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Hofmeister MG, Ly KN, Yin S, Spradling PR. Evolving Characteristics of Decedents With Hepatitis A Listed as a Cause of Death, United States, 2011-2021. J Viral Hepat 2024; 31:783-794. [PMID: 39225298 PMCID: PMC11809443 DOI: 10.1111/jvh.14002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/02/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Hepatitis A is a vaccine-preventable disease that typically causes mild illness. Hepatitis A outbreaks associated with person-to-person transmission have been widespread in the United States since 2016. We used public-use US Multiple Cause of Death data to compare characteristics and listed comorbidities among decedents with hepatitis A-listed deaths during non-outbreak (2011-2015) and outbreak (2017-2021) periods and assessed the median age at death among decedents with and without hepatitis A-listed deaths during the outbreak period. From the non-outbreak period to the outbreak period, hepatitis A-listed deaths more than doubled (from 369 to 801), while the hepatitis A-listed age-adjusted mortality rate increased 150% (p < 0.001). When compared with the non-outbreak period, hepatitis A-listed decedents during the outbreak period were more frequently male, aged 18-49 years, non-Hispanic White, died in an inpatient setting, and had hepatitis A listed as their underlying cause of death. The median age at death for hepatitis A-listed decedents was significantly younger during the outbreak period overall and among females (62 and 66 years, respectively) compared with the non-outbreak period (64 and 72 years, respectively, p < 0.001). During the outbreak period, median age at death for hepatitis A-listed decedents was 14 years younger than decedents without hepatitis A listed. Compared with the general US population, decedents with hepatitis A listed on the death certificate died at younger ages during 2017-2021. Efforts are needed to improve hepatitis A vaccination coverage among adults recommended for hepatitis A vaccination to prevent additional premature hepatitis A deaths.
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Affiliation(s)
- Megan G Hofmeister
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen N Ly
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shaoman Yin
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip R Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Zulli A, Chan EMG, Boehm AB. Detection of Hepatovirus A (HAV) in wastewater indicates widespread national distribution and association with socioeconomic indicators of vulnerability. mSphere 2024; 9:e0064524. [PMID: 39475316 PMCID: PMC11580403 DOI: 10.1128/msphere.00645-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 10/08/2024] [Indexed: 11/22/2024] Open
Abstract
Wastewater-based epidemiology, which seeks to assess disease occurrence in communities through measurements of infectious disease biomarkers in wastewater, may represent a valuable tool for understanding the occurrence of hepatitis A infections in communities. In this study, we measured concentrations of Hepatovirus A (HAV) RNA, in samples from 191 wastewater treatment plants spanning 40 US states and the District of Columbia from September 2023 to June 2024 and compared the measurements with traditional measures of disease occurrence. Nationally, 13.76% of the 21,079 wastewater samples were positive for HAV RNA, and both concentrations and positivity rates were associated with NNDSS hepatitis A case data nationally (Kendall rank correlation coefficient = 0.20, concentrations; and 0.33, positivity rate; both P < 0.05). We further demonstrated that higher rates of wastewater HAV detection were positively associated with socioeconomic indicators of vulnerability including homelessness and drug overdose deaths (both P < 0.0001). Areas with above average levels of homelessness were 48% more likely to have HAV wastewater detections, while areas with above average levels of drug overdose deaths were 14% more likely to have HAV wastewater detections. Using more granular case data, we present a case study in the state of Maine that reinforces these results and suggests a potential lead time for wastewater over clinical case detection and exposure events. The ability to detect HAV RNA in wastewater before clinical cases emerge could allow public health officials to implement targeted interventions like vaccination campaigns.IMPORTANCEDespite the existence of a highly effective vaccine for hepatitis A, outbreaks in vulnerable populations remain common. The disease can be asymptomatic or subclinical, and disproportionately impacts populations with inadequate access to healthcare, leading to a severe underestimation of the occurrence of this viral infection. This study investigates the potential for wastewater measurements of biomarkers of the causative agent of hepatitis A (HAV RNA) to provide insights into disease occurrence. Results highlight the potential for wastewater-based epidemiology to be a complementary tool to traditional surveillance for monitoring and controlling HAV transmission.
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Affiliation(s)
- Alessandro Zulli
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California, USA
| | - Elana M. G. Chan
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California, USA
| | - Alexandria B. Boehm
- Department of Civil and Environmental Engineering, Stanford University, Stanford, California, USA
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Sileci AC, Cioffi CC, Trevino S, Fernandes L, Capron CG, Mauricio AM. Colocation of COVID-19 Vaccination Services at Syringe Service Programs for People Who Inject Drugs and People Experiencing Houselessness in Oregon. Public Health Rep 2024:333549241271720. [PMID: 39248220 PMCID: PMC11556581 DOI: 10.1177/00333549241271720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
OBJECTIVES Integrating vaccination services with other essential health services could increase vaccination rates among socially marginalized populations. We examined the associations between colocation of vaccines at syringe service programs and COVID-19 vaccination status among people who inject drugs and people experiencing houselessness. METHODS This study included 1891 participants aged ≥18 years at 9 sites in Oregon from July 2021 through March 2022. Participants self-reported whether they had ever received ≥1 dose of a COVID-19 vaccine. We calculated site-level COVID-19 vaccine availability and overall vaccination rates. We compared site-level vaccination rates and analyzed the association between vaccine availability and vaccination status. RESULTS We found no significant difference in vaccination rates between sites that did and did not offer COVID-19 vaccines (t7 = -0.33; P = .75). We also found no significant association between vaccine availability and vaccination status. However, the odds of having received a COVID-19 vaccine were 2.79 times higher for each additional site visit during which COVID-19 vaccines were available (odds ratio [OR] = 2.79; 95% CI, 2.18-3.58; P < .001). The association between vaccine availability and vaccine status was not moderated by participant age (OR = 1.03; 95% CI, 0.99-1.07; P = .13) or housing instability (OR = 0.59; 95% CI, 0.13-2.60; P = .48). CONCLUSIONS Colocating COVID-19 vaccines at syringe service programs was only positively associated with vaccination status if vaccines were offered frequently on-site. Future work should examine whether the frequency of offering vaccination services increases willingness to engage in vaccination and examine trust and convenience as potential mechanisms.
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Affiliation(s)
| | | | - Shaina Trevino
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
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Srivastava P, Modi V, Lier AJ. Sexually Transmitted Infection (STI) Incidence, STI Screening, and Human Immunodeficiency Virus Preexposure Prophylaxis Uptake in United States Veterans With Opioid Use Disorder in Long Island, New York. Open Forum Infect Dis 2024; 11:ofae429. [PMID: 39086462 PMCID: PMC11289836 DOI: 10.1093/ofid/ofae429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024] Open
Abstract
Background Opioid use disorder (OUD) confers increased risk of contracting bloodborne and sexually transmitted infections (STIs). Limited data exist on infectious disease screening and preexposure prophylaxis (PrEP) usage among United States Veterans (USVs) with OUD, including persons who inject drugs (PWID). This study aimed to evaluate the epidemiology of human immunodeficiency virus (HIV), hepatitis C virus (HCV), bacterial STIs, and PrEP uptake in USVs with OUD, including PWID. Methods A retrospective chart review of USVs with OUD seeking care at Northport Veterans Affairs Medical Center between 2012 and 2022 was completed. Sociodemographics, HIV, HCV, STI testing rates and diagnosis, and PrEP uptake were compared between USVs, stratified by injection drug use history. Results We identified 502 USVs with OUD; 43% had a history of injection drug use. Overall, 2.2% of USVs had HIV and 28.7% had HCV. An STI was diagnosed in 10% of USVs, most frequently syphilis (1.8%). PWID were more likely to be tested for HIV (93.5% PWID vs. 73.1% non-PWID; P < .001), HCV (95.8% PWID vs. 80.8% non-PWID; P < .001), and syphilis (80% PWID vs. 69.2% non-PWID; P = .006). Total gonorrhea and chlamydia testing rates were 31.9% and 33.7%, respectively, without difference between the groups. PrEP was prescribed in 1.2% of USVs. Conclusions In USVs with OUD, gonorrhea and chlamydia screening occurred less frequently than syphilis, HCV, and HIV. PWID were more likely to be screened for HIV, HCV, and syphilis. PrEP uptake was low. Both PWID and non-PWID may benefit from increased STI screening and linkage to PrEP.
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Affiliation(s)
- Pronoma Srivastava
- Department of Internal Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Viraj Modi
- Department of Medicine, Northport Veterans Affairs Medical Center, Northport, New York, USA
| | - Audun J Lier
- Department of Medicine, Northport Veterans Affairs Medical Center, Northport, New York, USA
- Division of Infectious Diseases, Department of Medicine, Northport Veterans Affairs Medical Center, Northport, New York, USA
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Horn EK, Herrera-Restrepo O, Acosta AM, Simon A, Jackson B, Lucas E. The Burden of Hepatitis A Outbreaks in the United States: Health Outcomes, Economic Costs, and Management Strategies. J Infect Dis 2024; 230:e199-e218. [PMID: 39052742 PMCID: PMC11272058 DOI: 10.1093/infdis/jiae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Hepatitis A (HepA) vaccines are recommended for US adults at risk of HepA. Ongoing United States (US) HepA outbreaks since 2016 have primarily spread person-to-person, especially among at-risk groups. We investigated the health outcomes, economic burden, and outbreak management considerations associated with HepA outbreaks from 2016 onwards. METHODS A systematic literature review was conducted to assess HepA outbreak-associated health outcomes, health care resource utilization (HCRU), and economic burden. A targeted literature review evaluated HepA outbreak management considerations. RESULTS Across 33 studies reporting on HepA outbreak-associated health outcomes/HCRU, frequently reported HepA-related morbidities included acute liver failure/injury (n = 6 studies of 33 studies) and liver transplantation (n = 5 of 33); reported case fatality rates ranged from 0% to 10.8%. Hospitalization rates reported in studies investigating person-to-person outbreaks ranged from 41.6% to 84.8%. Ten studies reported on outbreak-associated economic burden, with a national study reporting an average cost of over $16 000 per hospitalization. Thirty-four studies reported on outbreak management; challenges included difficulty reaching at-risk groups and vaccination distrust. Successes included targeted interventions and increasing public awareness. CONCLUSIONS This review indicates a considerable clinical and economic burden of ongoing US HepA outbreaks. Targeted prevention strategies and increased public awareness and vaccination coverage are needed to reduce HepA burden and prevent future outbreaks.
