title: The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies.
abstract: 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.
authors.affiliation: Division of Viral and Rickettsial Diseases, Centers for Disease Control, Atlanta, Ga 30333.
authors.forename: M J
authors.initials: MJ
authors.lastname: Alter
authors.forename: S C
authors.initials: SC
authors.lastname: Hadler
authors.forename: H S
authors.initials: HS
authors.lastname: Margolis
authors.forename: W J
authors.initials: WJ
authors.lastname: Alexander
authors.forename: P Y
authors.initials: PY
authors.lastname: Hu
authors.forename: F N
authors.initials: FN
authors.lastname: Judson
authors.forename: A
authors.initials: A
authors.lastname: Mares
authors.forename: J K
authors.initials: JK
authors.lastname: Miller
authors.forename: L A
authors.initials: LA
authors.lastname: Moyer
mesh_terms: 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*