Deaths From Hepatitis a Underscore the Need for Better Vaccination of Populations at Risk for Severe Disease

An cites data collected from August 2016 to October 2022 on cases and deaths during outbreaks of hepatitis A.

is a liver disease caused by the hepatitis A virus (HAV). The virus is transmitted through the fecal-oral route. This means an infected person transmits the virus to close contacts when clean water for hand washing and sanitation for bathroom use are not available. The virus can also be transmitted through contaminated blood products, so people who inject drugs are also at high risk of being infected.

Interestingly, , like jaundice (yellowing of the skin or eyes), abdominal pain, poor appetite, dark urine, diarrhea, vomiting, or fever. In adults, the proportion of symptomatic cases can be as high as 70%.

The MMWR article indicates 315 people lost their lives to hepatitis A during the six-plus years of analyzed data from 27 states. Most of them (63%) “had at least one documented preexisting indication for hepatitis A vaccination,” according to the article. In the United States, the . Because the vaccine was (with additional recommendations in 2006), many adults have not been immunized. And because hepatitis A infection is relatively rare, immunity is also rare.

The MMWR article supports this: “The median age at death was 55 years; most deaths occurred among males (73%) and non-Hispanic White persons (84%). Nearly two thirds (63%) of decedents had at least one documented indication for hepatitis A vaccination, including drug use (41%), homelessness (16%), or coinfection with hepatitis B (12%) or hepatitis C (31%); only 12 (4%) had evidence of previous hepatitis A vaccination. Increasing vaccination coverage among adults at increased risk for infection with hepatitis A virus or for severe disease from infection is critical to preventing future hepatitis A–related deaths.”

In 2017, the City of San Diego, California, . The official count for that outbreak is 592 cases and 20 deaths, and the outbreak lasted until January 2018. The control measures included giving out more than 200,000 doses of hepatitis A vaccine, giving people who experience homelessness sanitary bathroom facilities, and increasing awareness of the epidemic in people who use injected substances. In 2018, Nashville, Tennessee, experienced , with over 500 cases and one death. That epidemic triggered concern in 2019 when a person with hepatitis A was . More recently, in 2023, .

As the MMWR article points out, hepatitis A is vaccine-preventable, and the vaccine is highly effective. Over 94% of people who get one dose become immune to HAV, and many in the cohort who received their vaccine as children since 2000 (more than 20 years now) continue to show immunity against the virus.

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