Molecular Genotyping of Hepatitis A Virus, California, USA, 2017-2018.

We implemented subgenomic and whole-genome sequencing to support the investigation of a large hepatitis A virus outbreak among persons experiencing homelessness, users of illicit drugs, or both in California, USA, during 2017-2018. Genotyping data helped confirm case-patients, track chains of transmission, and monitor the effectiveness of public health control measures.

Direct Medical Costs of 3 Reportable Travel-Related Infections in Ontario, Canada, 2012-2014.

Immigrants traveling to their birth countries to visit friends or relatives are disproportionately affected by travel-related infections, in part because most preventive travel health services are not publicly funded. To help identify cost-effective policies to reduce this disparity, we measured the medical costs (in 2015 Canadian dollars) of 3 reportable travel-related infectious diseases (hepatitis A, malaria, and enteric fever) that accrued during a 3-year period (2012-2014) in an ethnoculturally diverse region of Canada (Peel, Ontario) by linking reportable disease surveillance and health administrative data. In total, 318 case-patients were included, each matched with 2 controls. Most spending accrued in inpatient settings. Direct healthcare spending totaled $2,058,196; the mean attributable cost per case was $6,098 (95% CI $5,328-$6,868) but varied by disease (range $4,558-$7,852). Costs were greatest for enteric fever. Policies that address financial barriers to preventive health services for high-risk groups should be evaluated.

History of the Discovery of Hepatitis A Virus.

Disease outbreaks resembling hepatitis A have been known since antiquity. However, it was not until World War II when two forms of viral hepatitis were clearly differentiated. After the discovery of Australia antigen and its association with hepatitis B, similar methodologies were used to find the hepatitis A virus. The virus was ultimately identified when investigators changed the focus of their search from serum to feces and applied appropriate technology.

The impact of expanded program on immunization with live attenuated and inactivated Hepatitis A vaccines in China, 2004-2016.

INTRODUCTION: Since 2008, two types of hepatitis A (HepA) vaccines were integrated into the expanded program on immunization (EPI) in China. Children were given either one dose of live attenuated HepA (L-HepA) or two doses of inactivated HepA (I-HepA), depending on geographic regions. We sought to evaluate the impact of the EPI on HepA incidence in China. METHODS: We reviewed the epidemiology of HepA during 2004-2016 from National Notifiable Disease Reporting System (NNDRS). We collected data of L-HepA and I-HepA coverage from Children Immunization Information Management System (CIIMS). Based on the regions where two types of HepA vaccines were used, the coverage and incidence of HepA were compared over time. RESULTS: In 2008-2016, the HepA vaccine coverage was 98.8% among target children, with 99.6% in I-HepA region and 98.7% in L-HepA region. HepA incidence declined by 78.0% and 82.3% in L-HepA region and I-HepA region, respectively, without significant difference. Dramatic decline were seen in all age groups of both regions. CONCLUSION: The study suggests that the EPI, with high coverage for both I-HepA and L-HepA, had positive impact on HepA incidence in China.

Hepatitis A vaccination coverage among adolescents (13-17 years) in the United States, 2008-2016.

BACKGROUND: The hepatitis A (HepA) vaccine was recommended by the Advisory Committee on Immunization Practices (ACIP) incrementally from 1996 to 1999. In 2006, HepA vaccine was recommended (1) universally for children aged 12-23 months, (2) for persons who are at increased risk for infection, or (3) for any person wishing to obtain immunity. Catch-up vaccination can be considered. OBJECTIVE: To assess HepA vaccine coverage among adolescents and factors independently associated with vaccination administration in the US. METHODS: The 2008-2016 National Immunization Survey-Teen was utilized to determine 1 and ≥2 dose HepA vaccination coverage among adolescents aged 13-17 years. Factors associated with HepA vaccine series initiation (1 dose) were determined by bivariate and multivariable analyses. Data were stratified by state groups based on ACIP recommendation: universal child vaccination recommended since 1999 (group 1); child vaccination considered since 1999 (group 2); universal child vaccination recommendation since 2006 (group 3). RESULTS: In 2016, national vaccination coverage for 1 and ≥2 doses of HepA vaccine among adolescents was 73.9% and 64.4%, respectively. Nationally, a 40 percentage point increase in vaccination coverage occurred among adolescents born in 1995 compared to adolescents born in 2003. Nationally, the independent factors associated with increased vaccine initiation was race/ethnicity (Hispanic, American Indian/Alaskan Native, Asian), military payment source and provider recommendation for HepA vaccination (2008-2013). Living in a suburban or rural region, living in poverty (level <1.33-5.03), and absence of state daycare or school HepA requirement were common factors associated with decreased likelihood of vaccine initiation. CONCLUSIONS: Efforts to increase HepA vaccine coverage in adolescents in all regions of the country would strengthen population protection from hepatitis A virus (HAV).

19th-century and early 20th-century jaundice outbreaks, the USA.

