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. 2015 Jul 15;212(2):176-82.
doi: 10.1093/infdis/jiu834. Epub 2015 Jan 29.

Trends in disease and complications of hepatitis A virus infection in the United States, 1999-2011: a new concern for adults

Kathleen N Ly  1 , R Monina Klevens  1
Affiliations

Trends in disease and complications of hepatitis A virus infection in the United States, 1999-2011: a new concern for adults

Kathleen N Ly et al. J Infect Dis. .

Abstract

Background: In recent years, few US adults have had exposure and resultant immunity to hepatitis A virus (HAV). Further, persons with liver disease have an increased risk of adverse consequences if they are infected with HAV.

Methods: This study used 1999-2011 National Notifiable Diseases Surveillance System and Multiple Cause of Death data to assess trends in the incidence of HAV infection, HAV-related hospitalization, and HAV-related mortality.

Results: During 1999-2011, the incidence of HAV infection declined from 6.0 cases/100 000 to 0.4 cases/100 000. Similar declines were seen by sex and age, but persons aged ≥80 years had the highest incidence of HAV infection in 2011 (0.8 cases/100 000). HAV-related hospitalizations increased from 7.3% in 1999 to 24.5% in 2011. The mean age of hospitalized cases increased from 36.0 years in 1999 to 45.1 years in 2011. While HAV-related mortality declined, the mean age at death among decedents with HAV infection increased from 48.0 years in 1999 to 76.2 years in 2011. The median age range of decedents who had HAV infection and a liver-related condition was 51.0 to 68.0 years.

Conclusions: Although vaccine-preventable, HAV-related hospitalizations increased greatly, mostly among adults, and liver-related conditions were frequently reported among HAV-infected individuals who died. Public health efforts should focus on the need to assess protection from hepatitis A among adults, including those with liver disease.

Keywords: hepatitis A complications; hepatitis A hospitalizations; hepatitis A mortality; hepatitis A trends; hepatitis A virus.

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Conflict of interest statement

Potential conflict of interest. Both authors: No reported conflicts.

Both authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Hepatitis A incidence, by sex and year—United States, 1999–2011. Data are from the National Notifiable Diseases Surveillance System [13] and the US Census Bureau [20].
Figure 2.
Figure 2.
Hepatitis A incidence, by age group and year—United States, 1999–2011. Data are from the National Notifiable Diseases Surveillance System [13] and the US Census Bureau [20].
Figure 3.
Figure 3.
Hepatitis A–related hospitalizations and hepatitis A—related deaths, by year—United States, 1999–2011. Data are from the National Notifiable Diseases Surveillance System [13].
Figure 4.
Figure 4.
Mean age of individuals with hepatitis A–related hospitalizations and hepatitis A–related deaths, by year—United States, 1999–2011. Data are from the National Notifiable Diseases Surveillance System (NNDSS) [13] and the National Vital Statistics System [14].
Figure 5.
Figure 5.
Hepatitis A–related mortality incidence, by year—United States, 1999–2011. Data are from the National Vital Statistics System [14] and the US Census Bureau [20].
See this image and copyright information in PMC

Comment in

References

    1. Centers for Disease Control and Prevention. Surveillance for viral hepatitis—United States, 2011. http://www.cdc.gov/hepatitis/Statistics/2011Surveillance/index.htm. Accessed 14 November 2013.
    1. Collier M, Khudyakov Y, Delvage S, et al. Outbreak of hepatitis A in the USA associated with frozen pomegranate arils imported from Turkey: an epidemiological case study. Lancet Infect Dis 2014; 14:976–81. - PubMed
    1. Wheeler C, Vogt T, Armstrong G, et al. An outbreak of hepatitis A associated with green onions. N Engl J Med 2005; 353:890–7. - PubMed
    1. Dentinger C, Bower W, Nainan O, et al. An outbreak of hepatitis A associated with green onions. J Infect Dis 2001; 183:1273–6. - PubMed
    1. Hutin Y, Pool V, Cramer E, et al. A multistate, foodborne outbreak of hepatitis A. National Hepatitis A Investigation Team. N Engl J Med 1999; 340:595–602. - PubMed

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