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Price O, Swanton R, Grebely J, Hajarizadeh B, Webb P, Peacock A, Dore GJ, Cowie BC, Vickerman P, Degenhardt L. Vaccination coverage among people who inject drugs: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104382. [PMID: 38503233 DOI: 10.1016/j.drugpo.2024.104382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND People who inject drugs may be at excess risk of acquiring vaccine-preventable diseases and negative associated health outcomes, but experience barriers to vaccination. We aimed to determine vaccination coverage among people who inject drugs globally. METHODOLOGY We conducted systematic searches of the peer-reviewed and grey literature, date limited from January 2008 to August 2023, focusing on diseases for which people who inject drugs are at elevated risk for and for which an adult vaccination dose is recommended (COVID-19, hepatitis A, hepatitis B, human papillomavirus, influenza, pneumococcal disease, tetanus). To summarise available data, we conducted a narrative synthesis. RESULTS We included 78 studies/reports comprising 117 estimates of vaccination coverage across 36 countries. Most estimates were obtained from high income countries (80%, n=94). We located estimates for hepatitis B vaccination in 33 countries, which included 18 countries with data on serological evidence of vaccine-derived hepatitis B immunity (range: 6-53%) and 22 countries with self-report data for vaccine uptake (<1-96%). Data for other vaccines were scarcer: reported hepatitis A vaccination coverage ranged 3-89% (five countries), COVID-19 ranged 4-84% (five countries), while we located estimates from fewer than five countries for influenza, tetanus, pneumococcal disease, and human papillomavirus. CONCLUSION Estimates were sparse but where available indicative of suboptimal vaccination coverage among people who inject drugs. Improving the consistency, timeliness, and geographic coverage of vaccine uptake data among this population is essential to inform efforts to increase uptake.
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Affiliation(s)
- Olivia Price
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
| | - Rosie Swanton
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | | | | | - Paige Webb
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | | | - Benjamin C Cowie
- Department of Infectious Diseases, University of Melbourne, Melbourne, Australia; WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
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Yang J, Lo NC, Dankwa EA, Donnelly CA, Gupta R, Montgomery MP, Weng MK, Martin NK. Determining Herd Immunity Thresholds for Hepatitis A Virus Transmission to Inform Vaccination Strategies Among People Who Inject Drugs in 16 US States. Clin Infect Dis 2024; 78:976-982. [PMID: 37738564 PMCID: PMC11006109 DOI: 10.1093/cid/ciad552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Widespread outbreaks of person-to-person transmitted hepatitis A virus (HAV), particularly among people who inject drugs (PWID), continue across the United States and globally. However, the herd immunity threshold and vaccination coverage required to prevent outbreaks are unknown. We used surveillance data and dynamic modeling to estimate herd immunity thresholds among PWID in 16 US states. METHODS We used a previously published dynamic model of HAV transmission calibrated to surveillance data from outbreaks involving PWID in 16 states. Using state-level calibrated models, we estimated the basic reproduction number (R0) and herd immunity threshold for PWID in each state. We performed a meta-analysis of herd immunity thresholds to determine the critical vaccination coverage required to prevent most HAV outbreaks among PWID. RESULTS Estimates of R0 for HAV infection ranged from 2.2 (95% confidence interval [CI], 1.9-2.5) for North Carolina to 5.0 (95% CI, 4.5-5.6) for West Virginia. Corresponding herd immunity thresholds ranged from 55% (95% CI, 47%-61%) for North Carolina to 80% (95% CI, 78%-82%) for West Virginia. Based on the meta-analysis, we estimated a pooled herd immunity threshold of 64% (95% CI, 61%-68%; 90% prediction interval, 52%-76%) among PWID. Using the prediction interval upper bound (76%) and assuming 95% vaccine efficacy, we estimated that vaccination coverage of 80% could prevent most HAV outbreaks. CONCLUSIONS Hepatitis A vaccination programs in the United States may need to achieve vaccination coverage of at least 80% among PWID in order to prevent most HAV outbreaks among this population.
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Affiliation(s)
- Judy Yang
- Division of Infectious Diseases and Global Public Health, University of California–San Diego, La Jolla, California, USA
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Emmanuelle A Dankwa
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Christl A Donnelly
- Department of Statistics, University of Oxford, Oxford, United Kingdom
- Medical Research Council Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Ribhav Gupta
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Martha P Montgomery
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark K Weng
- Division of Viral Hepatitis, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California–San Diego, La Jolla, California, USA
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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K AK, Mahesh Y, Panwar J, Gupta S. Remediation of multifarious metal ions and molecular docking assessment for pathogenic microbe disinfection in aqueous solution by waste-derived Ca-MOF. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:21545-21567. [PMID: 38393560 DOI: 10.1007/s11356-024-32311-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
The present study demonstrates an eco-friendly and cost-effective synthesis of calcium terephthalate metal-organic frameworks (Ca-MOF). The Ca-MOF were composed of metal ions (Ca2+) and organic ligands (terephthalic acid; TPA); the former was obtained from egg shells, and the latter was obtained from processing waste plastic bottles. Detailed characterization using standard techniques confirmed the synthesis of Ca-MOF with an average particle size of 461.9 ± 15 nm. The synthesized Ca-MOF was screened for its ability to remove multiple metal ions from an aqueous solution. Based on the maximum sorption capacity, Pb2+, Cd2+, and Cu2+ ions were selected for individual parametric batch studies. The obtained results were interpreted using standard isotherms and kinetic models. The maximum sorption capacity (qm) obtained from the Langmuir model was found to be 644.07 ± 47, 391.4 ± 26, and 260.5 ± 14 mg g-1 for Pb2+, Cd2+, and Cu2+, respectively. Moreover, Ca-MOF also showed an excellent ability to remove all three metal ions simultaneously from a mixed solution. The metal nodes and bonded TPA from Ca-MOF were dissociated by the acid dissolution method, which protonated and isolated TPA for reuse. Further, the crystal structure of Ca-MOF was prepared and docked with protein targets of selected pathogenic water-borne microbes, which showed its disinfection potential. Overall, multiple metal sorption capability, regeneration studies, and broad-spectrum antimicrobial activity confirmed the versatility of synthesized Ca-MOF for industrial wastewater treatment.
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Affiliation(s)
- Anil Kumar K
- Department of Chemical Engineering, Birla Institute of Technology and Science, Pilani, 333031, India
| | - Yeshwanth Mahesh
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jitendra Panwar
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, 333031, India
| | - Suresh Gupta
- Department of Chemical Engineering, Birla Institute of Technology and Science, Pilani, 333031, India.
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Satybaldiyeva N, Martinez LS, Cooper B, Oren E. The Association between Message Framing and Intention to Vaccinate Predictive of Hepatitis A Vaccine Uptake. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:207. [PMID: 38397696 PMCID: PMC10888360 DOI: 10.3390/ijerph21020207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
As ongoing, sporadic outbreaks of hepatitis A virus (HAV) infections present public health challenges, it is critical to understand public perceptions about HAV, especially regarding vaccination. This study examines whether message framing changes the intention to vaccinate against HAV and self-reported vaccine behavior. Using a randomized controlled trial (N = 472) in February 2019 via Amazon Mechanical Turk, participants were randomized to one of four HAV vaccination message groups or a no-message control group. The message groups varied in their emphasis on the nature of outcomes (gain versus loss) and for whom (individual versus collective). The message frames were compared by intention to vaccinate, differences in message characteristics, and behavioral determinants. There was no difference in intention to vaccinate between gain- versus loss-framed messages (MD = 0.1, 95% CI = -0.1, 0.3) and individual- versus collective-framed messages (MD = 0.1, 95% CI = -0.1, 0.3). The intention to vaccinate against HAV in the no-message control group was very similar to that in the message groups. However, gain-framed messages were rated more positively in valence than loss-framed messages (MD = -0.5, 95% CI = -0.7, -0.3), which may be helpful for cultivating a positive public perception of HAV vaccination. The study also highlights the importance of comparing message frames to a no-message control in designing health communication messaging promoting HAV vaccination.
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Affiliation(s)
- Nora Satybaldiyeva
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (N.S.); (B.C.)
| | - Lourdes S. Martinez
- School of Communication, San Diego State University, San Diego, CA 92182, USA;
| | - Brittany Cooper
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (N.S.); (B.C.)
| | - Eyal Oren
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA; (N.S.); (B.C.)
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Wasuwanich P, So JM, Rajborirug S, Karnsakul W. Hepatitis A hospitalisations in the United States and risk factors for inpatient mortality: A nationwide population study, 1998-2020. J Viral Hepat 2024; 31:88-95. [PMID: 38062864 DOI: 10.1111/jvh.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 01/18/2024]
Abstract
Hepatitis A virus infections in the United States have been declining; however, recent widespread outbreaks have brought the disease back into the spotlight. We aim to describe the epidemiology of hepatitis A hospitalisations from 1998 to 2020 in the United States and investigate risk factors for inpatient mortality. We utilised the National Inpatient Sample database and identified hepatitis A-related hospitalisations using ICD-9 and ICD-10 diagnosis codes. Demographic and clinical data including death, coinfections, comorbidities and pregnancy status were extracted. Data were analysed by logistic and Poisson regression. We identified a total of 213,681 hepatitis A-related hospitalisations between 1998 and 2020, with hospitalisation rates ranging between 22.4 per 1,000,000 and 62.9 per 1,000,000. Between 1998 and 2015, the hospitalisation rate for hepatitis A was decreasing (IRR = 0.98; 95% CI: 0.97-0.98; p < .001); however, between 2015 and 2020, it increased overall (IRR = 1.22; 95% CI: 1.21-1.23; p < .001). The overall inpatient mortality rate was 2.7%. Age ≥55 years (OR = 1.84; 95% CI: 1.41-2.40; p < .001), alcoholic cirrhosis (OR = 2.53; 95% CI: 1.64-3.90; p < .001), ascites (OR = 2.65; 95% CI: 1.86-3.78; p < .001), hepatorenal syndrome (OR = 9.04; 95% CI: 5.93-13.80; p < .001), heart failure (OR = 1.76; 95% CI: 1.29-2.39; p < .001), pulmonary hypertension (OR = 2.02; 95% CI: 1.28-3.19; p = .003) and malignant neoplasm (OR = 1.75; 95% CI: 1.25-2.45; p = .001) were associated with increased odds of mortality. Tobacco use disorder (OR = 0.52; 95% CI: 0.38-0.70; p < .001) was associated with decreased odds of mortality. None of the hepatitis A-associated hospitalisations involving pregnant women resulted in death. Hepatitis A hospitalisations initially declined but increased rapidly after 2015. Certain risk factors can be used to predict prognosis of hospitalised patients.
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Affiliation(s)
- Paul Wasuwanich
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Joshua M So
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Songyos Rajborirug
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wikrom Karnsakul
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Zufan SE, Mercoulia K, Kwong JC, Judd LM, Howden BP, Seemann T, Stinear TP. High-performance enrichment-based genome sequencing to support the investigation of hepatitis A virus outbreaks. Microbiol Spectr 2024; 12:e0283423. [PMID: 38018979 PMCID: PMC10783085 DOI: 10.1128/spectrum.02834-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/14/2023] [Indexed: 11/30/2023] Open
Abstract
IMPORTANCE This proof-of-concept study introduces a hybrid capture oligo panel for whole-genome sequencing of all six human pathogenic hepatitis A virus (HAV) subgenotypes, exhibiting a higher sensitivity than some conventional genotyping assays. The ability of hybrid capture to enrich multiple targets allows for a single, streamlined workflow, thus facilitating the potential harmonization of molecular surveillance of HAV with other enteric viruses. Even challenging sample matrices can be accommodated, making them suitable for broad implementation in clinical and public health laboratories. This innovative approach has significant implications for enhancing multijurisdictional outbreak investigations as well as our understanding of the global diversity and transmission dynamics of HAV.