Historical enquiry into diseases with morbidity or mortality predilections for particular demographic groups can permit clarification of their emergence, endemicity, and epidemicity. During community-wide outbreaks of hepatitis A in the pre-vaccine era, clinical attack rates were higher among juveniles rather than adults. In community-wide hepatitis E outbreaks, past and present, mortality rates have been most pronounced among pregnant women. Examination for these characteristic predilections in reports of jaundice outbreaks in the USA traces the emergence of hepatitis A and also of hepatitis E to the closing three decades of the 19th century. Thereafter, outbreaks of hepatitis A burgeoned, whereas those of hepatitis E abated. There were, in addition, community-wide outbreaks that bore features of neither hepatitis A nor E; they occurred before the 1870s. The American Civil War antedated that period. If hepatitis A had yet to establish endemicity, then it would not underlie the jaundice epidemic that was widespread during the war. Such an assessment may be revised, however, with the discovery of more extant outbreak reports.

A historical perspective on the discovery and elucidation of the hepatitis B virus.

The discovery in 1965 of the "Australia antigen," subsequently identified as the hepatitis B virus surface antigen (HBsAg), was such a watershed event in virology that it is often thought to mark the beginning of hepatitis research, but it is more accurately seen as a critical breakthrough in a long effort to understand the pathogenesis of infectious hepatitis. A century earlier, Virchow provided an authoritative explanation of "catarrhal jaundice," which did not consider an infectious etiology, but the transmission of jaundice by human serum was clearly identified in two outbreaks in 1885, and the distinction between "infectious" and "serum" hepatitis was recognized by the early 1920s. The inability to culture a virus or reproduce either syndrome in laboratory animals led to numerous studies in human volunteers; by the end of World War II, it was known that the diseases were caused by different filterable agents, and the terms "hepatitis A" and "B" were introduced in 1947 (though some long-incubation cases then designated B must in retrospect have been hepatitis C). The development of a number of liver function tests during the 1950s led to the recognition of anicteric infections and the existence of chronic carriers, but little more could be done until an infectious agent had been identified. Once Blumberg and colleagues had found a specific viral marker, the vast amount of accumulated epidemiologic and clinical data, together with huge numbers of stored serum samples, enabled rapid progress in understanding hepatitis B, and revealed the existence of a vast population of chronically infected people in Asia, Oceania and Africa. In this article, we place the identification of the Australia antigen within the historical context of research on viral hepatitis. Following a chronological review from 1865 to 1965, we summarize how the discovery led to improved safety of blood transfusion, the development of a highly effective vaccine and the eventual identification of the hepatitis C, D and E viruses. This article forms part of a symposium in Antiviral Research on "An unfinished story: from the discovery of the Australia antigen to the development of new curative therapies for chronic hepatitis B."

[Hepatitis: a longstanding companion in human history]. / L'epatite: un compagno di lungo corso della storia umana.

Hepatitis has gone along with human history since its origins, due to its prompt identifiability linked to jaundice as a symptom. Written evidence of outbreaks of epidemic jaundice can be tracked back a few millenniums before Christ. Unavoidable confusion arises due to the overlap of different sources possibly linked to different aetiologies, identified over time as epidemic jaundice (HAV or HEV hepatitis?) and serum hepatitis (HBV or HCV hepatitis?). The journey that brought to recognize viruses as the main cause of jaundice was long and started midway during the last century, when the infectious hypothesis, which had taken place step by step, was finally confirmed by epidemiological investigations of an outbreak occurring in the US army in 1942, after a yellow fever immunization campaign. Further research identified two clinically different types of hepatitis, called for the first time hepatitis A and hepatitis B.

Advances in viral hepatitis: 50 years of Australian gastroenterology.

Viral hepatitis classification, treatments and pathogenesis has been increasingly defined over the past 50 years. Australian researchers have made significant contributions in the areas of viral hepatitis A vaccine development, treatment outcomes for chronic hepatitis B and C, the role of liver transplantation and the pathogenesis of injury and disease progression. This review outlines some of these contributions.

Concerns about infectious hepatitis and Delacorte's Welfare Island Fountain.

In 1969, philanthropist George T. Delacorte donated a spectacular water fountain to New York City on the southern tip of Welfare Island. Architects designed the fountain's jet geyser to pump a plume of water from the East River more than 400 feet into the air. Public health experts feared that the water from the heavily polluted East River could be a possible source for the spread of infectious hepatitis. Water droplets could be airborne by the prevailing winds to land on the densely populated east side of Manhattan. Upon the insistence of the New York City Department of Health, the fountain's water intake source was chlorinated. This action was initiated before the discovery of the hepatitis A virus (HAV) in 1973. A miscellany of continuing problems plagued the fountain for about two decades, causing the donor to label the fountain "Delacorte's Folly." Eventually, Delacorte gave up. In the late 1980s, the fountain ceased spouting and was finally dismantled.