LB10. Changing Epidemiology of Hepatitis A Virus Infections–– United States, 2007–2017

Abstract Background Hepatitis A virus (HAV) is primarily spread fecal-orally and causes acute illness including fever, jaundice, and diarrhea. After introduction and widespread use of the hepatitis A vaccine in the United States, infection with HAV decreased and outbreaks typically associated with a common-source were uncommon. Method CDC receives reports of hepatitis A infections from states through the National Notifiable Disease Surveillance System (NNDSS) and/or directly to the viral hepatitis outbreak response team. We analyzed NNDSS hepatitis A data for 2007–2016, and a combination of NNDSS data and cases directly reported to the CDC hepatitis A outbreak response team during 2017; excluding 2017 NNDSS data from the four states that directly reported outbreaks to the outbreak response team to eliminate the potential for double-counting cases. Result During 2007–2011, a total of 10,619 hepatitis A cases were reported; 521 (5%) were associated with outbreaks. Of the 274 outbreak-associated cases for whom clinical data were reported, 102 (37%) were hospitalized and one (0.3%) died. Of the 407 outbreak-associated cases for whom risk exposure data were reported, 210 (52%) were associated with a common source. Comparatively, during 2012–2017, a total of 11,483 hepatitis A cases were reported; 2,323 (20%) were associated with outbreaks. Of the outbreak-associated cases for whom clinical data were reported, 1,306/2,162 (60%) were hospitalized and 43/2,178 (2%) died. Of the outbreak-associated cases for whom risk exposure data were reported, 379/2,188 (17%) were associated with a common source. Conclusion In the United States, outbreaks of hepatitis A infections in the decade prior to 2017 were infrequent and typically associated with a common source. Reported cases associated with hepatitis A outbreaks are increasing, along with concurrent increases in hospitalizations and deaths among persons with outbreak-associated infections. Recent outbreaks indicate a decrease in cases associated with a common-source exposure. Decreasing the susceptible population through adherence to childhood vaccination recommendations and targeted vaccination of recommended at-risk groups can prevent future hepatitis A outbreaks of any transmission pattern. Disclosures All authors: No reported disclosures.

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Hepatitis A virus infections associated with clotting factor concentrate in the United States

Transfusion ◽

10.1046/j.1537-2995.1998.38698326337.x ◽

1998 ◽

Vol 38 (6) ◽

pp. 573-579 ◽

Cited By ~ 78

Author(s):

JM Soucie ◽

BH Robertson ◽

BP Bell ◽

KA McCaustland ◽

BL Evatt

Keyword(s):

United States ◽

Hepatitis A ◽

Hepatitis A Virus ◽

The United States ◽

Clotting Factor ◽

Virus Infections ◽

Factor Concentrate

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Outbreaks of Shellfish-Associated Enteric Virus Illness in the United States: Requisite for Development of Viral Guidelines

Journal of Food Protection ◽

10.4315/0362-028x-48.9.815 ◽

1985 ◽

Vol 48 (9) ◽

pp. 815-823 ◽

Cited By ~ 79

Author(s):

GARY P. RICHARDS

Keyword(s):

United States ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Enteric Virus ◽

The United States ◽

Viral Gastroenteritis ◽

Norwalk Virus ◽

Virus Contamination ◽

Pathogenic Viruses

Outbreaks of hepatitis A, Norwalk illness, and nonspecific viral gastroenteritis are associated with consumption of sewage-contaminated shellfish. Over 100 outbreaks have been reported in the United States during the past 50 years. Reported cases of shellfish-associated enteric virus illness are on the increase, whereas bacterial illness from shellfish is on the decline. As yet, there are no procedures for detecting hepatitis A virus, Norwalk virus and numerous other pathogenic viruses in environmental samples, but virus extraction and assay procedures for water and shellfish are available for the more easily cultivated enteric viruses. Current standards rely on bacterial indicators as a means to evaluate the sanitary quality of shellfish and their growing waters, but the adequacy of using bacteria as indicators of possible virus contamination is questionable. The feasibility of employing enteroviruses or rotaviruses as possible viral indiators is discussed. It is proposed that easily cultivated enteroviruses, such as poliovirus, be used as an interim indicator for the possible presence of human pathogenic viruses in seafoods, with the subsequent formulation of guidelines to limit the levels of virus contamination in shellfish.

