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Epidemiologic Reviews Advance Access published online on June 14, 2006
Epidemiologic Reviews, doi:10.1093/epirev/mxj012
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Epidemiologic Reviews Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Accepted March 27, 2006

Article

Hepatitis A in the Era of Vaccination

Annemarie Wasley 1 *, Anthony Fiore 1, and Beth P. Bell 1

1 From the Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA

* To whom correspondence should be addressed.
Annemarie Wasley, E-mail: awasley{at}cdc.gov


  Abstract

The World Health Organization estimates an annual total of 1.5 million clinical cases of hepatitis A worldwide, but seroprevalence data indicate that tens of millions of hepatitis A virus infections occur each year. In the United States in the 1980s-1990s, an average of 26,000 acute hepatitis A cases were reported per year, representing approximately 270,000 infections annually. Since licensure of effective hepatitis A vaccines in the mid-1990s, US hepatitis A rates have fallen precipitously--particularly since 1999, when routine childhood vaccination was recommended in states with consistently elevated rates. By 2004, the overall rate had declined to 1.9/100,000 population, the lowest rate ever recorded and 79% lower than any previously recorded nadir. These marked declines occurred with relatively modest vaccination coverage, suggesting that strong herd immunity accompanies the initiation of routine vaccination programs. Routine childhood vaccination has produced similar results in Israel and selected regions of Italy, Spain, and Australia. Hepatitis A vaccination will probably remain a low priority for some time in the poorest countries, where most persons are infected as young children. However, shifts in the epidemiologic patterns of disease associated with declining hepatitis A virus transmission are occurring in many regions of the world. These shifts are likely to create circumstances where strategically targeted vaccination of children could produce substantial public health benefits.

Keywords: hepatitis A; hepatitis A vaccine; hepatitis A virus; vaccines.
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