Epidemiology

Hepatitis A mortality rates down sharply since advent of vaccine

Last Updated: 2008-06-10 13:54:07 -0400 (Reuters Health)

By Martha Kerr

NEW YORK (Reuters Health) - Since the introduction of the hepatitis A vaccine in the mid-1990s, deaths due to hepatitis A are down 32% overall, researchers report in the May 1 issue of the Journal of Infectious Diseases.

Dr. Tara M. Vogt of the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, and colleagues analyzed US death certificates from 1990 through 2004 on which the underlying cause of death was listed as hepatitis A. Deaths that occurred between 1990 and 1995 in the pre-vaccine era were compared with those occurring between 2000 and 2004. Hepatitis A-related deaths in which chronic liver disease (CLD) was a contributing factor were also identified.

There were 1,476 deaths due to hepatitis A, or an average of 96 deaths per year. The peak was in 1995 with 142 deaths, and the low point was in 2003 with 54 deaths. States that established vaccine recommendations had a 45% decline in deaths, while states that did not institute recommendations only had a decline of 23%.

These reductions "parallel documented decreases in the incidence of hepatitis A," Dr. Vogt and colleagues point out.

The investigators also found that "the proportion of hepatitis A deaths that were CLD-related rose during the study period and...declined less dramatically in the age group/birth cohort with the highest prevalence of CLD." This is consistent with "low vaccination coverage and a modest impact of herd immunity in this group."

In an accompanying editorial, Dr. Jules L. Dienstag of Massachusetts General Hospital and Harvard Medical School in Boston comments: "Vaccines should prevent disease and disease consequences. For hepatitis A, the time from virus discovery to vaccine availability was two decades, and the time from vaccine availability to fulfillment of the vaccine's promise may be even quicker -- the vaccine dividend has been dramatic."

J Infect Dis 2008;197:1220-1222,1282-1288.