OBJECTIVES
The incidence of hepatitis A declined in the United States following the introduction of hepatitis A vaccines, before increasing in the setting of recent widespread outbreaks associated with person-to-person transmission. We describe the hepatitis A epidemiology in the United States, identify susceptible populations over time, and demonstrate the need for improved hepatitis A vaccination coverage, especially among adults at increased risk for hepatitis A.
METHODS
We calculated the hepatitis A incidence rates for sociodemographic characteristics and percentages for risk factors and clinical outcomes for hepatitis A cases reported to the National Notifiable Diseases Surveillance System during 1990-2020. We generated nationally representative estimates and 95% CIs of hepatitis A seroprevalence during 1976-March 2020 and self-reported hepatitis A vaccination coverage during 1999-March 2020 for the noninstitutionalized civilian US population using data from the National Health and Nutrition Examination Survey.
RESULTS
Overall, the rate per 100 000 population of reported cases of hepatitis A virus infection in the United States declined 17.3-fold, from 10.4 during 1990-1998 to 0.6 during 2007-2015, and then increased to 2.8 during 2016-2020. The overall hepatitis A seroprevalence in the United States increased from 38.2% (95% CI, 36.2%-40.1%) during 1976-1980 to 47.3% (95% CI, 45.4%-49.2%) during 2015-March 2020. The prevalence of self-reported hepatitis A vaccination coverage in the United States increased more than 2.5-fold, from 16.3% (95% CI, 15.0%-17.7%) during 1999-2006 to 41.9% (95% CI, 40.2%-43.7%) during 2015-March 2020.
CONCLUSIONS
Hepatitis A epidemiology in the United States changed substantially during 1976-2020. Improved vaccination coverage, especially among adults recommended for vaccination by the Advisory Committee on Immunization Practices, is vital to stop current hepatitis A outbreaks associated with person-to-person transmission in the United States and prevent similar future recurrences.
[1]
J. Xing,et al.
Hepatitis A person-to-person outbreaks: Epidemiology, morbidity burden, and factors associated with hospitalization - Multiple States, 2016-2019.
,
2020,
The Journal of infectious diseases.
[2]
Noele P. Nelson,et al.
Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, 2020
,
2020,
MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.
[3]
G. Xia,et al.
Hepatitis Awareness Month and Testing Day — May 2019
,
2019,
Morbidity and Mortality Weekly Report.
[4]
Noele P. Nelson,et al.
Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness
,
2019,
MMWR. Morbidity and mortality weekly report.
[5]
D. Thoroughman,et al.
Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness — California, Kentucky, Michigan, and Utah, 2017
,
2018,
MMWR. Morbidity and mortality weekly report.
[6]
Noele P. Nelson,et al.
Progress Toward Eliminating Hepatitis A Disease in the United States.
,
2016,
MMWR supplements.
[7]
M. Denniston,et al.
Decreasing immunity to hepatitis A virus infection among US adults: Findings from the National Health and Nutrition Examination Survey (NHANES), 1999-2012.
,
2015,
Vaccine.
[8]
N. Kemmer,et al.
Hepatitis A.
,
2000,
Infectious disease clinics of North America.