MMWR Morb Mortal Wkly Rep. 2021 Feb 26;70(8):269-272. doi: 10.15585/mmwr.mm7008a2.
Hepatitis A is a vaccine-preventable disease caused by the hepatitis A virus (HAV). Transmission of the virus most commonly occurs through the fecal-oral route after close contact with an infected person. Widespread outbreaks of hepatitis A among persons who use illicit drugs (injection and noninjection drugs) have increased in recent years (1). The Advisory Committee on Immunization Practices (ACIP) recommends routine hepatitis A vaccination for children and persons at increased risk for infection or severe disease, and, since 1996, has recommended hepatitis A vaccination for persons who use illicit drugs (2). Vaccinating persons who are at-risk for HAV infection is a mainstay of the public health response for stopping ongoing person-to-person transmission and preventing future outbreaks (1). In response to a large hepatitis A outbreak in West Virginia, an analysis was conducted to assess total hepatitis A-related medical costs during January 1, 2018-July 31, 2019, among West Virginia Medicaid beneficiaries with a confirmed diagnosis of HAV infection. Among the analysis population, direct clinical costs ranged from an estimated $1.4 million to $5.6 million. Direct clinical costs among a subset of the Medicaid population with a diagnosis of a comorbid substance use disorder ranged from an estimated $1.0 million to $4.4 million during the study period. In addition to insight on preventing illness, hospitalization, and death, the results from this study highlight the potential financial cost jurisdictions might incur when ACIP recommendations for hepatitis A vaccination, especially among persons who use illicit drugs, are not followed (2).
甲型肝炎是一种由甲型肝炎病毒(HAV)引起的可通过疫苗预防的疾病。该病毒主要通过与感染者的密切接触,经粪-口途径传播。近年来,与非法药物(注射和非注射药物)使用者相关的甲型肝炎广泛爆发有所增加(1)。免疫实践咨询委员会(ACIP)建议对儿童和感染或患严重疾病风险增加的人群进行常规甲型肝炎疫苗接种,并自 1996 年以来,建议对使用非法药物的人群进行甲型肝炎疫苗接种(2)。为甲型肝炎病毒感染风险人群接种疫苗是公共卫生应对措施的主要内容,可阻止正在进行的人际传播并预防未来的爆发(1)。为应对西弗吉尼亚州的大规模甲型肝炎爆发,进行了一项分析,以评估 2018 年 1 月 1 日至 2019 年 7 月 31 日期间,西弗吉尼亚州医疗补助计划(Medicaid)受益人中经确诊感染甲型肝炎病毒的人群的甲型肝炎相关医疗总费用。在分析人群中,直接临床费用估计在 140 万至 560 万美元之间。在研究期间,患有合并物质使用障碍诊断的 Medicaid 人群亚组中,直接临床费用估计在 100 万至 440 万美元之间。除了深入了解预防疾病、住院和死亡的情况外,该研究结果还强调了不遵循免疫实践咨询委员会(ACIP)关于甲型肝炎疫苗接种的建议(特别是对使用非法药物的人群)时,司法管辖区可能产生的潜在财务成本(2)。