Vaccination programs have helped take the state’s disease rate from one of the 17 worst to near the U.S. average
By Carey Hamilton
The Salt Lake Tribune
08/01/2005
From 1987 to 1997, Utah – for reasons unknown – had the dubious distinction of being one of 17 states with the highest rate of hepatitis A infections.
However, the number of cases has since declined steadily in all the high-risk states, thanks in large part to a vaccination program targeting children, according to a recent report in The Journal of the American Medical Association.
The hepatitis A vaccine was licensed in 1995 for use in people older than 2 years. It has been required for school entry in Utah since 1999.
Reported cases in Utah decreased from 3.2 cases per 100,000 people in 2000 to 1.7 cases per 100,000 people in 2003. The cases reached a peak of 1,073 overall for all age groups in 1996 and dropped to their lowest at 36 in 2004. People 19 to 39 years old were affected the most in 1996, with 533 illnesses reported. That age group had only 13 cases in 2004.

Hepatitis A is a liver disease that is typically spread through contact with feces. Good personal hygiene and sanitation can help prevent the disease, an inflammation of the liver typically caused by a virus. Symptoms, including nausea, fever, abdominal discomfort and jaundice, usually last less than two months. Once patients exhibit symptoms and the virus has been in the body more than two weeks, there is no medicine available to cure it. They just have to ride out the illness.
Aside from school children, experts recommend the vaccine for international travelers, men who have sex with other men, and drug users who share needles or other paraphernalia.
Federal researchers discovered that about 65 percent of all cases in the United States during 1987 to 1997 occurred in 17 states, largely concentrated in the West and Southwest. Now the rates in Utah and those other states are close to the national rate of 2.6 cases per 100,000 people.
“Vaccination wasn’t a requirement then, and the rates were increased throughout the nation,” said Marilee Poulson, an epidemiologist with the Utah Department of Health.
“A lot of it is a mystery. We just don’t know why it was so much higher [in Utah] than the national rate.”
The reasons why the rates have dropped are easier to track, she said. For starters, the hepatitis A vaccine has become more widely used, with several health departments holding well- attended mass vaccination clinics.
Educational campaigns targeting restaurants, schools, day-care centers and hospitals also have been successful.
People with hepatitis A can receive preventive treatment if it is administered within two weeks of exposure. Those who believe they may have been exposed can ask their doctor for an immunoglobulin shot, an antibody which is more than 85 percent effective in preventing symptomatic infection.
“The response time of health care professionals and public health investigators contributes to the decreased number of cases,” Poulson said.
“While these measures were in place during the late ’80s and ’90s, improvements are seen every year.”
The vaccine also appears to produce an immunity that is ”long-lasting,” said David Daigle of the National Center for Infectious Diseases at the Centers for Disease Control and Prevention in Atlanta.
Studies of the levels of antibodies against the hepatitis A virus after vaccination indicate that protective levels could be present for 20 or more years, he added.
“As has been done with other vaccines, surveillance is being conducted to monitor the long-term protective efficacy of the vaccine,” Daigle added.
“Data to date do not indicate that a booster dose is necessary.”
chamilton@sltrib.com