Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: In the United States, the dramatic declines in the incidence of hepatitis A among children and their close contacts have resulted in changes in the epidemiologic profile of this disease, including a shift in the distribution of cases by age, race, and region, as well as changes in the frequency of potential sources of infection as reported in national surveillance data.
The large community-wide outbreaks that were driven by infections among children and transmission within households and extended family settings, previously accounting for the majority of cases in the United States, have become rare. A declining proportion of cases report sexual or household contact with another case or potential exposure through attendance in child day care.1 As sources of local, community-based transmission have been reduced, an increasing proportion of the cases that continue to occur are in high-risk groups such as international travelers.
Wasley A, Bell B. Declining Incidence of Hepatitis A—Reply. JAMA. 2006;295(3):282. doi:10.1001/jama.295.3.282-b