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Affiliation(s)
- Sara E. Zufan
- The Center for Pathogen Genomics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Karolina Mercoulia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jason C. Kwong
- Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Louise M. Judd
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Doherty Applied Microbial Genomics, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Benjamin P. Howden
- The Center for Pathogen Genomics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Torsten Seemann
- The Center for Pathogen Genomics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Timothy P. Stinear
- The Center for Pathogen Genomics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Streifel AC, Rivera Sarti JE, Sikka MK, Conte M, Winders B, Varley CD. Fixing a Hole: a retrospective cohort study evaluating HAV, HBV, tetanus screening, and vaccination during hospitalization in persons who use substances. Ther Adv Infect Dis 2024; 11:20499361241245822. [PMID: 38681966 PMCID: PMC11055482 DOI: 10.1177/20499361241245822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Background Rates of serious injection-related infections in persons who use drugs have increased. Resulting admissions are an opportunity for screening and vaccination of preventable infections such as hepatitis A virus (HAV), hepatitis B virus (HBV), and tetanus. Design and methods We conducted a retrospective review of adults with documented substance use admitted for bacterial infection between July 2015 and March 2020. We evaluated HAV, HBV, and tetanus vaccination status at admission, along with screening for HAV and HBV infection and immunity. We identified the proportion of patients at risk for infection who received HAV, HBV, and tetanus vaccines during admission and patient-level factors associated with vaccination. Results We identified 280 patients who met our inclusion criteria. Of the 198 (70.7%) patients at risk for HAV, infectious disease providers recommended vaccination for 21 (10.6%) and 15 (7.6%) received HAV vaccine. Of the 174 (62.1%) patients at risk for HBV, infectious disease providers recommended vaccination for 32 (18.3%) and 25 (14.4%) received HBV vaccine. A large proportion of patients (31.4%, 88) had no documentation of prior tetanus vaccination, and infectious disease providers recommended tetanus vaccination for three (1.1%) and five patients (1.8%) received a tetanus booster. Infectious disease consult vaccine recommendations were statistically significantly associated with HAV or HBV vaccination prior to discharge. Conclusion Over 70% of our population is at risk for one or more of these preventable infections. Efforts are needed to maximize inpatient screening and vaccination for HAV, HBV, and tetanus in patients with barriers to care.
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Affiliation(s)
- Amber C. Streifel
- Department of Pharmacy, Oregon Health & Science University, Portland, OR, USA
| | - Jose Eduardo Rivera Sarti
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Monica K. Sikka
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Michael Conte
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Bradie Winders
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Cara D. Varley
- School of Medicine, Division of Infectious Diseases, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mailcode L457, Portland, OR 97239-3098, USA
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
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13
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Van Damme P, Pintó RM, Feng Z, Cui F, Gentile A, Shouval D. Hepatitis A virus infection. Nat Rev Dis Primers 2023; 9:51. [PMID: 37770459 DOI: 10.1038/s41572-023-00461-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
Hepatitis A is a vaccine-preventable infection caused by the hepatitis A virus (HAV). Over 150 million new infections of hepatitis A occur annually. HAV causes an acute inflammatory reaction in the liver that usually resolves spontaneously without chronic sequelae. However, up to 20% of patients experience a prolonged or relapsed course and <1% experience acute liver failure. Host factors, such as immunological status, age, pregnancy and underlying hepatic diseases, can affect the severity of disease. Anti-HAV IgG antibodies produced in response to HAV infection persist for life and protect against re-infection; vaccine-induced antibodies against hepatitis A confer long-term protection. The WHO recommends vaccination for individuals at higher risk of infection and/or severe disease in countries with very low and low hepatitis A virus endemicity, and universal childhood vaccination in intermediate endemicity countries. To date, >25 countries worldwide have implemented such programmes, resulting in a reduction in the incidence of HAV infection. Improving hygiene and sanitation, rapid identification of outbreaks and fast and accurate intervention in outbreak control are essential to reducing HAV transmission.
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Affiliation(s)
- Pierre Van Damme
- Centre for the Evaluation of Vaccination, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Rosa M Pintó
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Zongdi Feng
- Centre for Vaccines and Immunity, The Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Angela Gentile
- Department of Epidemiology, Hospital de Niños Ricardo Gutierrez, University of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Shouval
- Institute of Hepatology, Hadassah-Hebrew University Hospital, Jerusalem, Israel
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14
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Dennett JM, Gonsalves GS. Early OxyContin Marketing Linked To Long-Term Spread Of Infectious Diseases Associated With Injection Drug Use. Health Aff (Millwood) 2023; 42:1081-1090. [PMID: 37467441 PMCID: PMC10521060 DOI: 10.1377/hlthaff.2023.00146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
The initial marketing of the opioid analgesic OxyContin in 1996 increased fatal drug overdoses over the course of the opioid epidemic in the US. However, the long-term impacts of this marketing on complications of injection drug use, a key feature of the ongoing crisis, are undetermined. This study evaluated the effects of exposure to initial OxyContin marketing on the long-term trajectories of injection drug use-related outcomes in the US. We used a difference-in-differences analysis to compare outcomes in states with high versus low exposure to initial marketing before and after the 2010 reformulation of OxyContin, which facilitated the use of illicit drugs and the spread of infectious disease. Exposure to initial OxyContin marketing statistically significantly increased rates of fatal synthetic opioid-related overdoses; acute hepatitis A, B, and C viral infections; and infective endocarditis-related deaths. The greatest burden of adverse long-term outcomes has been in states that experienced the highest exposure to early OxyContin marketing. Our findings indicate that OxyContin marketing decisions from the mid-1990s increased viral and bacterial complications of injection drug use and illicit opioid-related overdose deaths twenty-five years later.
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15
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Nolan NS, Fracasso Francis SM, Marks LR, Beekmann SE, Polgreen PM, Liang SY, Durkin MJ. Harm Reduction: A Missing Piece to the Holistic Care of Patients Who Inject Drugs. Open Forum Infect Dis 2023; 10:ofad402. [PMID: 37593531 PMCID: PMC10428197 DOI: 10.1093/ofid/ofad402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023] Open
Abstract
Background The rise in injection drug use (IDU) has led to an increase in drug-related infections. Harm reduction is an important strategy for preventing infections among people who inject drugs (PWID). We attempted to evaluate the harm reduction counseling that infectious diseases physicians provide to PWID presenting with infections. Methods An electronic survey was distributed to physician members of the Emerging Infections Network to inquire about practices used when caring for patients with IDU-related infections. Results In total, 534 ID physicians responded to the survey. Of those, 375 (70%) reported routinely caring for PWID. Most respondents report screening for human immunodeficiency virus (HIV) and viral hepatitis (98%) and discussing the risk of these infections (87%); 63% prescribe immunization against viral hepatitis, and 45% discuss HIV preexposure prophylaxis (PrEP). However, 55% of respondents (n = 205) reported not counseling patients on safer injection strategies. Common reasons for not counseling included limited time and a desire to emphasize antibiotic therapy/medical issues (62%), lack of training (55%), and believing that it would be better addressed by other services (47%). Among respondents who reported counseling PWID, most recommended abstinence from IDU (72%), handwashing and skin cleansing before injection (62%), and safe disposal of needles/drug equipment used before admission (54%). Conclusions Almost all ID physicians report screening PWID for HIV and viral hepatitis and discussing the risks of these infections. Despite frequently encountering PWID, fewer than half of ID physicians provide safer injection advice. Opportunities exist to standardize harm reduction education, emphasizing safer injection practices in conjunction with other strategies to prevent infections (eg, HIV PrEP or hepatitis A virus/hepatitis B virus vaccination).
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Affiliation(s)
- Nathanial S Nolan
- Division of Infectious Disease, VA St Louis Health Care, St Louis, Missouri, USA
- Division of Infectious Disease, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Laura R Marks
- Division of Infectious Disease, Washington University School of Medicine, St Louis, Missouri, USA
| | - Susan E Beekmann
- Division of Infectious Disease, Carver College of Medicine, Iowa City, Iowa, USA
| | - Philip M Polgreen
- Division of Infectious Disease, Carver College of Medicine, Iowa City, Iowa, USA
| | - Stephen Y Liang
- Division of Infectious Disease, Washington University School of Medicine, St Louis, Missouri, USA
- Department of Emergency Medicine, Washington University School of Medicine, St Louis Missouri, USA
| | - Michael J Durkin
- Division of Infectious Disease, Washington University School of Medicine, St Louis, Missouri, USA
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16
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Ali F, Kaura A, Russell C, Bonn M, Bruneau J, Dasgupta N, Imtiaz S, Martel-Laferrière V, Rehm J, Shahin R, Elton-Marshall T. Identifying barriers and facilitators to COVID-19 vaccination uptake among People Who Use Drugs in Canada: a National Qualitative Study. Harm Reduct J 2023; 20:99. [PMID: 37516836 PMCID: PMC10387201 DOI: 10.1186/s12954-023-00826-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, and disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making. METHODS Between March and October 2022, semi-structured interviews with PWUD across Canada were conducted. Fully vaccinated (2 or more doses) and partially or unvaccinated (1 dose or less) participants were recruited from a convenience sample to participate in telephone interviews to discuss facilitators, barriers, and concerns about receiving COVID-19 vaccines and subsequent boosters, and ways to address concerns. A total of 78 PWUD participated in the study, with 50 participants being fully vaccinated and 28 participants partially or unvaccinated. Using thematic analysis, interviews were coded based on the capability, opportunity, and motivation-behavior (COM-B) framework. RESULTS Many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust toward government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD. CONCLUSION PWLLE should be supported to design tailored information to reduce barriers and address mistrust. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.
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Affiliation(s)
- Farihah Ali
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada.
| | - Ashima Kaura
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Cayley Russell
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montreal, QC, H2X 0A9, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 Boul, Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Nabarun Dasgupta
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Sameer Imtiaz
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, & Institute of Medical Science (IMS), Toronto, Canada
- 1 King's College Circle, University of Toronto, Toronto, ON, M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | | | - Tara Elton-Marshall
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Room 2035, 33 Russell Street, Toronto, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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17
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Fallucca A, Restivo V, Sgariglia MC, Roveta M, Trucchi C. Hepatitis a Vaccine as Opportunity of Primary Prevention for Food Handlers: A Narrative Review. Vaccines (Basel) 2023; 11:1271. [PMID: 37515087 PMCID: PMC10383099 DOI: 10.3390/vaccines11071271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The hepatitis A virus (HAV) is still a leading cause of viral hepatitis worldwide. After a long incubation period, the clinical manifestations range from asymptomatic infection to acute liver failure. The severity of the disease increases with age and pre-existing liver disease. The transmission is mainly via person-to-person contact or ingestion of contaminated food or water. Food contamination can occur at any step of the food chain, especially when infected people handle not-heated or otherwise-treated food. HAV is endemic in low-income countries because of poor sanitary and sociodemographic conditions. The populations of developed countries are highly susceptible, and large outbreaks occur when HAV is introduced from endemic countries due to globalization, travel, and movement of foodstuffs. HAV prevention includes hygiene practices, immunoglobulins, and vaccination. Safe and effective inactivated and live attenuated vaccines are available and provide long-term protection. The vaccine targets are children and subjects at increased risk of HAV exposure or serious clinical outcomes. This review discusses the critical role of food handlers in the spread of HAV and the opportunity for food industry employers to consider food handler immunization a tool to manage both food safety in compliance with HACCP principles and food operators' biologic risk.
