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Wasley A, Samandari T, Bell BP. Incidence of Hepatitis A in the United States in the Era of Vaccination. JAMA. 2005;294(2):194–201. doi:https://doi.org/10.1001/jama.294.2.194
Author Affiliations: Division of Viral Hepatitis
(Drs Wasley, Samandari, and Bell) and Epidemic Intelligence Service, Epidemiology
Program Office (Dr Samandari), Centers for Disease Control and Prevention,
Atlanta, Ga. Dr Samandari is now with BOTUSA, Division of Tuberculosis Elimination,
Centers for Disease Control and Prevention, Republic of Botswana, Africa.
Context In the United States, hepatitis A is a frequently reported vaccine-preventable
disease. Vaccination has been recommended for persons at increased risk since
1996. In 1999, it was recommended that children living in 11 states with the
highest incidence of hepatitis A be routinely vaccinated, and that children
living in 6 additional states, with incidence above the national average,
be considered for routine vaccination.
Objective To assess impact of the current vaccination strategy by evaluating trends
in reported cases of hepatitis A since implementation.
Design, Setting, and Cases A longitudinal analysis of characteristics of cases of hepatitis A reported
in the United States since 1990 to the National Notifiable Diseases Surveillance
Main Outcome Measure Incidence rates of reported cases of hepatitis A. Incidence rates in
2003 were compared with those for the prevaccination baseline period (1990-1997)
overall and in the 17 states in which children should be routinely vaccinated
or considered for routine vaccination (vaccinating states). Incidence rates
in vaccinating states were also compared with those in the remaining states
where there is no recommendation for statewide vaccination of children (nonvaccinating
Results Between the baseline period (1990-1997) and 2003, overall hepatitis
A rates declined 76% to 2.6 per 100 000, significantly lower than previous
nadirs in 1983 (9.2/100 000) and 1992 (9.1/100 000). The rate in
vaccinating states declined 88% to 2.5 per 100 000 compared with 53%
elsewhere (to 2.7/100 000). In 2003, cases from vaccinating states accounted
for 33% of the national total vs 65% during the baseline period. Declines
were greater among children aged 2 to 18 years (87%) than among persons older
than age 18 years (69%); the proportion of cases in children dropped from
35% to 19%. Since 2001, rates in adults have been higher than among children,
with the highest rates now among men aged 25 through 39 years.
Conclusions Following implementation of routine hepatitis A vaccination of children,
hepatitis A rates have declined to historic lows, accompanied by substantial
changes in the epidemiologic profile. Greater decreases in the age groups
and regions where routine vaccination of children is recommended likely reflect
the results of implementation of this novel vaccination strategy. Continued
monitoring is needed to verify that implementation continues to proceed and
that low rates are sustained.
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