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The Changing Epidemiology of Hepatitis B in the United States:  Need for Alternative Vaccination Strategies

Miriam J. Alter, PhD; Stephen C. Hadler, MD; Harold S. Margolis, MD; W. James Alexander, MD; Pin Ya Hu, MD; Franklyn N. Judson, MD; Allene Mares, BSN; Joan K. Miller; Linda A. Moyer
JAMA. 1990;263(9):1218-1222. doi:10.1001/jama.1990.03440090052025.
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To determine trends in the incidence and epidemiology of acute hepatitis B in the United States we conducted intensive surveillance for viral hepatitis in four sentinel counties from October 1, 1981, to September 30, 1988. The overall incidence of hepatitis B remained relatively constant throughout the study period (average, 13.2 cases per 100 000 population), but disease transmission patterns changed significantly. The proportions of hepatitis B cases accounted for by homosexual activity and health care employment decreased 62% and 75%, respectively; the proportions of cases accounted for by parenteral drug use and heterosexual exposure increased 80% and 38%, respectively. The percentage of patients for whom no risk factor was identified (30% to 40%) did not change over time. These patients tended to belong to minority populations, and their socioeconomic level was low. The decline in the number of hepatitis B cases among homosexual men probably results from the modification of high-risk sexual behavior; the decline among health care workers is due mostly to hepatitis B immunization. The current strategy for prevention of hepatitis B, which targets high-risk groups for immunization, has failed to have a significant impact on the incidence of disease.

(JAMA. 1990;263:1218-1222)

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