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Affiliation(s)
- Alessandra Fallucca
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | | | - Marco Roveta
- Food Hygiene and Nutrition Service, Department of Prevention, Local Health Unit 3, 16142 Genoa, Italy
| | - Cecilia Trucchi
- Food Hygiene and Nutrition Service, Department of Prevention, Local Health Unit 3, 16142 Genoa, Italy
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18
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Hofmeister MG, Yin S, Nelson NP, Weng MK, Gupta N. Trends and Opportunities: Hepatitis A Virus Infection, Seroprevalence, and Vaccination Coverage-United States, 1976-2020. Public Health Rep 2023:333549231184007. [PMID: 37480244 PMCID: PMC11296220 DOI: 10.1177/00333549231184007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
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.
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Affiliation(s)
- Megan G. Hofmeister
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shaoman Yin
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Noele P. Nelson
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark K. Weng
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neil Gupta
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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19
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Hagan LM, Montgomery MP, Lauro PL, Cima M, Stringer G, Kupferman NM, Leapley A, Gandhi AP, Nims D, Iberg Johnson J, Bouton L, Burkholder C, Grilli GA, Kittle T, Hansen K, Sievers MM, Newman AP, Albertson JP, Taylor B, Pietrowski M, Stous S, Qiu-Shultz Z, Jones C, Barbeau B, Nicolai LA, McCombs K, Chan M, Cooley L, Gupta N, Nelson N. Recent Incarceration Among Individuals Infected With Hepatitis A Virus During Person-to-Person Community Outbreaks, United States, 2016-2020. Public Health Rep 2023; 138:619-624. [PMID: 35856418 PMCID: PMC10291163 DOI: 10.1177/00333549221108413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Although many people who are incarcerated have risk factors for hepatitis A virus (HAV) infection, the proportion of hepatitis A cases among people with a recent incarceration is unknown. We examined the relationship between recent incarceration and HAV infection during community-based, person-to-person outbreaks to inform public health recommendations. METHODS The Centers for Disease Control and Prevention surveyed health departments in 33 jurisdictions reporting person-to-person HAV outbreaks during 2016-2020 on the number of outbreak-associated cases, HAV-infected people recently incarcerated, and HAV-associated hospitalizations and deaths. RESULTS Twenty-five health departments reported 18 327 outbreak-associated hepatitis A cases during January 11, 2016-January 24, 2020. In total, 2093 (11.4%) HAV-infected people had been recently incarcerated. Of those with complete data, 1402 of 1462 (95.9%) had been held in a local jail, and 1513 of 1896 (79.8.%) disclosed hepatitis A risk factors. Eighteen jurisdictions reported incarceration timing relative to the exposure period. Of 9707 cases in these jurisdictions, 991 (10.2%) were among recently incarcerated people; 451 of 688 (65.6%) people with complete data had been incarcerated during all (n = 55) or part (n = 396) of their exposure period. CONCLUSIONS Correctional facilities are important settings for reaching people with risk factors for HAV infection and can also be venues where transmission occurs. Providing HAV vaccination to incarcerated people, particularly people housed in jails, can be an effective component of community-wide outbreak response.
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Affiliation(s)
- Liesl M. Hagan
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martha P. Montgomery
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Michael Cima
- Arkansas Department of Health, Little Rock, AR, USA
| | - Ginger Stringer
- Colorado Department of Public Health & Environment, Denver, CO, USA
| | - Nikki M. Kupferman
- Division of Public Health, Delaware Department of Health and Social Services, Dover, DE, USA
| | | | - Ami P. Gandhi
- Georgia Department of Public Health, Atlanta, GA, USA
| | - Dawn Nims
- Illinois Department of Public Health, Springfield, IL, USA
| | | | | | - Cole Burkholder
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | | | - Theresa Kittle
- Mississippi State Department of Health, Jackson, MS, USA
| | - Katrina Hansen
- New Hampshire Department of Health and Human Services, Concord, NH, USA
| | | | | | | | | | | | - Sarah Stous
- San Diego County Health and Human Services Agency, San Diego, CA, USA
| | | | | | - Bree Barbeau
- Utah Department of Public Health, Salt Lake City, UT, USA
| | | | | | - Mary Chan
- Washington State Department of Health, Tumwater, WA, USA
| | - Laura Cooley
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Neil Gupta
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Noele Nelson
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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20
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Rich KM, Solomon DA. Medical Complications of Injection Drug Use - Part II. NEJM EVIDENCE 2023; 2:EVIDra2300019. [PMID: 38320028 DOI: 10.1056/evidra2300019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Medical Complications of Injection Drug Use - Part IIDuring the past 2 decades, the risk of death, as well as the prevalence of hospitalizations in the United States, has increased substantially among people who inject drugs, mainly because of the opioid epidemic. In Part Two of this two-part review, the authors review complications observed in people who inject drugs and strategies to reduce harm.
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Affiliation(s)
| | - Daniel A Solomon
- Harvard Medical School, Boston
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston
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21
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Hepatitis A: Viral Structure, Classification, Life Cycle, Clinical Symptoms, Diagnosis Error, and Vaccination. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:4263309. [PMID: 36644336 PMCID: PMC9833905 DOI: 10.1155/2023/4263309] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
Hepatitis A virus (HAV) is one of the well-known viruses that cause hepatitis all around the globe. Although this illness has decreased in developed countries due to extensive immunization, numerous developing and under-developed countries are struggling with this virus. HAV infection can be spread by oral-fecal contact, and there are frequent epidemics through nutrition. Improvements in socioeconomic and sanitary circumstances have caused a shift in the disease's prevalence worldwide. Younger children are usually asymptomatic, but as they become older, the infection symptoms begin to appear. Symptoms range from slight inflammation and jaundice to acute liver failure in older individuals. While an acute infection may be self-limiting, unrecognized persistent infections, and the misapplication of therapeutic methods based on clinical guidelines are linked to a higher incidence of cirrhosis, hepatocellular carcinoma, and mortality. Fortunately, most patients recover within two months of infection, though 10-15% of patients will relapse within the first six months. A virus seldom leads to persistent infection or liver damage. The mainstay of therapy is based on supportive care. All children from 12-23 months, as well as some susceptible populations, should receive routine vaccinations, according to the Centers for Disease Control and Prevention and the American Academy of Pediatrics. Laboratory diagnosis of HAV is based on antigen detection, checking liver enzyme levels, and antibody screening. Furthermore, polymerase chain reaction (PCR) technology has identified HAV in suspected nutrition sources; therefore, this technique is used for preventative measures and food-related laws.
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Kiyohara T, Ishii K, Satake M, Matsubayashi K, Suzuki R, Sugiyama R, Sunagawa T, Muramatsu M. Seroepidemiology of hepatitis A virus infection in Japan: An area of very low endemicity. Microbiol Immunol 2023; 67:14-21. [PMID: 36333781 DOI: 10.1111/1348-0421.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 11/08/2022]
Abstract
The incidence of hepatitis A virus (HAV) infection has declined significantly worldwide, including in Japan. A nationwide seroepidemiological study on hepatitis A in Japan has taken place almost every 10 years since 1973, and the last study was performed in 2003. In the present study, we describe the latest seroepidemiological pattern of hepatitis A in Japan using 7867 serum specimens obtained from healthy individuals collected between 2013 and 2017, approximately 10 years after the last study. Among them, 223 were anti-HAV positive. About 68% of individuals aged 60 years and older had anti-HAV antibodies, whereas only 1.1% of those aged below 60 years old had immunity; thus, almost all individuals younger than 60 years of age were HAV susceptible. In comparison with previous investigations, the susceptible population has increased and aged. According to data from the National Epidemiological Surveillance of Infectious Diseases (NESID) program, between 1989 and 2016, the proportion of patients with hepatitis A aged 60 years and older continuously increased with each year. The NESID data also suggested that recently, typical large foodborne outbreaks of hepatitis A have become rare, and cases tend to be reported among at-risk groups; overseas travelers contributed to 25% of hepatitis A cases, and in 2018, the first nationwide hepatitis A outbreak that affected mostly men who have sex with men was reported. The purpose of this study was to determine the current status of HAV infection in Japan, based on both seroepidemiology and the national surveillance data from the NESID.
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Affiliation(s)
- Tomoko Kiyohara
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koji Ishii
- Department of Quality Assurance and Radiological Protection, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Japanese Red Cross Society, Tokyo, Japan
| | | | - Ryosuke Suzuki
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ryuichi Sugiyama
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Center for Field Epidemic Intelligence, Research and Professional Development, Tokyo, Japan
| | - Masamichi Muramatsu
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
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23
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Frew PM, Schamel JT, Randall LA, King AR, Spaulding AC, Wu E, Holloway IW. Vaccine confidence among people who use drugs: A cross-sectional survey. Hum Vaccin Immunother 2022; 18:2123201. [PMID: 36170655 DOI: 10.1080/21645515.2022.2123201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Adult immunization coverage remains low in the US, particularly for people who use drugs (PWUD), a population that experiences a disproportionate burden of vaccine-preventable diseases. The extent of and characteristics associated with vaccine confidence (VC) held by PWUD is poorly understood. As VC strongly correlates with vaccine uptake, this cross-sectional study identifies mutable factors associated with VC and quantifies its relationship to immunization status within a highly vulnerable, underimmunized population of PWUD. Using a community-engaged research strategy with select partner organizations hosting syringe exchange programs in Atlanta, Los Angeles, and Las Vegas, USA, we surveyed participants ages 18-69 years served by these organizations from 2019 to 2020. Survey measures included sociodemographics, health behavior including immunization receipt, and vaccine confidence in adult vaccinations using a modified Emory Vaccine Confidence Index (EVCI). The findings reflect relatively low VC among the 1,127 recruited participants, with 56% expressing low VC (EVCI 0-12), 35% medium (EVCI 13-20) and 10% high (EVCI 21-24). EVCI varied by city, with lowest confidence in Atlanta and highest in Las Vegas. VC was associated with past receipt of specific vaccines, including hepatitis A, MMR, Tdap, and influenza. VC varied by specific sociodemographic correlates such as housing insecurity (reduced confidence) and receipt of public benefits or disability (increased confidence). This study identified correlates associated with VC based on site and sociodemographic characteristics for this priority population, highlighting the need for specific interventions to raise VC among PWUD, especially among those experiencing housing insecurity and without public benefits.
