Introduction. Patients with chronic liver disease (CLD) are more likely to have severe morbidity and fatality rate due to superimposed acute or chronic hepatitis B (HBV) infection. The literature has shown that hepatitis B vaccines are safe and effective in patients with CLD, but the data in cirrhosis liver is lacking. We assessed the safety and immunogenicity of HBV vaccine in patients with cirrhosis liver. Methods. CTP classes A and B CLD patients negative for hepatitis B surface antigen and antibody to hepatitis B core antigen were included. All patients received three doses of hepatitis B vaccine 20？mcg intramuscularly at 0, 30, and 60 days. Anti-HBs antibody was measured after 120 days. Results. 52 patients with mean age years were studied. Response rates in CTP classes A and B were 88% and 33.3%. We observed that the alcoholic chronic liver disease had less antibody response (44%) than other causes of chronic liver disease such as cryptogenic 69% and HCV 75%. Conclusions. Patients with cirrhosis liver will have low antibody hepatitis B titers compared to general population. As the age and liver disease progress, the response rate for hepatitis B vaccination will still remain to be weaker. 1. Introduction Globally, chronic HBV infection affects over 350 million people, and up to 40% of these cases may progress to cirrhosis, liver failure, or hepatocellular carcinoma [1]. Chronic liver disease [CLD] contributes to approximately 400000 hospitalizations and nearly 30,000 deaths annually worldwide [2, 3]. When compared with patients without liver disease, patients with CLD are more likely to have severe complications and also severe fatality rate due to superimposed acute or chronic HBV infection. Both acute and chronic coinfections with HBV can be prevented by HBV vaccination [4, 5]. Strong epidemiological evidence suggests an increased occurrence of fulminant liver failure, cirrhosis and hepatocellular carcinoma in patients with HBV, and HCV coinfection [6, 7]. HBV vaccination is safe and well tolerated and has high seroconversion rates in patients with mild to moderate CLD but has reduced efficacy in advanced liver disease and after liver transplantation [8–17]. To minimize the occurrence of HBV infection in CLD, a variety of organizations have recommended HBV vaccination for these patients [18, 19]. The immune response to HBV vaccines among patients with CLD varies from 70% to 90%. Hence in evaluating HBV vaccination in patients with cirrhosis liver, three questions need to be answered: (1) who needs vaccination? And (2) is the vaccination safe?
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