Hepatitis A historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Historical Perspective
Prevaccine Era
Hepatitis A epidemiology in the United States has fundamentally changed with licensure of hepatitis A vaccine and implementation of national ACIP recommendations for its use. Before vaccine licensure during 1995-1996, hepatitis A incidence was primarily cyclic, with peaks occurring every 10-15 years. In the United States, during 1980-1995, approximately 22,000-36,000 hepatitis A cases were reported annually to CDC (rate: 9.0-14.5 cases per 100,000 population), but incidence models indicate that the number of infections was substantially higher.[1][2] One such analysis estimated an average of 271,000 infections per year during 1980-1999, representing 10.4 times the reported number of cases.[1] Each year in the United States, an estimated 100 persons died as a result of acute liver failure attributed to hepatitis A.
The costs associated with hepatitis A are substantial. Surveillance data indicate that 11%-22% of persons with hepatitis A are hospitalized.[3] The average duration of work loss for adults who become ill has been estimated at 15.5 days for nonhospitalized patients and 33.2 days for hospitalized patients.[4] Estimates of the annual direct and indirect costs of hepatitis A in the United States have ranged from $300 million to $488.8 million in 1997 dollars.[5][4] A recent Markov model analysis estimated economic costs of $133.5 million during the lifetime of a single age cohort of children born in 2005, in the absence of vaccination.
Sources of Infection
In the prevaccine era, the majority of U.S. cases of hepatitis A resulted from person-to-person transmission of HAV during communitywide outbreaks.[6][7] The most frequently reported source of infection (in 12%-26% of cases) was household or sexual contact with a person with hepatitis A.[8] Cyclic outbreaks occurred among users of injection and noninjection drugs and among men who have sex with men (MSM),[9][10][11][12][13] and up to 15% of nationally reported cases occurred among persons reporting one or more of these behaviors. Other potential sources of infection (e.g., international travel and recognized foodborne outbreaks) were reported among 3%--6% of cases.[8] For approximately 50% of persons with hepatitis A, no source was identified for their infection.
Vaccine Era
With the licensure of inactivated hepatitis A vaccines by the Food and Drug Administration (FDA) during 1995-1996, hepatitis A became a disease that was not only common but also vaccine-preventable. Since 1996, and particularly since ACIP's 1999 recommendations for routine vaccination of children living in areas with consistently elevated hepatitis A rates, national hepatitis A rates have declined sharply.[14] The 1999 recommendations called for routine vaccination of children living in states and communities in which the average hepatitis A rate during a baseline period of 1987-1997 was >20 cases per 100,000 population, approximately twice the national average, and for consideration of hepatitis A vaccination of children in those states and communities in which the average rate during the baseline period was at least the national average.[15]
In 2004, a total of 5,683 cases (rate: 1.9 cases per 100,000 population) were reported, representing an estimated 24,000 acute clinical cases when underreporting is taken into account. This rate was the lowest ever recorded and was 79% lower than the previously recorded low in 1992.[16] This decline is reflected in other fundamental shifts in hepatitis A epidemiology.
References
- ↑ 1.0 1.1 Armstrong GL, Bell BP (2002). "Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization". Pediatrics. 109 (5): 839–45. PMID 11986444. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ CDC. Hepatitis surveillance. Report no. 61. Atlanta, GA: US Department of Health and Human Services, CDC. 2006
- ↑ CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-12):1-37
- ↑ 4.0 4.1 Berge JJ, Drennan DP, Jacobs RJ, Jakins A, Meyerhoff AS, Stubblefield W, Weinberg M (2000). "The cost of hepatitis A infections in American adolescents and adults in 1997". Hepatology (Baltimore, Md.). 31 (2): 469–73. doi:10.1002/hep.510310229. PMID 10655272. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-12):1-37
- ↑ Bell BP, Shapiro CN, Alter MJ, Moyer LA, Judson FN, Mottram K, Fleenor M, Ryder PL, Margolis HS (1998). "The diverse patterns of hepatitis A epidemiology in the United States-implications for vaccination strategies". The Journal of Infectious Diseases. 178 (6): 1579–84. PMID 9815207. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ CDC. Communitywide outbreaks of hepatitis A. Hepatitis surveillance. Report no. 51. Atlanta, GA: US Department of Health and Human Services, CDC; 1987:6-8.
- ↑ 8.0 8.1 Shapiro CN, Coleman PJ, McQuillan GM, Alter MJ, Margolis HS (1992). "Epidemiology of hepatitis A: seroepidemiology and risk groups in the USA". Vaccine. 10 Suppl 1: S59–62. PMID 1476001.
|access-date=requires|url=(help) - ↑ Cotter SM, Sansom S, Long T, Koch E, Kellerman S, Smith F, Averhoff F, Bell BP (2003). "Outbreak of hepatitis A among men who have sex with men: implications for hepatitis A vaccination strategies". The Journal of Infectious Diseases. 187 (8): 1235–40. doi:10.1086/374057. PMID 12696002. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Harkess J, Gildon B, Istre GR (1989). "Outbreaks of hepatitis A among illicit drug users, Oklahoma, 1984-87". American Journal of Public Health. 79 (4): 463–6. PMC 1349976. PMID 2929804. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Schade CP, Komorwska D (1988). "Continuing outbreak of hepatitis A linked with intravenous drug abuse in Multnomah County". Public Health Reports (Washington, D.C. : 1974). 103 (5): 452–9. PMC 1478131. PMID 3140269.
|access-date=requires|url=(help) - ↑ Hutin YJ, Bell BP, Marshall KL, Schaben CP, Dart M, Quinlisk MP, Shapiro CN (1999). "Identifying target groups for a potential vaccination program during a hepatitis A communitywide outbreak". American Journal of Public Health. 89 (6): 918–21. PMC 1508638. PMID 10358687. Unknown parameter
|month=ignored (help);|access-date=requires|url=(help) - ↑ Vong S, Fiore AE, Haight DO, Li J, Borgsmiller N, Kuhnert W, Pinero F, Boaz K, Badsgard T, Mancini C, Nainan OV, Wiersma S, Bell BP (2005). "Vaccination in the county jail as a strategy to reach high risk adults during a community-based hepatitis A outbreak among methamphetamine drug users". Vaccine. 23 (8): 1021–8. doi:10.1016/j.vaccine.2004.07.038. PMID 15620475. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ Wasley A, Samandari T, Bell BP (2005). "Incidence of hepatitis A in the United States in the era of vaccination". JAMA : the Journal of the American Medical Association. 294 (2): 194–201. doi:10.1001/jama.294.2.194. PMID 16014593. Retrieved 2012-02-28. Unknown parameter
|month=ignored (help) - ↑ CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-12):1-37.
- ↑ CDC. Hepatitis surveillance. Report no. 61. Atlanta, GA: US Department of Health and Human Services, CDC. 2006