Wednesday, July 13, 2005
By Brad Wible
Los Angeles Times
The rate of hepatitis A infections in the United States has shrunk by 76 percent since the beginning of a vaccination program in 1999 targeting children in 17 high-risk states, federal researchers reported today.
The program has driven the rate of infection down to 2.6 cases per 100,000 people, or 7,653 cases, in 2003, the latest year for which figures are available. That is the lowest rate since monitoring of the disease began in the 1960s, according to the report published in the Journal of the American Medical Association.

The program’s biggest impact has been on children ages 2 to 9. Their infection rate nationwide has dropped 89 percent in the past six years, from 18.1 cases per 100,000 children to 2 cases per 100,000. A decline of 84 percent occurred among people 10 to 18.
Epidemiologist Annemarie Wasley of the federal Centers for Disease Control and Prevention said it was heartening to see the impact of the agency’s vaccination strategy. “It’s nice when common sense actually works,” said Wasley, lead author of the report.
Hepatitis A is a liver disease that causes fever, nausea, abdominal discomfort and jaundice. It is rarely fatal.
The virus is most commonly spread in poor sanitary conditions through close physical contact with infected people or feces. Children are significant promoters of the virus because they frequently carry it without showing symptoms.
Analysis of infection rates in the late 1990s showed that about 65 percent of all cases in the United States were found in 17 states, largely concentrated in the West and Southwest. These high-risk states averaged at least 10 infections per 100,000 people from 1987-97, with 11 states averaging 20 or more cases. Low-risk states averaged fewer than six cases over that period.
Hepatitis A vaccinations had been focused on gay men, intravenous drug users, Native Americans and overseas travelers. The geographic analysis showed that the strategy was missing a large group of infections.
“Targets are not typically based on geography,” Wasley said. “But the natural focus should be where the highest rates [are].”
The CDC issued a recommendation in 1999 that encouraged routine vaccination of children living in the high-risk states.
Although it was a recommendation, some states implemented mandatory vaccination for entry into day-care and preschool programs, Wasley said.