The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies.
To determine trends in the incidence and epidemiology of acute hepatitis B in the United States we conducted intensive surveillance for viral hepatitis in four sentinel counties from October 1, 1981, to September 30, 1988. The overall incidence of hepatitis B remained relatively constant throughout the study period (average, 13.2 cases per 100,000 population), but disease transmission patterns changed significantly. The proportions of hepatitis B cases accounted for by homosexual activity and health care employment decreased 62% and 75%, respectively; the proportions of cases accounted for by parenteral drug use and heterosexual exposure increased 80% and 38%, respectively. The percentage of patients for whom no risk factor was identified (30% to 40%) did not change over time. These patients tended to belong to minority populations, and their socioeconomic level was low. The decline in the number of hepatitis B cases among homosexual men probably results from the modification of high-risk sexual behavior; the decline among health care workers is due mostly to hepatitis B immunization. The current strategy for prevention of hepatitis B, which targets high-risk groups for immunization, has failed to have a significant impact on the incidence of disease.
Alter
M J
MJ
Division of Viral and Rickettsial Diseases, Centers for Disease Control, Atlanta, Ga 30333.
Hadler
S C
SC
Margolis
H S
HS
Alexander
W J
WJ
Hu
P Y
PY
Judson
F N
FN
Mares
A
A
Miller
J K
JK
Moyer
L A
LA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D014611:Vaccination / Q000379:methods*