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Affiliation(s)
- Paula M Frew
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Jay T Schamel
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Laura A Randall
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Adrian R King
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Anne C Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,Southern California HIV/AIDS Policy Research Center, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,UCLA Hub for Health Intervention, Policy, and Practice, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,Southern California HIV/AIDS Policy Research Center, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,UCLA Hub for Health Intervention, Policy, and Practice, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
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24
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Bukhsh MA, Thyagarajan R, Todd B, Chen NW, Qu L, Swaminathan L. An electronic medical record-based intervention to improve hepatitis A vaccination rates in the emergency department during a regional outbreak. BMJ Open Qual 2022; 11:bmjoq-2022-001876. [DOI: 10.1136/bmjoq-2022-001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022] Open
Abstract
BackgroundIn response to the severe hepatitis A outbreak that occurred in Michigan between August 2016 and September 2019, our multihospital health system implemented an electronic medical record (EMR)-based vaccination intervention across its nine emergency departments (EDs). The objectives were to explore the impact of this intervention on increasing vaccination rates among high-risk individuals and to assess the barriers to use of a computerised vaccine reminder system.MethodsAll patients who were 18 years or older were screened using an electronic nursing questionnaire. If a patient was at high risk based on the questionnaire, an electronic best practice advisory (BPA) would trigger and give the physician or advanced practice provider the option to order the hepatitis A vaccine. We explored the vaccination rates in the 24-month preintervention and the 18-month intervention periods. We then administered a survey to physicians, advanced practice providers and nurses evaluating their perceptions and barriers to use of the EMR intervention.ResultsDuring the preintervention period, 49 vaccines were ordered (5.5 per 100 000 patient visits) and 32 were administered (3.6 per 100 000 patient visits). During the intervention period, 574 865 patient visits (74.3%) were screened. 2494 vaccines (322 per 100 000 patient visits) were ordered, and 1205 vaccines (155 per 100 000 patients visits) were administered. Physicians and advanced practice providers were initially compliant with the BPA’s use, but compliance declined over time. Surveys revealed that the major barrier to use was lack of time.ConclusionsEMR screening tools and BPAs can be used in the ED as an effective strategy to vaccinate high-risk individuals. This may be translatable to outbreaks of other vaccine-preventable illnesses like influenza, measles or SARS-CoV-2. Providing ongoing education about the public health initiative and giving feedback to physicians, advanced practice providers and nurses about tool compliance are needed to sustain the improvement over time.
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25
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Foster MA, Hofmeister MG, Yin S, Montgomery MP, Weng MK, Eckert M, Nelson NP, Mermin J, Wester C, Teshale EH, Gupta N, Cooley LA. Widespread Hepatitis A Outbreaks Associated with Person-to-Person Transmission — United States, 2016–2020. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1229-1234. [PMID: 36173747 PMCID: PMC9533732 DOI: 10.15585/mmwr.mm7139a1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Mashhadi A, Khalili M, Moghaddam AA, Zadehmir M. Prognostic Value of Porta-Hepatis Lymphadenopathy in Children with Hepatitis A. J Med Ultrasound 2022; 30:272-276. [PMID: 36844764 PMCID: PMC9944826 DOI: 10.4103/jmu.jmu_196_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/08/2021] [Accepted: 01/27/2022] [Indexed: 12/29/2022] Open
Abstract
Background The present study aimed to investigate the prognostic value of porta-hepatis lymphadenopathy (PHL) in children with hepatitis A virus. Methods The present prospective cohort study included 123 pediatric patients with a definite diagnosis of hepatitis A who were divided into two groups based on the presence or absence of PHL in their abdominal ultrasound: Group A included the patients with a porta-hepatis lymph node of >6 mm in diameter, whereas the patients with a porta-hepatis lymph node of <6 mm in diameter were classified in Group B. The patients were also classified based on the presence or absence of para-aortic lymphadenopathy: Group C had bisecting para-aortic lymph nodes, whereas Group D did not have such findings in their ultrasound. Afterward, the groups were compared in laboratory investigation results and hospital stay. Results According to our results, Group A (n = 57) was significantly higher in aspartate and alanine aminotransferase and alkaline phosphatase levels compared to Group B (P < 0.05), whereas these two groups were not significantly different in the hospital stay. Furthermore, except bilirubin, all laboratory test results were significantly higher in Group C (n = 3) than in Group D. However, there was no significant correlation between the patients' prognosis with the absence or presence of porta-hepatis or para-aortic lymphadenopathy. Conclusion We concluded that there was no significant relationship between porta-hepatis or para-aortic lymphadenopathy and the prognosis of the children with hepatitis A. However, ultrasound findings can help determine the disease severity in pediatric patients with hepatitis A.
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Affiliation(s)
- Amin Mashhadi
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Manijeh Khalili
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, Zahedan University Medical Sciences, Zahedan, Iran
| | - Alireza Ansari Moghaddam
- Health Promotion Research Center, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohadeseh Zadehmir
- Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran,Address for correspondence: Dr. Mohadeseh Zadehmir, Department of Radiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. E-mail:
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27
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Montgomery MP, Zhong Y, Roberts E, Asher A, Bixler D, Doshani M, Christensen A, Eckert M, Weng MK, Carry M, Samuel CR, Teshale EH. Vaccination barriers and opportunities at syringe services programs in the United States, June-August 2021-A cross-sectional survey. Drug Alcohol Depend 2022; 237:109540. [PMID: 35753280 DOI: 10.1016/j.drugalcdep.2022.109540] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Syringe services programs (SSPs) are an important venue for reaching people who inject drugs (PWID) to offer preventive services; however, not all SSPs offer vaccinations. We aimed to describe barriers and opportunities for SSPs to offer vaccinations. METHODS During June-August 2021, we conducted a descriptive, cross-sectional survey of SSP providers in the United States. SSPs were recruited from national listservs using purposive sampling to ensure geographic diversity. The survey included questions about SSP characteristics, client demographics, existing vaccination resources, resource needs, and staff perspectives on client vaccination barriers. Statistical comparisons were made using Pearson's chi-square test. RESULTS In total, 105 SSPs from 34 states responded to the survey; 46 SSPs (43.8%) offered on-site vaccinations. SSPs without on-site vaccinations were more likely operated by community-based organizations (81.4% vs 30.4%, p < 0.001) in urban areas (71.4% vs 40.0%, p = 0.002) than SSPs offering on-site vaccinations. The most common staffing need was for personnel licensed to administer vaccines (74/98, 75.5%). Over half of SSPs reported vaccine supply, administration supplies, storage equipment, and systems to follow-up clients for multidose series as important resource needs. The most common resource need was for reminder/recall systems for vaccines with multidose series (75/92, 81.5%). Vaccine safety concerns (92/95, 96.8%) and competing priorities (92/96, 95.8%) were the most common staff-reported client barriers to vaccinations. CONCLUSIONS Addressing missed opportunities for offering vaccinations to PWID who use SSPs will require increased numbers of on-site personnel licensed to administer vaccines and additional training, vaccination supplies, and storage and handling equipment.
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Affiliation(s)
- Martha P Montgomery
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.
| | - Yuna Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Emma Roberts
- National Harm Reduction Coalition, 22 West 27th Street, 5th Floor, New York, NY 10001, USA
| | - Alice Asher
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Danae Bixler
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Mona Doshani
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Aleta Christensen
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Maribeth Eckert
- Immunization Services Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Mark K Weng
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Monique Carry
- Division of Global HIV & TB, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Christina R Samuel
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA
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28
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Ballard AM, Cooper HLF, Young AM, Caruso BA. 'You feel how you look': Exploring the impacts of unmet water, sanitation, and hygiene needs among rural people experiencing homelessness and their intersection with drug use. PLOS WATER 2022; 1:e0000019. [PMID: 38742171 PMCID: PMC11090493 DOI: 10.1371/journal.pwat.0000019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Existing literature attests to water, sanitation, and hygiene (WASH) inequities among people experiencing homelessness (PEH) in the United States, but there is a dearth of research on such issues in rural areas. Homelessness is an emerging public health concern in rural areas where homelessness is on the rise, infectious disease outbreaks are becoming increasingly common, and PEH face unique WASH-related challenges compared to their urban counterparts. We conducted an exploratory study to understand the impacts of unmet WASH needs among rural PEH and their intersection with drug use through in-depth interviews (n = 10). Eligible participants were 18 years or older, lived in one of five Central Appalachian counties, and had experienced homelessness in the previous six months. Using thematic analysis, we identified factors that inhibit WASH access, and adverse health and well-being outcomes that result from unmet WASH needs. We also explore how WASH experiences compare among rural PEH who self-reported drug use to those who did not. Our findings revealed that factors at multiple levels inhibited WASH access, including stigma and place-based characteristics, which contributed to the adverse physical, mental, and emotional health of PEH. Comparisons between PEH who used drugs to those that did not revealed the intricate relationship between WASH, homelessness, and substance use in communities impacted by the opioid epidemic. Expanded WASH facilities that are safe and available with no prerequisites can address inadequate access among rural PEH and collaboration with harm reduction services may be advantageous to reach those who inject drugs.
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Affiliation(s)
- April M. Ballard
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Hannah L. F. Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - April M. Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, United States of America
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Bethany A. Caruso
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
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29
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Werenski HE, Jay CL, Maves RC. Hepatitis A transmission to two kidney transplant recipients from a shared donor. Transpl Infect Dis 2022; 24:e13857. [PMID: 35595264 DOI: 10.1111/tid.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hope E Werenski
- Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.,Abdominal Organ Transplant Program, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Colleen L Jay
- Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.,Abdominal Organ Transplant Program, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Ryan C Maves
- Abdominal Organ Transplant Program, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA.,Section of Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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30
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Partida D, Powell J, Gonzalez D, Khalili M. Gaps in Hepatitis A and Hepatitis B Vaccination Among Hepatitis C Antibody-Positive Individuals Experiencing Homelessness. Open Forum Infect Dis 2022; 9:ofac175. [PMID: 35531381 PMCID: PMC9070334 DOI: 10.1093/ofid/ofac175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
Vaccination for both hepatitis A (HAV) and hepatitis B (HBV) is recommended in hepatitis C infection (HCV). Among HCV antibody-positive persons experiencing homelessness, we identified high rates of HAV (34%) and HBV vaccine (35%) eligibility, highlighting critical gaps in HCV preventative services. Following education, 54% and 72% underwent HAV and HBV vaccination, respectively.
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Affiliation(s)
- Diana Partida
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jesse Powell
- Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Daniel Gonzalez
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mandana Khalili
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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31
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Miranda-García MA, Hoffelner M, Stoll H, Ruhaltinger D, Cichutek K, Siedler A, Bekeredjian-Ding I. A 5-year look-back at the notification and management of vaccine supply shortages in Germany. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35485267 PMCID: PMC9052770 DOI: 10.2807/1560-7917.es.2022.27.17.2100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundUnavailability of vaccines endangers the overall goal to protect individuals and whole populations against infections.MethodsThe German notification system includes the publication of vaccine supply shortages reported by marketing authorisation holders (MAH), information on the availability of alternative vaccine products, guidance for physicians providing vaccinations and an unavailability reporting tool to monitor regional distribution issues.AimThis study provides a retrospective analysis of supply issues and measures in the context of European and global vaccine supply constraints.Resultsbetween October 2015 and December 2020, the 250 notifications concerned all types of vaccines (54 products). Most shortages were caused by increased demand associated with immigration in Germany in 2015 and 2016, new or extended vaccine recommendations, increased awareness, or changes in global immunisation programmes. Shortages of a duration up to 30 days were mitigated using existing storage capacities. Longer shortages, triggered by high demand on a national level, were mitigated using alternative products and re-allocation; in a few cases, vaccines were imported. However, for long lasting supply shortages associated with increased global demand, often occurring in combination with manufacturing issues, few compensatory mechanisms were available. Nevertheless, only few critical incidents were identified: (i) shortage of hexavalent vaccines endangering neonatal immunisation programmes in 2015;(ii) distribution issues with influenza vaccines in 2018; and (iii) unmet demand for pneumococcal and influenza vaccines during the coronavirus disease (COVID)-19 pandemic.ConclusionVaccine product shortages in Germany resemble those present in neighbouring EU states and often reflect increased global demand not matched by manufacturing capacities.
