Hofmeister Megan G, Yin Shaoman, Nelson Noele P, Weng Mark K, Gupta Neil
Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Public Health Rep. 2023 Jul 21:333549231184007. doi: 10.1177/00333549231184007.
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.
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.
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.
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.
在美国，甲型肝炎疫苗引入后发病率下降，但在近期与人际传播相关的广泛疫情背景下又有所上升。我们描述了美国甲型肝炎的流行病学情况，确定了不同时期的易感人群，并证明了提高甲型肝炎疫苗接种覆盖率的必要性，尤其是在甲型肝炎风险增加的成年人中。
我们计算了1990 - 2020年期间向国家法定传染病监测系统报告的甲型肝炎病例按社会人口学特征分类的发病率，以及危险因素和临床结局的百分比。我们利用美国国家健康与营养检查调查的数据，对1976年至2020年3月期间美国非机构化平民人口的甲型肝炎血清流行率以及1999年至2020年3月期间自我报告的甲型肝炎疫苗接种覆盖率进行了全国代表性估计和95%置信区间估计。
总体而言，美国每10万人口中报告的甲型肝炎病毒感染病例数下降了17.3倍，从1990 - 1998年期间的10.4例降至2007 - 2015年期间的0.6例，然后在2016 - 2020年期间升至2.8例。美国的总体甲型肝炎血清流行率从1976 - 1980年期间的38.2%（95%置信区间，36.2% - 40.1%）升至2015年至2020年3月期间的47.3%（95%置信区间，45.4% - 49.2%）。美国自我报告的甲型肝炎疫苗接种覆盖率从1999 - 2006年期间的16.3%（95%置信区间，15.0% - 17.7%）增加了2.5倍多，至2015年至2020年3月期间的41.9%（95%置信区间，40.2% - 43.7%）。
1976 - 2020年期间，美国甲型肝炎的流行病学情况发生了重大变化。提高疫苗接种覆盖率，尤其是在免疫实践咨询委员会建议接种疫苗的成年人中提高覆盖率，对于阻止美国当前与人际传播相关的甲型肝炎疫情以及预防未来类似疫情的再次发生至关重要。
