What You Should Know About Vaccines and NASH

Somehow, vaccines have become a very divisive and political topic. However, if you weed through the noise, you’ll find a wealth of evidence-based research that highlights the benefits of vaccines. Beyond antibiotics, little else has changed health the way vaccines have. Over the last 100 years, our life spans have increased by 2 to 3 decades. We also have fewer virus-related disabilities like hearing or vision loss or paralysis.¹

As a healthcare provider, I see that people typically think about vaccines as being an important part of health for the very young and the very old. However, those with complicated health diagnoses also need vaccines to reduce the risk of complications from viruses like the flu, pneumonia, and shingles. This includes those living with chronic liver disease, like nonalcoholic steatohepatitis (NASH).²

Your liver and your immune system

The immune system is how your body keeps you healthy. It plays a part in killing off pathogens such as viruses, bacteria, foreign materials (things your body doesn’t recognize), and even your own cells that are not growing/working correctly. The liver stores important immune cells and proteins. Nearly 30 percent of your body’s blood passes through your liver every minute. The liver also has a role in digestion and gut function.³

Because of your liver’s high exposure to both your immune and digestive systems, it is great at screening for and destroying pathogens – even if it hasn’t been exposed to that particular one before. Below are some of the common vaccines recommended for people with chronic liver disease and the reasons I find them important for people living with NASH.³

Vaccine-prevented infections and your liver

It is important to talk to your provider about the recommended vaccines you may need. For most people, getting vaccinated can lower the risk of severe infections and complications from viral illness. Like any health decision, you and your provider should review the vaccine risks and benefits that are specific to you.⁴

Influenza (flu) vaccine

Influenza (flu) is a respiratory infection. Studies have found that people with chronic liver disease have a higher risk of severe influenza infections and death. Even with timely treatment, the rate of death and other complications, such as liver inflammation and bacterial infections, was higher. The yearly, inactivated flu vaccine is recommended for people with chronic liver disease.²

Pneumococcal vaccine

Pneumococcal infections are most often caused by Streptococcus pneumoniae (S. pneumoniae). S. pneumoniae can create infections in your blood, lungs, brain, and nervous system. Research shows that people with chronic liver disease have nearly double the risk of developing serious pneumococcal infections, though some studies suggest rates are even higher than that. In fact, S. pneumoniae is the most common cause of pneumonia in those with chronic liver disease, whether you have cirrhosis or not.²

The PPSV23 vaccine is recommended for those under 65 who have chronic liver disease. If you are older than 65, you need an additional injection of PPSV23, and potentially the PCV13 pneumococcal vaccine as well.²

COVID-19 vaccine

Studies have shown people with chronic liver disease, and especially those with cirrhosis, have a higher risk of complications and death from COVID-19 infections. There are a variety of COVID-19 vaccines and boosters available. A yearly dose of the COVID-19 vaccine is recommended for people with chronic liver disease.²

Hepatitis A and B vaccines

If you already have a liver condition like NASH, getting an additional liver infection like hepatitis can be hard on your liver. In some cases, it can create a higher risk for cirrhosis or liver cancers. Unfortunately, hepatitis A and B vaccines may not provide as much protection for people with chronic liver disease as they do for people without liver disease. Regardless, hepatitis A and B vaccines are still recommended. They come in a combined injection or separately. These vaccines often require 2 to 3 doses.²

Herpes zoster (shingles) vaccine

At this time, chronic liver disease does not appear to increase your risk of developing herpes zoster (shingles). However, older age is one of the biggest risk factors for shingles. For that reason, people over the age of 50 with chronic liver disease are encouraged to get the two-dose Shingrix vaccine.²

Tdap (tetanus, diphtheria, pertussis) vaccine

Often called the tetanus vaccine, this vaccine lowers the risk of developing tetanus, diphtheria, and pertussis (whooping cough). While some of these illnesses, like whooping cough, are often thought of as childhood illnesses, they can happen at any age. Tdap vaccine recommendations for people with chronic liver disease are the same as those for the general population, with a booster recommended every 10 years.²

Again, it's important to speak with your own healthcare provider about the risks and benefits of vaccines.