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Affiliation(s)
| | | | | | | | | | - Anette Siedler
- Robert-Koch-Institut, Department for Infectious Disease Epidemiology, Berlin, Germany
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32
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Nagra N, Kozarek RA, Burman BE. Therapeutic Advances in Viral Hepatitis A-E. Adv Ther 2022; 39:1524-1552. [PMID: 35220557 DOI: 10.1007/s12325-022-02070-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
Viral hepatitis remains a significant global health problem. All forms of viral hepatitis A through E (A-E) can lead to acute symptomatic infection, while hepatitis B and C can lead to chronic infection associated with significant morbidity and mortality related to progression to cirrhosis, end-stage-liver disease, and liver cancer. Viral hepatitis occurs worldwide, though certain regions are disproportionately affected. We now, remarkably, have highly effective curative regimens for hepatitis C, and safe and tolerable medications to suppress hepatitis B activity, and to prevent liver damage and slow disease progression. We have effective vaccines for hepatitis A and B which provide long-lasting immunity, while improved sanitation and awareness can curb outbreaks of hepatitis A and E. However, more effective and available preventive and curative strategies are needed to achieve global eradication of viral hepatitis. This review provides an overview of the epidemiology, transmission, diagnosis, and clinical features of each viral hepatitis with a primary focus on current and future therapeutic and curative options.
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Affiliation(s)
- Navroop Nagra
- Department of Gastroenterology, University of Louisville, Louisville, KY, 40202, USA
| | - Richard A Kozarek
- Center for Digestive Health, Virginia Mason Franciscan Health, 1100 9th Ave., Seattle, WA, 98101, USA
| | - Blaire E Burman
- Center for Digestive Health, Virginia Mason Franciscan Health, 1100 9th Ave., Seattle, WA, 98101, USA.
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33
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LaMori J, Feng X, Pericone CD, Mesa-Frias M, Sogbetun O, Kulczycki A. Hepatitis vaccination adherence and completion rates and factors associated with low compliance: A claims-based analysis of U.S. adults. PLoS One 2022; 17:e0264062. [PMID: 35176102 PMCID: PMC8853527 DOI: 10.1371/journal.pone.0264062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/21/2022] [Indexed: 01/04/2023] Open
Abstract
Poor compliance with multi-dose vaccine schedules by adults for whom hepatitis (Hep) A and B vaccines are recommended contributes to major Hep A and B disease burdens among high-risk U.S. adults. Evidence on hepatitis vaccine series adherence, completion, timeliness of completion, and factors associated with these outcomes, is limited and not readily generalizable for U.S. adults. This retrospective, observational study examined adherence, completion, its timeliness, and the impact of sociodemographic and clinical factors on these outcomes among a large, geographically representative sample of U.S. adults. We analyzed the Optum Clinformatics SES administrative claims database (1/1/2010-6/30/2020) for recipients of 2-dose (HepA, HepB2) or 3-dose (HepB3, HepAB) hepatitis vaccines. Adherence was defined as receipt of booster doses within specified assessment periods, per label-recommended schedules. Completion (receipt of all doses) was assessed at 6, 12, 18, and 24 months.The study included 356,828 adults ≥19 years old who were continuously enrolled in a medical benefit plan for one (HepB2), six (HepB3; HepAB), or 18 months (HepA) prior to and following the index date (first observed vaccine dose). Adherence and 24-month completion rates were: HepA (27.0%, 28.4%), HepB2 (32.2%, 44.8%), HepB3 (14.3%, 37.3%), HepAB, (15.3%, 33.8%). Kaplan-Meier completion curves plateaued after about 6 months for HepB2 and about 12 months for HepA, HepB3, and HepAB vaccines. Logistic regression analyses showed risk for low adherence/completion was generally associated with male gender, younger age, Black or Hispanic race/ethnicity, lower educational or household income attainment, and more comorbidities. Adherence and completion rates for all hepatitis vaccine series are low, especially for males, younger adults, those with lower socio-economic status and more comorbidities. To our knowledge, this is the largest claims-based analysis of adherence and completion rates for U.S. adults initiating all currently available HepA and HepB vaccines. Findings may inform hepatitis vaccination programming.
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Affiliation(s)
- Joyce LaMori
- Janssen Scientific Affairs, Titusville, New Jersey, United States of America
| | - Xue Feng
- Janssen Scientific Affairs, Titusville, New Jersey, United States of America
| | | | - Marco Mesa-Frias
- Janssen Scientific Affairs, Titusville, New Jersey, United States of America
| | - Obiageli Sogbetun
- Janssen Medical Affairs, Titusville, New Jersey, United States of America
| | - Andrzej Kulczycki
- Department of Health Organization & Policy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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34
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Ghaswalla P, Davis K, Sweeney C, Davenport E, Trofa A, Herrera-Restrepo O, Buck PO. Health Care Providers’ Knowledge, Practices, and Barriers to Hepatitis Vaccination Guidelines. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Kozak RA, Rutherford C, Richard-Greenblatt M, Chau NYE, Cabrera A, Biondi M, Borlang J, Day J, Osiowy C, Ramachandran S, Mayer N, Glaser L, Smieja M. Development and Evaluation of a Molecular Hepatitis A Virus Assay for Serum and Stool Specimens. Viruses 2022; 14:v14010159. [PMID: 35062362 PMCID: PMC8777614 DOI: 10.3390/v14010159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/26/2022] Open
Abstract
Hepatitis A virus (HAV) is an emerging public health concern and there is an urgent need for ways to rapidly identify cases so that outbreaks can be managed effectively. Conventional testing for HAV relies on anti-HAV IgM seropositivity. However, studies estimate that 10–30% of patients may not be diagnosed by serology. Molecular assays that can directly detect viral nucleic acids have the potential to improve diagnosis, which is key to prevent the spread of infections. In this study, we developed a real-time PCR (RT-PCR) assay to detect HAV RNA for the identification of acute HAV infection. Primers were designed to target the conserved 5′-untranslated region (5′-UTR) of HAV, and the assay was optimized on both the Qiagen Rotor-Gene and the BD MAX. We successfully detected HAV from patient serum and stool samples with moderate differences in sensitivity and specificity depending on the platform used. Our results highlight the clinical utility of using a molecular assay to detect HAV from various specimen types that can be implemented in hospitals to assist with diagnostics, treatment and prevention.
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Affiliation(s)
- Robert A. Kozak
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (R.A.K.); (N.Y.E.C.)
| | - Candace Rutherford
- St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada; (C.R.); (M.R.-G.)
| | - Melissa Richard-Greenblatt
- St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada; (C.R.); (M.R.-G.)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (N.M.); (L.G.)
| | - N. Y. Elizabeth Chau
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (R.A.K.); (N.Y.E.C.)
| | - Ana Cabrera
- Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada;
| | - Mia Biondi
- Toronto Centre for Liver Disease, University Health Network, Toronto, ON M6H 3M1, Canada;
| | - Jamie Borlang
- National Microbiology Laboratory, Winnipeg, MB R3E 3PG, Canada; (J.B.); (J.D.); (C.O.)
| | - Jaqueline Day
- National Microbiology Laboratory, Winnipeg, MB R3E 3PG, Canada; (J.B.); (J.D.); (C.O.)
| | - Carla Osiowy
- National Microbiology Laboratory, Winnipeg, MB R3E 3PG, Canada; (J.B.); (J.D.); (C.O.)
| | - Sumathi Ramachandran
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Nancy Mayer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (N.M.); (L.G.)
| | - Laurel Glaser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (N.M.); (L.G.)
| | - Marek Smieja
- St. Joseph’s Healthcare, Hamilton, ON L8N 4A6, Canada; (C.R.); (M.R.-G.)
- Correspondence: ; Tel.: +1-905-521-6083
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Son H, Lee M, Eun Y, Park W, Park K, Kwon S, Kim S, Kim C. An outbreak of hepatitis A associated with salted clams in Busan, Korea. Epidemiol Health 2021; 44:e2022003. [PMID: 34990534 PMCID: PMC8989951 DOI: 10.4178/epih.e2022003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES In July 2019, there were multiple reports on patients with hepatitis A among the visitors of a restaurant in Busan. The current study presents the results of an epidemiological investigation and outlines the supplementary measures that would help with hepatitis A control. METHODS A cohort study was conducted for all 2,865 customers who visited restaurant A from June to July. Using a standardized questionnaire, participants reported the presence of hepatitis A symptoms and whether they had consumed any of 19 food items. As for participants who had visited public health centers, their specimens were collected. RESULTS From the study cohort, 155 participants (5.4%) had confirmed hepatitis A. The epidemic curve was unimodal, and the median number of days from the restaurant visit to symptom onset was 31 days. A genotype analysis indicated that 89 of 90 tested patients had hepatitis A virus (HAV) genotype 1A. The results of a multivariate logistic regression analysis indicated that the ingestion of salted clams increased the risk of hepatitis A by 68.12 times (95% confidence interval [CI], 9.22 to 510.87). In an unopened package of salted clams found and secured through traceback investigation, HAV genotype 1A was detected. CONCLUSIONS To prevent people from ingesting uncooked clams, there needs to be more efforts to publicize the dangers of uncooked clams; the food sampling test standards for salted clams should also be expanded. Furthermore, a laboratory surveillance system based on molecular genetics should be established to detect outbreaks earlier.
