High-risk adults need increased hepatitis A vaccination

Interventions to increase vaccination against hepatitis A virus (HAV) infection are needed to maintain the progress made in preventing HAV-related mortality, according to findings published in the 2017 issue of the National Cancer Institute. Morbidity and Mortality Weekly Report.

Researchers from the U.S. Centers for Disease Control and Prevention (CDC) examined mortality associated with HAV outbreaks using unidentified demographic, risk factor, and clinical data. Data for this analysis came from state health department outbreak databases, all of which reported at least one death related to an HAV outbreak between August 2016 and October 2022. An outbreak-related death is defined as a death determined by state health department officials to be attributable to: Hepatitis A virus infection. CDC researchers also reviewed death certificates to determine whether hepatitis A virus infection was the cause of death or a significant contributor to death.

The final analysis included data on 315 HAV outbreak-related deaths from 27 state agencies. Among outbreak-related deaths that occurred between September 2016 and June 2022, 73.0% were male, 84.0% were non-Hispanic white, and the median age at death was 55 years.

Drug use is the most common risk factor for HAV infection, with 41% of outbreak-related deaths recorded. Additionally, 16% of pandemic-related deaths were among people experiencing homelessness or unstable housing.

Although hepatitis A is usually a self-limiting and preventable disease, it can have fatal consequences when it is introduced into populations with limited access to preventive care…

Further analysis of deaths related to the hepatitis A epidemic showed that hepatitis C virus co-infection rates were higher than hepatitis B virus (31.0% and 12.0%, respectively). Overall, vaccination against HAV infection was recorded in only 12 (4.0%) outbreak-related deaths, whereas evidence of vaccination was recorded in 63% of outbreak-related deaths.

Of the 164 death certificates in which HAV infection was documented, HAV infection was noted as the cause of death in 142 (87.0%) and as an important cause of death in 26 (16.0%).

Limitations of this analysis include the lack of a uniform definition of HAV-related mortality, the possibility of unknown outbreak-related deaths, the use of self-reported data, and insufficient data on HAV vaccination status.

“Although hepatitis A is generally a self-limited and preventable disease, if introduced into a population with limited access to preventive care, it can have fatal consequences…” the researchers said.

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