AASLD專家組共識聲明：預防肝病患者的COVID-19感染疫苗

StephenW

AASLD EXPERT PANEL CONSENSUS STATEMENT: VACCINES TO PREVENT COVID-19 INFECTION IN PATIENTS WITH LIVER DISEASE

LINK…..
NEW! Download AASLD's Expert Panel Consensus Statement Vaccines to Prevent COVID-19 Infection in Patients with Liver Disease. [Updated: February 2, 2021]

All healthcare workers should be prioritized for the COVID-19 vaccine (Phase 1a). •Patients with comorbidities identified as high risk by the CDC, including CLD, should be prioritized for vaccination (Phase 1c).78

Excerpts

CONCLUSION

Since the identification of the SARS-CoV-2 genome in January 2020, remarkable progress has been made in the development of two highly effective and generally safe mRNA vaccines for COVID-19. The CDC currently recommends that all adults over the age of 18 should receive these 2-dose vaccines according to the manufacturers’ recommendations to prevent future COVID-19. Pre- and post-vaccination serological testing is not recommended due to the absence of studies regarding their impact on outcomes. Due to their mechanism of action, both mRNA COVID-19 vaccines are recommended for all patients with CLD (compensated or decompensated) and immunosuppressed SOT recipients. The AASLD recommends that providers advocate for prioritizing patients with compensated or decompensated cirrhosis or liver cancer, patients receiving immunosuppression such as SOT recipients, and living liver donors for COVID-19 vaccination based upon local health policies, protocols, and vaccine availability. The clinical impact of SARS-CoV-2 viral variants is a rapidly evolving area, and until further studies are available, COVID-19 vaccination should not be withheld or deferred in any patient because of efficacy or safety concerns. All COVID-19 vaccine recipients are recommended to continue social distancing, masking, frequent hand washing, and follow other exposure-mitigating behaviors.

COVID-19 Vaccination in Patients with Chronic Liver Disease

Due to the increased mortality with COVID-19 infection in adult CLD patients and particularly those with cirrhosis, it is recommended that these patients be prioritized for COVID-19 vaccination (Phase 1c). Although safety and efficacy data with the two available mRNA vaccines in CLD patients are limited, adverse events are not anticipated to be more frequent nor is efficacy expected to be lower than the general population; however, additional prospective studies are needed. Although studies of patients with alcohol-associated liver disease suggest they may have worse outcomes with COVID-19,82 it is unknown if vaccination safety or efficacy will differ compared to other CLD patients. If the supply of COVID-19 vaccine is limited, it is reasonable to prioritize patients with higher MELD or CTP scores for vaccination or those who are anticipated to undergo imminent liver transplantation, but all CLD patients should be vaccinated whenever possible.

StephenW

AASLD专家组共识声明：预防肝病患者的COVID-19感染疫苗

链接…..
新！下载AASLD的专家小组共识声明疫苗，以预防肝病患者的COVID-19感染。 [更新：2021年2月2日]

所有医护人员应优先使用COVID-19疫苗（阶段1a）。 •疾病预防控制中心认定患有合并症的高风险患者，包括CLD，应优先接种疫苗（1c阶段）。78

摘录

结论

自2020年1月鉴定出SARS-CoV-2基因组以来，在为COVID-19研制出两种高效且通常安全的mRNA疫苗方面取得了显着进展。美国疾病预防控制中心目前建议，所有18岁以上的成年人都应按照制造商的建议服用2剂疫苗，以防止将来出现COVID-19。不建议在接种前和接种后进行血清学检测，因为目前尚无关于其对结果影响的研究。由于它们的作用机制，两种mRNA COVID-19疫苗均推荐用于所有CLD（代偿或代偿）和免疫抑制的SOT接受者。 AASLD建议提供商根据当地的卫生政策，方案和疫苗使用情况，对患有代偿性或代偿性肝硬化或肝癌的患者，接受免疫抑制的患者（如SOT接受者）和活体肝供体进行COVID-19疫苗接种进行优先处理。 SARS-CoV-2病毒变体的临床影响是一个快速发展的领域，在没有进一步的研究可用之前，由于功效或安全性考虑，任何患者都不应暂停或推迟COVID-19疫苗接种。建议所有COVID-19疫苗接种者继续疏远社交，蒙面，经常洗手并遵循其他减轻接触的行为。

慢性肝病患者的COVID-19疫苗接种

由于成人CLD患者（尤其是肝硬化患者）COVID-19感染死亡率增加，因此建议优先考虑对这些患者进行COVID-19疫苗接种（阶段1c）。尽管在CLD患者中使用两种可用的mRNA疫苗的安全性和有效性数据有限，但预计不良事件不会比一般人群更频繁，疗效也不会比一般人群低。但是，还需要进行其他前瞻性研究。尽管对酒精相关性肝病患者的研究表明，COVID-19可能使他们的结局更糟82，但与其他CLD患者相比，疫苗的安全性或功效是否会有所不同尚不得而知。如果COVID-19疫苗的供应有限，则合理的做法是优先对那些具有更高MELD或CTP评分的患者进行疫苗接种，或者对那些即将进行肝移植的患者进行优先治疗，但应尽可能对所有CLD患者进行疫苗接种。