title: Risk factors for hospitalisation and associated costs among patients with hepatitis A associated with imported pomegranate arils, United States, 2013.
abstract: OBJECTIVE
  To assess hospitalisation risk factors and economic effects associated with a multistate hepatitis A outbreak in 2013.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Eligible outbreak-related cases confirmed by September 1, 2013, were defined as acute hepatitis symptoms and positive IgM anti-hepatitis A during March 15-August 12 among patients who consumed the food vehicle or had the outbreak genotype. We reviewed medical records, comparing demographic and clinical characteristics among hospitalized and non-hospitalized patients; we used logistic regression analysis to identify factors associated with hospitalization. We interviewed patients regarding symptom duration and healthcare usage and estimated per-patient and total costs. Health departments reported outbreak-related personnel hours.
  
  
  RESULTS
  Medical records were reviewed for 147/159 (92%) eligible patients; median age was 48 (range: 1-84) years, and 64 (44%) patients were hospitalized. Having any chronic medical condition was independently associated with hospitalisation (odds ratio, 3.80; 95% confidence interval, 1.68-8.62). Interviews were completed for 114 (72%) eligible patients; estimated per-patient cost of healthcare and productivity loss was $13,467 for hospitalized and $2138 for non-hospitalized patients and $1,304,648 for all 165 outbreak-related cases. State and local public health personnel expenditures included 82 h and $3221/outbreak-related case.
  
  
  CONCLUSIONS
  Hospitalisations in this outbreak were associated with chronic medical conditions and resulted in substantial healthcare usage and lost productivity. These data can be used to inform future evaluation of expansion of hepatitis A vaccination recommendations to include adults with chronic medical conditions.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Colorado Department of Public Health and Environment, Denver, CO, USA. Electronic address: Erin.Epson@cdph.ca.gov.
authors.forename: E E
authors.initials: EE
authors.lastname: Epson
authors.affiliation: Colorado Department of Public Health and Environment, Denver, CO, USA.
authors.forename: A
authors.initials: A
authors.lastname: Cronquist
authors.affiliation: California Department of Public Health, Richmond, CA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Lamba
authors.affiliation: California Department of Public Health, Richmond, CA, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Kimura
authors.affiliation: Arizona Department of Health Services, Phoenix, AZ, USA.
authors.forename: R
authors.initials: R
authors.lastname: Hassan
authors.affiliation: New Mexico Department of Health, Santa Fe, NM, USA.
authors.forename: D
authors.initials: D
authors.lastname: Selvage
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; New Mexico Department of Health, Santa Fe, NM, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: McNeil
authors.affiliation: County of San Diego Health and Human Services Agency, San Diego, CA, USA; Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Varan
authors.affiliation: CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA; Los Angeles County Department of Public Health, Acute Communicable Disease Control Program, Los Angeles, CA, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Silvaggio
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Fan
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: X
authors.initials: X
authors.lastname: Tong
authors.affiliation: Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: pspradling@cdc.gov.
authors.forename: P R
authors.initials: PR
authors.lastname: Spradling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000191:economics*; D005260:Female; D005506:Food Contamination; D006506:Hepatitis A / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D029561:Lythraceae / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014421:Turkey; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Disease outbreaks; Health economics and organizations; Hepatitis A