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Viral Hepatitis A

10.2310/em.14068 ◽

2021 ◽

Author(s):

Kenrad E Nelson ◽

Brittany L Kmush

Keyword(s):

United States ◽

Acute Hepatitis ◽

Injection Drug Users ◽

Drug Users ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Severe Disease ◽

The United States ◽

Childhood Immunization ◽

Effective Prevention

Epidemics of infectious jaundice have been reported throughout recorded history. However, the proof that many of these outbreaks and individual cases of acute hepatitis were caused by a viral infection, the hepatitis A virus (HAV), did not appear until the 1960s. After the transmission of infection to marmosets and humans, the epidemiologic and virologic characteristics that differed between hepatitis A and hepatitis B virus infections were defined more clearly. After the development and licensure of hepatitis A vaccines in the 1990s, it became possible to implement an effective prevention program involving routine immunization of young children in the United States and several other Western countries. However, despite the dramatic efficacy of the childhood immunization program in reducing the incidence of acute hepatitis from HAV in the population, older children and adults remained susceptible. Significant morbidity continues to occur in the United States among international travelers, injection drug users, persons with underlying liver disease, and other high-risk populations. Since HAV is a global pathogen, the prevention of increasing morbidity from hepatitis A attributable to the incidence of clinically more severe disease increases in countries transitioning from high to intermediate or low endemic status is a major public health challenge. In this review, we discuss the epidemiology, virology, clinical characteristics, and prevention of hepatitis A infections. This review contains 8 figures, 3 tables and 89 references Key words: epidemiology, global impact, hepatitis A vaccine, hepatitis A virus, prevention, reservoirs, risk factors, treatment

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Hepatitis A Virus Transmission by Blood Products in the United States

Vox Sanguinis ◽

10.1159/000462666 ◽

1994 ◽

Vol 67 (1) ◽

pp. 24-28 ◽

Cited By ~ 2

Author(s):

James W. Mosley ◽

Marek J. Nowicki ◽

Carol K. Kasper ◽

Elizabeth Donegan ◽

Louis M. Aledort ◽

...

Keyword(s):

United States ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Virus Transmission ◽

The United States ◽

Blood Products

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Susceptibility to Hepatitis A Virus Infection in the United States, 2007–2016

Clinical Infectious Diseases ◽

10.1093/cid/ciaa298 ◽

2020 ◽

Vol 71 (10) ◽

pp. e571-e579 ◽

Cited By ~ 2

Author(s):

Shaoman Yin ◽

Laurie Barker ◽

Kathleen N Ly ◽

Greta Kilmer ◽

Monique A Foster ◽

...

Keyword(s):

United States ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Risk Groups ◽

The United States ◽

Poverty Level ◽

Health And Nutrition ◽

National Immunization ◽

Vaccination Recommendations ◽

Sex With Men

Abstract Background Despite national immunization efforts, including universal childhood hepatitis A (HepA) vaccination recommendations in 2006, hepatitis A virus (HAV)–associated outbreaks have increased in the United States. Unvaccinated or previously uninfected persons are susceptible to HAV infection, yet the susceptibility in the US population is not well known. Methods Using National Health and Nutrition Examination Survey 2007–2016 data, we estimated HAV susceptibility prevalence (total HAV antibody negative) among persons aged ≥2 years. Among US-born adults aged ≥20 years, we examined prevalence, predictors, and age-adjusted trends of HAV susceptibility by sociodemographic characteristics. We assessed HAV susceptibility and self-reported nonvaccination to HepA among risk groups and the “immunization cohort” (those born in or after 2004). Results Among US-born adults aged ≥20 years, HAV susceptibility prevalence was 74.1% (95% confidence interval, 72.9–75.3%) during 2007–2016. Predictors of HAV susceptibility were age group 30–49 years, non-Hispanic white/black, 130% above the poverty level, and no health insurance. Prevalences of HAV susceptibility and nonvaccination to HepA, respectively, were 72.9% and 73.1% among persons who reported injection drug use, 67.5% and 65.2% among men who had sex with men, 55.2% and 75.1% among persons with hepatitis B or hepatitis C, and 22.6% and 25.9% among the immunization cohort. Susceptibility and nonvaccination decreased over time among the immunization cohort but remained stable among risk groups. Conclusions During 2007–2016, approximately three-fourths of US-born adults remained HAV susceptible. Enhanced vaccination efforts are critically needed, particularly targeting adults at highest risk for HAV infection, to mitigate the current outbreaks.

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