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Affiliation(s)
- Hyunjin Son
- Department of Preventive Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Miyoung Lee
- Busan Center for infectious Disease Control and Prevention, Busan National University Hospital, Busan, Korea
| | - Youngduck Eun
- Busan Center for infectious Disease Control and Prevention, Busan National University Hospital, Busan, Korea
| | - Wonseo Park
- Busan Center for infectious Disease Control and Prevention, Busan National University Hospital, Busan, Korea
| | - Kyounghee Park
- Busan Center for infectious Disease Control and Prevention, Busan National University Hospital, Busan, Korea
| | - Sora Kwon
- Busan Center for infectious Disease Control and Prevention, Busan National University Hospital, Busan, Korea
| | - Seungjin Kim
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Changhoon Kim
- Department of Preventive Medicine, College of Medicine, Pusan National University, Busan, Korea.,Busan Center for infectious Disease Control and Prevention, Busan National University Hospital, Busan, Korea
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Prabdial-Sing N, Motaze V, Manamela J, McCarthy K, Suchard M. Establishment of Outbreak Thresholds for Hepatitis A in South Africa Using Laboratory Surveillance, 2017–2020. Viruses 2021; 13:v13122470. [PMID: 34960739 PMCID: PMC8704411 DOI: 10.3390/v13122470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 12/01/2022] Open
Abstract
As South Africa transitions from endemic to intermediate endemicity, hepatitis A surveillance needs strengthening to monitor trends in disease incidence and to identify outbreaks. We used passive laboratory-based surveillance data from the National Health Laboratory Services to calculate national hepatitis A incidence and to establish thresholds for outbreaks. Incidence was calculated by age and geographic location. The static threshold used two or three standard deviations (SDs) above the mean hepatitis A incidence in 2017–2019, and a cumulative summation (CuSum2) threshold used three SDs above the mean of the preceding seven months. These thresholds were applied to hepatitis A data for 2020. From 2017 to 2020, the mean incidence of hepatitis A IgM was 4.06/100,000 and ranged from 4.23 to 4.85/100,000 per year. Hepatitis A incidence was highest in the Western Cape province (WCP) (7.00–10.92/100,000 per year). The highest incidence was in the 1–9-year-olds. The incidence of hepatitis A in 2020 exceeded the static threshold in two districts of the WCP: Cape Winelands in January and Overberg district in August. The provincial incidence did not exceed the static and CuSum2 thresholds. District-level analysis using either threshold was sensitive enough to monitor trends and to alert district health authorities, allowing early outbreak responses.
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Affiliation(s)
- Nishi Prabdial-Sing
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
- Faculty of Health Sciences, School of Pathology, University of Witwatersrand, Johannesburg 2000, South Africa
- Correspondence:
| | - Villyen Motaze
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7935, South Africa
| | - Jack Manamela
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
| | - Kerrigan McCarthy
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
| | - Melinda Suchard
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
- Faculty of Health Sciences, School of Pathology, University of Witwatersrand, Johannesburg 2000, South Africa
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Thompson MA, Horberg MA, Agwu AL, Colasanti JA, Jain MK, Short WR, Singh T, Aberg JA. Erratum to: Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2021; 74:1893-1898. [PMID: 34878522 DOI: 10.1093/cid/ciab801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Mamta K Jain
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - William R Short
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tulika Singh
- Internal Medicine, HIV and Infectious Disease, Desert AIDS Project, Palm Springs, California, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Mount Sinai Health System, New York, New York, USA
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Dankwa EA, Donnelly CA, Brouwer AF, Zhao R, Montgomery MP, Weng MK, Martin NK. Estimating vaccination threshold and impact in the 2017-2019 hepatitis A virus outbreak among persons experiencing homelessness or who use drugs in Louisville, Kentucky, United States. Vaccine 2021; 39:7182-7190. [PMID: 34686394 PMCID: PMC9128446 DOI: 10.1016/j.vaccine.2021.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/27/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Between September 2017 and June 2019, an outbreak of hepatitis A virus (HAV) occurred in Louisville, Kentucky, resulting in 501 cases and 6 deaths, predominantly among persons who experience homelessness or who use drugs (PEH/PWUD). The critical vaccination threshold (Vc) required to achieve herd immunity in this population is unknown. We investigated Vc and vaccination impact using epidemic modeling. METHODS To determine which population subgroups had high infection risks, we employed a technique based on comparing the proportion of cases arising before and after the epidemic peak, across subgroups. We also developed a dynamic deterministic model of HAV transmission among PEH/PWUD to estimate the basic reproduction number (R0), herd immunity threshold, Vc and the effect of timing of the vaccination intervention on epidemic and economic outcomes. RESULTS Of the 501 confirmed or probable cases, 385 (76.8%) were among PEH/PWUD. Among PEH/PWUD and within the general population, homelessness was a significant risk factor for infection in the initial stages of the outbreak (odds ratios for homeless versus not homeless: 2.62; 95% confidence interval (CI): 1.62-4.25 for PEH/PWUD and 2.39; 95% CI: 1.51-3.78 for all detected cases). Our estimate for R0 ranges between 2.85 and 3.54, corresponding to an estimate of 69% (95% CI: 65-72) for herd immunity threshold and 76% (95% CI: 72%-80%) for Vc, assuming a vaccine with 90% efficacy. The observed vaccination program was estimated to have averted 30 hospitalizations (95% CI: 19-43), associated with over US$490 000 (95% CI: $310 000-700 000) in hospitalization cost. Greater impact was observed with earlier and faster vaccination implementation. CONCLUSIONS Vaccination coverage of at least 77% is likely required to prevent outbreaks of HAV among PEH/PWUD in Louisville, assuming a 90% vaccine efficacy. Proactive hepatitis A vaccination programs among PEH/PWUD will maximize health and economic benefits of these programs and reduce the likelihood of another outbreak.
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Affiliation(s)
- Emmanuelle A Dankwa
- Department of Statistics, University of Oxford, 24-29 St Giles', Oxford OX1 3LB, UK.
| | - Christl A Donnelly
- Department of Statistics, University of Oxford, 24-29 St Giles', Oxford OX1 3LB, UK; MRC Centre for Global Infectious Disease Analysis, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Andrew F Brouwer
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
| | - Rui Zhao
- Louisville Metro Department of Public Health and Wellness, 400 E Gray St, Louisville, KY 40202, USA
| | - Martha P Montgomery
- Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop US12-3, Atlanta, GA 30329-4018, USA
| | - Mark K Weng
- Division of Viral Hepatitis, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop US12-3, Atlanta, GA 30329-4018, USA
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive, CA 92093, USA; Population Health Sciences, University of Bristol, Queens Road Bristol BS8 1QU, UK
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Schoch S, Wälti M, Schemmerer M, Alexander R, Keiner B, Kralicek C, Bycholski K, Hyatt K, Knowles J, Klochkov D, Simon T, Wenzel JJ, Roth NJ, Widmer E. Hepatitis A Virus Incidence Rates and Biomarker Dynamics for Plasma Donors, United States. Emerg Infect Dis 2021. [DOI: 10.3201/eid2711.20462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wurcel AG, Chen G, Zubiago JA, Reyes J, Nowotny KM. Heterogeneity in Jail Nursing Medical Intake Forms: A Content Analysis. JOURNAL OF CORRECTIONAL HEALTH CARE 2021; 27:265-271. [PMID: 34724807 DOI: 10.1089/jchc.20.04.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Despite high prevalence of infectious diseases and substance use disorders in jails, there are limited guidelines for the nursing intake process in this setting. We performed a content analysis of nursing intake forms used at each of the 14 Massachusetts county jails, focusing on infectious disease and substance use disorder. Only 85% of jails offered HIV testing during nursing intake and 50% of jails offered hepatitis C testing. Preventive interventions such as vaccines or pre-exposure prophylaxis therapy were infrequently offered during nursing intake. Screening for substance use disorder was present on the majority of intake forms, but only 23% of intake forms inquired about ongoing medication-assisted treatment for opioid use disorder. The results reflect heterogeneity in nursing intake forms, highlighting missed opportunities for public health interventions.
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Affiliation(s)
- Alysse G Wurcel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gang Chen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Julia A Zubiago
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jessica Reyes
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
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Schoch S, Wälti M, Schemmerer M, Alexander R, Keiner B, Kralicek C, Bycholski K, Hyatt K, Knowles J, Klochkov D, Simon T, Wenzel JJ, Roth NJ, Widmer E. Hepatitis A Virus Incidence Rates and Biomarker Dynamics for Plasma Donors, United States. Emerg Infect Dis 2021; 27:2718-2824. [PMID: 34670659 PMCID: PMC8544996 DOI: 10.3201/eid2711.204642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The United States is currently affected by widespread hepatitis A virus (HAV) outbreaks. We investigated HAV incidence rates among source plasma donors in the United States since 2016. Serial donations from HAV-positive frequent donors were analyzed for common biologic markers to obtain a detailed picture of the course of infection. We found a considerable increase in incidence rates with shifting outbreak hotspots over time. Although individual biomarker profiles were highly variable, HAV RNA typically had a high peak and a biphasic decrease and often remained detectable for several months. One donor had a biomarker pattern indicative of previous exposure. Our findings show that current HAV outbreaks have been spilling over into the plasma donor population. The detailed results presented improve our comprehension of HAV infection and related public health aspects. In addition, the capture of full RNA curves enables estimation of HAV doubling time.
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Migueres M, Lhomme S, Izopet J. Hepatitis A: Epidemiology, High-Risk Groups, Prevention and Research on Antiviral Treatment. Viruses 2021; 13:1900. [PMID: 34696330 PMCID: PMC8540458 DOI: 10.3390/v13101900] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/17/2022] Open
Abstract
The hepatitis A virus (HAV) is a leading cause of acute viral hepatitis worldwide. It is transmitted mainly by direct contact with patients who have been infected or by ingesting contaminated water or food. The virus is endemic in low-income countries where sanitary and sociodemographic conditions are poor. Paradoxically, improving sanitary conditions in these countries, which reduces the incidence of HAV infections, can lead to more severe disease in susceptible adults. The populations of developed countries are highly susceptible to HAV, and large outbreaks can occur when the virus is spread by globalization and by increased travel and movement of foodstuffs. Most of these outbreaks occur among high-risk groups: travellers, men who have sex with men, people who use substances, and people facing homelessness. Hepatitis A infections can be prevented by vaccination; safe and effective vaccines have been available for decades. Several countries have successfully introduced universal mass vaccination for children, but high-risk groups in high-income countries remain insufficiently protected. The development of HAV antivirals may be important to control HAV outbreaks in developed countries where a universal vaccination programme is not recommended.
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Affiliation(s)
- Marion Migueres
- Virology Laboratory, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France; (S.L.); (J.I.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, 31300 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Sébastien Lhomme
- Virology Laboratory, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France; (S.L.); (J.I.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, 31300 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
| | - Jacques Izopet
- Virology Laboratory, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France; (S.L.); (J.I.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), INSERM UMR1291-CNRS UMR5051, 31300 Toulouse, France
- Université Toulouse III Paul-Sabatier, 31062 Toulouse, France
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Lewin BJ, Rodriguez J, Yang SJ, Tartof SY. Predictors of hepatitis A immunity in adults in California in order to better utilize hepatitis A vaccine. Vaccine 2021; 39:5484-5489. [PMID: 34454784 DOI: 10.1016/j.vaccine.2021.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hepatitis A vaccine recommendations now include homelessness, illegal drug use, and HIV, as well as traditional risk factors and travel to areas endemic for hepatitis A. We examined a large diverse population for predictors of Hepatitis A immunity in order to better utilize Hepatitis A vaccine. METHODS We performed a cross-sectional descriptive study of members of a large integrated health plan with a test for Hepatitis A Immunoglobulin G (IgG) between January 1st, 2007, and December 31st, 2017. Exclusion criteria included age <18 years, <6 months of continuous enrollment, and Hepatitis A vaccine prior to Hepatitis A test. Variables of interest were age, gender, primary language spoken, ethnicity/race, neighborhood household income, and history of travel or history of jaundice. Multivariable logistic regression was performed to evaluate the association of risk factors on Hepatitis A immunity. RESULTS Of the 318,170 persons ≥ 18 years tested for Hepatitis A immunity, 155, 842 persons had a reactive Hepatitis A IgG test (49%). The lowest prevalence was for Whites at 28.1% followed by Blacks at 35.8%. Hispanics and Asian/Pacific Islanders had prevalence rates of 63% and 68.2% respectively. In adjusted analyses, Asian/Pacific Islanders, Hispanics and Blacks were 5.17, 3.44 and 1.42 times more likely to have Hepatitis A immunity than Whites. Those that spoke Spanish or language other than English or Spanish as their primary preferred language were 6.11 and 3.27 time more likely to have immunity than English speakers. Known travel history conferred a 2.16 likelihood of Hepatitis A immunity. CONCLUSIONS Persons of Hispanic and Asian/Pacific Islander background as well as persons with a preferred spoken language other than English have a high prevalence of Hepatitis A immunity. Testing for Hepatitis A immunity prior to vaccination should be considered for these groups.
