hepatitis web study h epatitis w eb s tudy hepatitis a: epidemiology presentation prepared by: david...
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Hepatitisweb study
HEPATITIS WEB STUDY
Hepatitis A: Epidemiology
Presentation Prepared by: David Spach, MD and Nina Kim, MDLast Updated: May 31, 2011
Hepatitisweb study
Acute Hepatitis A: 2011 Case Definition
HEPATITIS A : EPIDEMIOLOGY
• Clinical Case Definition
An acute illness with:
(a) discrete onset of symptoms and
(b) jaundice, dark urine, or elevated ALT levels (ALT > 200 IU/L)
• Laboratory Criteria for Diagnosis
Immunoglobulin (IgM) antibody to hepatitis A virus (anti-HAV) positive
• Case Classification
Confirmed: meets the clinical case definition and is laboratory
confirmed
Hepatitisweb studySource: CDC Division of Viral Hepatitis. Statistics and Surveillance.
Incidence of Hepatitis A in U.S., 1980-2008
HEPATITIS A : EPIDEMIOLOGY
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
0
10,000
20,000
30,000
40,000
50,000
Reported Acute Cases
Year
Nu
mb
er
of
Ca
se
s
Hepatitisweb studySource: CDC Division of Viral Hepatitis. Statistics and Surveillance.
Incidence of Hepatitis A in U.S., 1980-2008
HEPATITIS A : EPIDEMIOLOGY
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000 Estimated Acute Cases
Reported Acute Cases
Year
Nu
mb
er
of
Ca
se
s
Hepatitisweb studySource: CDC Division of Viral Hepatitis. Statistics and Surveillance.
Incidence of Hepatitis A in U.S., 1980-2008
HEPATITIS A : EPIDEMIOLOGY
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000 Estimated Total New Infections
Estimated Acute Cases
Reported Acute Cases
Year
Nu
mb
er
of
Ca
se
s
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000 Estimated Total New Infections
Estimated Acute Cases
Reported Acute Cases
Year
Nu
mb
er
of
Ca
se
s
Hepatitisweb studySource: CDC Division of Viral Hepatitis. Statistics and Surveillance.
Impact of Hepatitis A Vaccine on Estimated Total New Hepatitis A Infections in U.S., 1980-2008
HEPATITIS A : EPIDEMIOLOGY
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
0
100,000
200,000
300,000
400,000
500,000
600,000
Year
Nu
mb
er
of
Ca
se
s 1996: ACIP Recommends for High-Risk Groups
2006: ACIP Recommends Universal Childhood Immunization
1999: ACIP Expands Recommendations
1995HAV Vaccine Licensed
Hepatitisweb studySource: ACIP. MMWR Recomm Rep. 2006;55(RR-7):1-23.
Reported Hepatitis A, by Age Group and Year, United States, 1990-2004
HEPATITIS A : EPIDEMIOLOGY
†ACIP = Advisory Committee for Immunization Practices
Hepatitisweb studySource: ACIP. MMWR Recomm Rep. 2006;55(RR-7):1-23.
Rate* of Hepatitis A, by County in United States, 1987-1997 and 2004
HEPATITIS A : EPIDEMIOLOGY
*Rate per 100,000 population
National Notifiable Disease System
Hepatitisweb studySource: Klevens RM, et al. Arch Intern Med. 2010;170:1811-8.
Emerging Infections Program, Hepatitis Surveillance Sites, 2005-2007Potential Source of Infection or Risk Factor for Hepatitis A in US
HEPATITIS A : EPIDEMIOLOGY
Travel Contact Daycare Outbreak IDU MSM Unknown0
10
20
30
40
50
60
45.8
14.8
7.6 7.24.3 3.9
36.4
Ca
se
s (
%)
IDU = Injection drug useMSM: men who have sex with men
Hepatitisweb studySource: CDC. Hepatitis Surveillance Report No. 59;2004.
Reported Risk Factors for Hepatitis A Virus Infection
HEPATITIS A : EPIDEMIOLOGY
56.5 11.6
9.4
8.44.94.23.71.2
Unknown
Sexual or Household Contact
Travel
Men who have Sex with Men
Injection-Drug Use
Daycare or Daycare Contact
Other Contact with HAV
Food or Waterborne Outbreak
Note: if a case report was submitted with >1 risk factor, the case was attributed to the most common risk factor.
Percentage of Risk Factors Among Patients with Acute Hepatitis A Infection