Deaths From Hepatitis A: Vaccination Could Prevent Them

Hepatitis A outbreaks associated with person-to-person transmission have been a significant public health concern in the United States for almost a decade. Increased vaccination coverage among high-risk adults could greatly reduce the harm caused by these outbreak, including some preventable deaths, according to a study published in Morbidity and Mortality Weekly Report (MMWR).

Hepatitis A is a highly contagious liver infection. It is usually mild and self-limiting but can lead to serious health complications in older adults and vulnerable individuals.

Hepatitis A outbreaks have been on the rise in recent years, with many cases linked to contaminated food and water. Despite the availability of hepatitis A vaccines, the vaccination rate among high-risk adults remains disappointingly low.

Megan Hofmeister, M.D.

Megan Hofmeister, M.D., and Neil Gupta, M.D., both from the Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention within the Centers for Disease Control and Prevention, reported on data from 27 states affected by hepatitis A outbreaks in October 2023 in MMWR. Demographic, risk factor and clinical data were collected from state outbreak databases for hepatitis A outbreak-related deaths.

Neil Gupta, M.D.

During the study period from Aug. 1, 2016, through Oct. 31, 2022, a total of 315 deaths from hepatitis A outbreaks were reported. The median age at death was 55. Most of the deaths occurred among males (73%) and non-Hispanic White individuals (84%). Outbreak-related deaths peaked in 2019 and decreased through 2022.

Of the people who died, 63% had at least one documented indication for hepatitis A vaccination. The most common risk factors for hepatitis A infection were drug use (41%) and homelessness/unstable housing (16%). Coinfection with hepatitis B (12%) or hepatitis C (31%) was also prevalent among those who died from the disease.

Only 4% of the decedents had evidence of previous hepatitis A vaccination. Lack of stable housing and substance use disorder were identified as factors contributing to increased disease incidence and health disparities.

The authors highlighted several study limitations. Discrepancies existed in each state’s process of classifying deaths as being related to hepatitis A in addition to death from hepatitis A not being a reportable condition. Risk factor data were self-reported and subject to biases. Vaccination information was missing for almost half of the decedents. Because the analysis captured approximately 75% of publicly reported outbreak-related deaths, the data may not be generalizable to all outbreak-related deaths in the U.S.

This study underscores the importance of widespread hepatitis A vaccination to prevent future deaths. Efforts should focus on increasing vaccination coverage among vulnerable populations, including individuals who use drugs and those experiencing homelessness. Integrated services that address the social determinants of health, including housing stability and substance use disorder, are crucial in controlling hepatitis A outbreaks and reducing health disparities.

By implementing comprehensive prevention strategies, including vaccination and addressing social determinants of health, public health agencies can effectively control hepatitis A outbreaks and save lives.