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Affiliation(s)
- Bruno J Lewin
- Kaiser Permanente Southern California, Department of Family Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Clinical Science, United States.
| | - Janelle Rodriguez
- Kaiser Permanente Southern California, Department of Family Medicine, United States
| | - Su-Jau Yang
- Kaiser Permanente Southern California, Department of Research & Evaluation, United States
| | - Sara Y Tartof
- Kaiser Permanente Southern California, Department of Research & Evaluation, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, United States
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Montgomery MP, Eckert M, Hofmeister MG, Foster MA, Weng MK, Augustine R, Gupta N, Cooley LA. Strategies for Successful Vaccination Among Two Medically Underserved Populations: Lessons Learned From Hepatitis A Outbreaks. Am J Public Health 2021; 111:1409-1412. [PMID: 34464196 PMCID: PMC8489637 DOI: 10.2105/ajph.2021.306308] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Martha P Montgomery
- The authors are with the Centers for Disease Control and Prevention, Atlanta, GA. Martha P. Montgomery, Megan G. Hofmeister, Monique A. Foster, Mark K. Weng, Ryan Augustine, Neil Gupta, and Laura A. Cooley are with the Division of Viral Hepatitis. Maribeth Eckert is with the Immunization Services Division
| | - Maribeth Eckert
- The authors are with the Centers for Disease Control and Prevention, Atlanta, GA. Martha P. Montgomery, Megan G. Hofmeister, Monique A. Foster, Mark K. Weng, Ryan Augustine, Neil Gupta, and Laura A. Cooley are with the Division of Viral Hepatitis. Maribeth Eckert is with the Immunization Services Division
| | - Megan G Hofmeister
- The authors are with the Centers for Disease Control and Prevention, Atlanta, GA. Martha P. Montgomery, Megan G. Hofmeister, Monique A. Foster, Mark K. Weng, Ryan Augustine, Neil Gupta, and Laura A. Cooley are with the Division of Viral Hepatitis. Maribeth Eckert is with the Immunization Services Division
| | - Monique A Foster
- The authors are with the Centers for Disease Control and Prevention, Atlanta, GA. Martha P. Montgomery, Megan G. Hofmeister, Monique A. Foster, Mark K. Weng, Ryan Augustine, Neil Gupta, and Laura A. Cooley are with the Division of Viral Hepatitis. Maribeth Eckert is with the Immunization Services Division
| | - Mark K Weng
- The authors are with the Centers for Disease Control and Prevention, Atlanta, GA. Martha P. Montgomery, Megan G. Hofmeister, Monique A. Foster, Mark K. Weng, Ryan Augustine, Neil Gupta, and Laura A. Cooley are with the Division of Viral Hepatitis. Maribeth Eckert is with the Immunization Services Division
| | - Ryan Augustine
- The authors are with the Centers for Disease Control and Prevention, Atlanta, GA. Martha P. Montgomery, Megan G. Hofmeister, Monique A. Foster, Mark K. Weng, Ryan Augustine, Neil Gupta, and Laura A. Cooley are with the Division of Viral Hepatitis. Maribeth Eckert is with the Immunization Services Division
| | - Neil Gupta
- The authors are with the Centers for Disease Control and Prevention, Atlanta, GA. Martha P. Montgomery, Megan G. Hofmeister, Monique A. Foster, Mark K. Weng, Ryan Augustine, Neil Gupta, and Laura A. Cooley are with the Division of Viral Hepatitis. Maribeth Eckert is with the Immunization Services Division
| | - Laura A Cooley
- The authors are with the Centers for Disease Control and Prevention, Atlanta, GA. Martha P. Montgomery, Megan G. Hofmeister, Monique A. Foster, Mark K. Weng, Ryan Augustine, Neil Gupta, and Laura A. Cooley are with the Division of Viral Hepatitis. Maribeth Eckert is with the Immunization Services Division
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Ramachandran S, Xia GL, Dimitrova Z, Lin Y, Montgomery M, Augustine R, Kamili S, Khudyakov Y. Changing Molecular Epidemiology of Hepatitis A Virus Infection, United States, 1996-2019. Emerg Infect Dis 2021; 27:1742-1745. [PMID: 34013865 PMCID: PMC8153864 DOI: 10.3201/eid2706.203036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hepatitis A virus (HAV) genotype IA was most common among strains tested in US outbreak investigations and surveillance during 1996-2015. However, HAV genotype IB gained prominence during 2016-2019 person-to-person multistate outbreaks. Detection of previously uncommon strains highlights the changing molecular epidemiology of HAV infection in the United States.
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Foster MA, Hofmeister MG, Albertson JP, Brown KB, Burakoff AW, Gandhi AP, Glenn-Finer RE, Gounder P, Ho PY, Kavanaugh T, Latash J, Lewis RL, Longmire AG, Myrick-West A, Perella DM, Reddy V, Stanislawski ES, Stoltey JE, Sullivan SM, Utah OF, Zipprich J, Teshale EH. Hepatitis A Virus Infections Among Men Who Have Sex with Men - Eight U.S. States, 2017-2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:875-878. [PMID: 34138829 PMCID: PMC8220954 DOI: 10.15585/mmwr.mm7024a2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kang M, Horman SF, Taplitz RA, Clay B, Millen M, Sitapati A, Myers FE, McDonald EC, Abeles SR, Wallace DR, Stous S, Torriani FJ. Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016-2018. Emerg Infect Dis 2021; 26:1374-1381. [PMID: 32568038 PMCID: PMC7323565 DOI: 10.3201/eid2607.191352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
During 2016–2018, San Diego County, California, USA, experienced one of the largest hepatitis A outbreaks in the United States in 2 decades. In close partnership with local healthcare systems, San Diego County Public Health led a public health response to the outbreak that focused on a 3-pronged strategy to vaccinate, sanitize, and educate. Healthcare systems administered nearly half of the vaccinations delivered in San Diego County. At University of California San Diego Health, the use of informatics tools assisted with the identification of at-risk populations and with vaccine delivery across outpatient and inpatient settings. In addition, acute care facilities helped prevent further disease transmission by delaying the discharge of patients with hepatitis A who were experiencing homelessness. We assessed the public health roles that acute care hospitals can play during a large community outbreak and the critical nature of ongoing collaboration between hospitals and public health systems in controlling such outbreaks.
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Samala N, Abdallah W, Poole A, Shamseddeen H, S Are V, S Orman E, Patidar KR, Vuppalanchi R. Insight into an acute hepatitis A outbreak in Indiana. J Viral Hepat 2021; 28:964-971. [PMID: 33763937 DOI: 10.1111/jvh.13504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/01/2021] [Indexed: 12/30/2022]
Abstract
Hepatitis A virus (HAV) infection causes an acute enteric hepatitis associated with substantial morbidity and mortality, particularly in older individuals. Incidence of HAV infection is low in the United States, mostly related to consumption of contaminated food. Starting in 2017, Indiana reported a large HAV outbreak. We sought to characterize the risk-exposures, clinical features and outcomes of HAV and examine the differences based on underlying cirrhosis and age. Adults ≥18 years diagnosed with HAV between January 2017 and April 2019 at two large healthcare systems in Indiana were identified. Demographic data, risk-exposures, clinical features, laboratory data and clinical outcomes were collected for analysis. The HAV cohort constituted 264 individuals with mean age of 41-years, 62% male and 94% Caucasian. Risk-exposures identified were illicit drug use (74%), food-borne (15%), person-to-person (11%) and incarceration (11%). Mortality rate was 2%, acute liver failure (ALF) was seen in 4% and acute on chronic liver failure (ACLF) was seen in 30% (6 of 20 with underlying cirrhosis). Admission MELD score was the only factor associated with ALF [OR = 1.17 (1.08-1.2), p < 0.0001], on multivariable logistic regression analysis. Higher proportion of individuals with underlying cirrhosis developed acute kidney injury (AKI) (26% vs. 9%, p = 0.03), ascites (45% vs. 11%, p < 0.0001) and hepatic encephalopathy (35% vs. 4%, p < 0.0001). In conclusion, illicit drug use was the predominant risk-exposure in the current HAV outbreak, which was associated with 2% mortality rate, and those with cirrhosis had worse outcomes (AKI, ascites and HE), of whom 30% developed ACLF.
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Affiliation(s)
- Niharika Samala
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wassim Abdallah
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ashley Poole
- Graduate School of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hani Shamseddeen
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vijay S Are
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eric S Orman
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kavish R Patidar
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Raj Vuppalanchi
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
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Herzog C, Van Herck K, Van Damme P. Hepatitis A vaccination and its immunological and epidemiological long-term effects - a review of the evidence. Hum Vaccin Immunother 2021; 17:1496-1519. [PMID: 33325760 PMCID: PMC8078665 DOI: 10.1080/21645515.2020.1819742] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/16/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023] Open
Abstract
Hepatitis A virus (HAV) infections continue to represent a significant disease burden causing approximately 200 million infections, 30 million symptomatic illnesses and 30,000 deaths each year. Effective and safe hepatitis A vaccines have been available since the early 1990s. Initially developed for individual prophylaxis, HAV vaccines are now increasingly used to control hepatitis A in endemic areas. The human enteral HAV is eradicable in principle, however, HAV eradication is currently not being pursued. Inactivated HAV vaccines are safe and, after two doses, elicit seroprotection in healthy children, adolescents, and young adults for an estimated 30-40 years, if not lifelong, with no need for a later second booster. The long-term effects of the single-dose live-attenuated HAV vaccines are less well documented but available data suggest they are safe and provide long-lasting immunity and protection. A universal mass vaccination strategy (UMV) based on two doses of inactivated vaccine is commonly implemented in endemic countries and eliminates clinical hepatitis A disease in toddlers within a few years. Consequently, older age groups also benefit due to the herd protection effects. Single-dose UMV programs have shown promising outcomes but need to be monitored for many more years in order to document an effective immune memory persistence. In non-endemic countries, prevention efforts need to focus on 'new' risk groups, such as men having sex with men, prisoners, the homeless, and families visiting friends and relatives in endemic countries. This narrative review presents the current evidence regarding the immunological and epidemiological long-term effects of the hepatitis A vaccination and finally discusses emerging issues and areas for research.
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Affiliation(s)
- Christian Herzog
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Koen Van Herck
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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