PDF(Pubmed)
Abstract：
BACKGROUND: Hepatitis A (HepA) vaccines are recommended for US adults at risk of HepA. Ongoing United States (US) HepA outbreaks since 2016 have primarily spread person-to-person, especially among at-risk groups. We investigated the health outcomes, economic burden, and outbreak management considerations associated with HepA outbreaks from 2016 onwards.
METHODS: A systematic literature review was conducted to assess HepA outbreak-associated health outcomes, health care resource utilization (HCRU), and economic burden. A targeted literature review evaluated HepA outbreak management considerations.
RESULTS: Across 33 studies reporting on HepA outbreak-associated health outcomes/HCRU, frequently reported HepA-related morbidities included acute liver failure/injury (n = 6 studies of 33 studies) and liver transplantation (n = 5 of 33); reported case fatality rates ranged from 0% to 10.8%. Hospitalization rates reported in studies investigating person-to-person outbreaks ranged from 41.6% to 84.8%. Ten studies reported on outbreak-associated economic burden, with a national study reporting an average cost of over $16 000 per hospitalization. Thirty-four studies reported on outbreak management; challenges included difficulty reaching at-risk groups and vaccination distrust. Successes included targeted interventions and increasing public awareness.
CONCLUSIONS: This review indicates a considerable clinical and economic burden of ongoing US HepA outbreaks. Targeted prevention strategies and increased public awareness and vaccination coverage are needed to reduce HepA burden and prevent future outbreaks.
METHODS: A systematic literature review was conducted to assess HepA outbreak-associated health outcomes, health care resource utilization (HCRU), and economic burden. A targeted literature review evaluated HepA outbreak management considerations.
RESULTS: Across 33 studies reporting on HepA outbreak-associated health outcomes/HCRU, frequently reported HepA-related morbidities included acute liver failure/injury (n = 6 studies of 33 studies) and liver transplantation (n = 5 of 33); reported case fatality rates ranged from 0% to 10.8%. Hospitalization rates reported in studies investigating person-to-person outbreaks ranged from 41.6% to 84.8%. Ten studies reported on outbreak-associated economic burden, with a national study reporting an average cost of over $16 000 per hospitalization. Thirty-four studies reported on outbreak management; challenges included difficulty reaching at-risk groups and vaccination distrust. Successes included targeted interventions and increasing public awareness.
CONCLUSIONS: This review indicates a considerable clinical and economic burden of ongoing US HepA outbreaks. Targeted prevention strategies and increased public awareness and vaccination coverage are needed to reduce HepA burden and prevent future outbreaks.
摘要：
背景：甲型肝炎（HepA）疫苗推荐用于有HepA风险的美国成年人。自2016年以来持续的美国（US）HepA疫情主要在人与人之间传播，尤其是在高危人群中。我们调查了健康结果，经济负担,以及从2016年起与HepA疫情相关的疫情管理注意事项。
方法：进行了系统文献综述，以评估HepA爆发相关的健康结果，卫生保健资源利用(HCRU)，和经济负担。有针对性的文献综述评估了HepA暴发管理的考虑因素。
结果：在报告HepA爆发相关健康结果/HCRU的33项研究中，经常报告的HepA相关的发病率包括急性肝衰竭/损伤(n=6,共33项研究)和肝移植(n=5,共33项);报告的病死率为0%~10.8%.调查人与人之间爆发的研究报告的住院率从41.6%到84.8%不等。十项研究报告了与疫情相关的经济负担，一项全国性的研究报告说，每次住院的平均费用超过16000美元。34项研究报告了疫情管理；挑战包括难以接触高危人群和疫苗接种不信任。成功包括有针对性的干预措施和提高公众意识。
结论：本综述显示美国HepA疫情持续的临床和经济负担相当大。需要有针对性的预防策略以及提高公众意识和疫苗接种覆盖率，以减轻HepA负担并防止未来的疫情爆发。
方法：进行了系统文献综述，以评估HepA爆发相关的健康结果，卫生保健资源利用(HCRU)，和经济负担。有针对性的文献综述评估了HepA暴发管理的考虑因素。
结果：在报告HepA爆发相关健康结果/HCRU的33项研究中，经常报告的HepA相关的发病率包括急性肝衰竭/损伤(n=6,共33项研究)和肝移植(n=5,共33项);报告的病死率为0%~10.8%.调查人与人之间爆发的研究报告的住院率从41.6%到84.8%不等。十项研究报告了与疫情相关的经济负担，一项全国性的研究报告说，每次住院的平均费用超过16000美元。34项研究报告了疫情管理；挑战包括难以接触高危人群和疫苗接种不信任。成功包括有针对性的干预措施和提高公众意识。
结论：本综述显示美国HepA疫情持续的临床和经济负担相当大。需要有针对性的预防策略以及提高公众意识和疫苗接种覆盖率，以减轻HepA负担并防止未来的疫情爆发。
