The Diverse Patterns of Hepatitis A Epidemiology in the United States—Implications for Vaccination Strategies

• Published in: The Journal of infectious diseases Vol. 178; no. 6; pp. 1579 - 1584
• Main Authors: Bell, Beth P., Shapiro, Craig N., Alter, Miriam J., Moyer, Linda A., Judson, Franklyn N., Mottram, Karen, Fleenor, Michael, Ryder, Patricia L., Margolis, Harold S.
• Format: Journal Article
• Language: English
• Published: Chicago, IL University Chicago Press 01.12.1998; University of Chicago Press; Oxford University Press
• Subjects: Adolescent; Adult; Alabama - epidemiology; Biological and medical sciences; Child; Child, Preschool; Day care; Day care centers; Diseases; Epidemics; Epidemiology; Ethnic Groups - statistics & numerical data; Female; Florida - epidemiology; Fundamental and applied biological sciences. Psychology; Hepatitis A; Hepatitis A - epidemiology; Hepatitis A - immunology; Hepatitis A - prevention & control; Hepatitis A Vaccines; Hepatitis A Virus, Human - immunology; Hospitalization; Humans; Incidence; Infections; Major Article; Male; Male homosexuality; Microbiology; Notifiable diseases; Risk Factors; United States - epidemiology; Vaccination; Vaccination - methods; Viral Hepatitis Vaccines; Virology; Washington - epidemiology; United States; North America; America; Alabama; Florida; Washington; Human; Prevalence; Hepatitis A virus; Picornaviridae; Hepatic disease; Vaccine; Epidemiology; Hepatovirus; Infection; Virus; Viral hepatitis A; Follow up study; Viral disease; Risk factor; Race; Digestive diseases; Age
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/314518

Hepatitis A is the most frequently reported vaccine-preventable disease in the United States. Hepatitis A incidence and risk factors during 1983–1995 were examined among cases reported to the study's Sentinel Counties: Denver County, Colorado; Pierce County, Washington; Jefferson County, Alabama; and Pinellas County, Florida. Of 4897 serologically confirmed cases, 611 patients (13%) were hospitalized and 9 (0.2%) died. The average incidence was 14.7/100,000 (range, 0.6–100.7/100,000, depending on county and year). The frequency of reported sources of infection varied by county, but the largest single group overall (52%) did not report a source. During 3-year communitywide outbreaks in Denver (1991–1993) and Pierce (1987–1989) Counties, rates increased 4- and 13-fold, respectively, and increased in all age, racial/ethnic, and risk groups. During communitywide outbreaks, hepatitis A is not limited to specific risk groups; sustained nationwide reductions in incidence are more likely to result from routine childhood vaccination than from targeted vaccination of high-risk groups.