2Hung-Chih Yang3Jia-Huei Tsai4Ming-Han Wei5Chieh-Chang Chen6Chien-Chih Tung7Jia-Horng Kao8Pei-Jer Chen9Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanDivision of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Corresponding author. Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 1 Chang-Te Street, Taipei 10048, Taiwan.Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, TaiwanDivision of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanDepartment of Pathology, National Taiwan University Hospital, Taipei, TaiwanDivision of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, BioMedical Park Hospital, HsinChu, TaiwanDivision of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanDivision of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanDivision of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, TaiwanDivision of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Corresponding author. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, 1 Chang-Te Street, Taipei 10048, Taiwan.Background and aims: Coronavirus disease 2019 (COVID-19) vaccines were rapidly implemented globally and vaccine-associated immune-related hepatitis was recently reported. We aim to investigate its impact in regions endemic of chronic hepatitis B (CHB). Methods: We retrospectively collected patients who developed hepatitis within 90 days after COVID-19 vaccination in Taiwan. The mechanisms of hepatitis included vaccine induced liver injury (VILI) and immune-related hepatitis, which are direct liver injuries defined as aspartate or alanine aminotransferase (AST or ALT) increased ≥ 5-fold upper limit of normal (ULN) and/or AST or ALT ≥ 3-fold of ULN with concurrent total bilirubin ≥ 2-fold of ULN. Indirect liver injury due to HBV reactivation was defined as HBsAg reverse seroconversion or significant rise in HBV DNA level. The demographics, clinical data, and course of hepatitis were compared statistically. Results: Twenty-five patients were included with a median age of 54. The culprit vaccines were ChAdOx1 nCoV-19 (n = 9), mRNA-1273 (n = 12), and BNT162b2 (n = 4). The characteristics of hepatitis were comparable regardless of vaccine subtypes. The median onset of hepatitis was 25 days post vaccination, with a peak of 10-fold ALT-increase. The etiologies included HBV reactivation (n = 10), VILI (n = 10), and immune-related hepatitis (n = 5). HBV reactivation accounts for 90% of vaccine-induced hepatitis in patients of CHB (n = 10), and two patients died. Patients with initial AST levels >500 U/L increased 27-fold risks of liver injury greater than moderate severity compared with those without. Conclusion: COVID-19 vaccine induced hepatitis is a clinical significant complication, and HBV reactivation may account for a possible mechanism.http://www.sciencedirect.com/science/article/pii/S0929664623002358Autoimmune hepatitisDrug induced liver injuryHepatitis BSARS-CoV-2Vaccination |
| spellingShingle | Hsin-Yun Wu Tung-Hung Su Chun-Jen Liu Hung-Chih Yang Jia-Huei Tsai Ming-Han Wei Chieh-Chang Chen Chien-Chih Tung Jia-Horng Kao Pei-Jer Chen Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitis Journal of the Formosan Medical Association Autoimmune hepatitis Drug induced liver injury Hepatitis B SARS-CoV-2 Vaccination |
| title | Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitis |
| title_full | Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitis |
| title_fullStr | Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitis |
| title_full_unstemmed | Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitis |
| title_short | Hepatitis B reactivation: A possible cause of coronavirus disease 2019 vaccine induced hepatitis |
| title_sort | hepatitis b reactivation a possible cause of coronavirus disease 2019 vaccine induced hepatitis |
| topic | Autoimmune hepatitis Drug induced liver injury Hepatitis B SARS-CoV-2 Vaccination |
| url | http://www.sciencedirect.com/science/article/pii/S0929664623002358 |
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