Declining hepatitis A mortality in the United States during the era of hepatitis A vaccination.
BACKGROUND
Since the mid-1990s, hepatitis A vaccine has been recommended for US children living in historically high-incidence states and for persons with other risk factors or chronic liver disease (CLD). The incidence of hepatitis A has declined dramatically during the era of vaccination, but trends in mortality are largely unknown.


METHODS
US death certificates from 1990 to 2004 for which hepatitis A was listed as the underlying cause of death were analyzed. Average annual age-adjusted mortality rates during the prevaccine (1990-1995) and post-vaccination recommendation (2000-2004) periods were compared using a Mantel-Haenszel test of association. The number of deaths for which CLD was listed as a contributing cause was determined.


RESULTS
Overall, 1436 deaths due to hepatitis A occurred, averaging 96 annually (range, 142 in 1995 to 54 in 2003). CLD contributed to nearly half of these deaths. Mortality rates paralleled incidence rates, beginning to decline in the mid-1990s and achieving low points in 2003 and 2004. Average rates were 32% lower in the post-vaccination recommendation period than in the prevaccine period (P < .01). The decline was more dramatic for states with (45%; P < .001) than without (23%; P = .002) recommendations.


CONCLUSIONS
Hepatitis A mortality rates have declined over the past decade. CLD remains an important and preventable contributing cause of death due to hepatitis A.
Vogt
Tara M
TM
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. tcv3@cdc.gov
Wise
Matthew E
ME
Bell
Beth P
BP
Finelli
Lyn
L
D003644:Death Certificates; D006506:Hepatitis A / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*; D022362:Hepatitis A Vaccines / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data*
D022362:Hepatitis A Vaccines