Hepatitis A is an extremely infectious liver infection caused by hepatitis A virus (Hepatitis A, n.
d.). It is one of the infections that significantly affect the American population and has been a burden to the country. The virus causes inflammation and affects the liver’s ability to function. Hepatitis A virus is transmitted sexually and commonly spread by eating or drinking substances contaminated with fecal matter. The risk factors include traveling or working in places where hepatitis A is prevalent as well as being in contact with infected person. The symptoms and signs often do not appear until after a few weeks.
The signs and symptoms include fatigue, loss of appetite, vomiting, nausea, low-grade fever, joint pain, dark urine, intense itching, and abdominal discomfort or pain (Hamer & Griffiths, 2010). Antibodies generated in response to the infection often last for life and protect the victim against re-infection. Therefore, vaccination is helpful in preventing hepatitis A infection. Prevalence/Burden of Hepatitis AHepatitis A is prevalent in areas with underdeveloped sanitation systems. Mandell, Bennett, Dolin, and Blaser (2015) posit that the United States is one of the countries that had been hit by the infection because about one-third of its population has been affected previously by hepatitis A virus (HAV). Approximately 50,000 cases of HAV are being reported annually in the United States. However, Centers for Disease Control and Prevention (CDC) indicate that the number is low due to underreporting and asymptomatic infections. The number can be estimated to be 263,000 infections each year.
The rate of HAV infections has been declining from the last peak witnessed in 1995 with the lowest being recorded in 2007 where 25,000 new infections were realized. According to the CDC (2017) the incidence of acute case of HAV has declined by 88.3% from 2000 (13,397 reported cases) to 2012 (1,562 reported cases) with a respective increase rate of 14% and 12.2 % from 2012-2013 and 2014-2015 (Figure 2.1). The incidence of HAV is always high among male compared to females for 2000 to 2011 although this rate is the similar in both sexes and is estimated at 0.5 cases per 100,000 in 2012 (Figure 2.3).
Similarly, the rate of acute cases of HAV by age group has seen a decline from 2000 to 2015 with the highest incidence among the 20-29 years age group and the lowest incidence among children less than 9 years old. However, from 2012 through 2013, the incidence rate has slightly increased among all age group except among 19 years or younger individuals (Figure 2.2). Even though the rates of HAV infection have reduced over the past years, rates are approximately twice as high among Alaskan Natives and Native Americans (Hamer & Griffiths, 2010). Moreover, Hispanics are twice as likely to be infected as compared to non-Hispanic Whites in America. Figure 2.
4 shows the rates of HAV among Hispanics were generally higher than any other ethnic group from 2000 to 2007. Also, despite an overall decline from 2004 to 2012, the HAV acute cases rate among Asian/Pacific Islanders has been the highest among all ethnic group since 2008 and is estimated at 0.6 per 100,000 population in 2015. Rates among Alaskan Natives and American Indians have significantly reduced because of increased vaccination of children in rural and urban communities (Mandell et al., 2015).
The rates of hepatitis A in the U.S. fluctuate in a cyclical pattern. The prevalence in the southwestern and western United States has been higher compared to other regions in the country. The prevalence rate is higher in Oregon, North Dakota New Jersey and California and is estimated at 0.
7 per 100,000 population; California having the highest in 2013 (Table 1).The estimates of the direct and indirect annual costs of hepatitis A in the United States often range from $300 to $488.8 million annually. Children aged between five and fourteen years have the highest incidence based on surveillance data historically. This high prevalence is witnessed among those below five years old as well as people with lower household incomes (Keystone, 2013). Children being brought up in families with low income are exposed to poor sanitation systems, which expose them to HAV infection.
The introduction of hepatitis A vaccine helped to reduce the infection by 80% compared to the previous years. Vaccine recommendation was made in 1996, and this included collective regular vaccination of children in high prevalence areas as well as vaccination of adults with high risk of infection. Vaccination of all children was recommended in 2006, and this has helped to reduce the incidence of hepatitis A. HAV infection is typically symptomatic among older children and adults, but jaundice occurs in over 70% of patients. There are about 40,000 new cases of HAV every year in the United States (Keystone, 2013). Nonetheless, the incidence varies significantly with age, geography, socioeconomic class, and other factors. Risk Factors and preventionThe transmission of hepatitis A is mainly through fecal contamination as well as oral ingestion.
There are different risk factors for hepatitis A that affect the American citizens, which include:Exposure to contaminated food: Individuals who always eat raw shellfish are at risk of HAV infection and should consider hepatitis A vaccination. Inappropriate food handling and improper sanitation practices in hotels and other institutional eating facilities also contribute to HAV. Additionally, a major outbreak of hepatitis A is often associated with imported vegetables and fruits. For instance, the 1997 outbreak of HAV infection in school going children was traced back to strawberries brought in from Mexico and later sold to National School Lunch Program (Hennessey et al., 2009). More than 700 citizens in 10 states contracted hepatitis A in 2003 from eating imported green onions.
In 2015, the HAV prevalence linked to foodborne or waterborne was estimated at 1.5% (Figure 2.6b).An occurrence of natural disaster: Catastrophes such as flood can contaminate the water supplies, which can compromise sanitation systems.
Hurricanes such as Katrina and Harvey led to extensive flooding that affected the water quality. These disasters often leave people with no clean water to drink, which puts them at risk of infections. Recovery workers in places where calamities have occurred are always at high risk of infection.
Living in close quarters: Individuals living in dorms, correctional institutions, group homes, nursing homes, or other housing conditions involving close contact with several unrelated people are at high risk of HAV infection. The United States has several correctional institutions in poor conditions, which facilitate the spread of diseases (Long, Pickering, & Prober, 2012). The virus can spread faster in such facilities because there is overcrowding. Military personnel have also been affected by HAV because they stay in the camps that at times are in poor conditions.
Besides, they interact with different groups of people especially in war-torn areas where the incidence of infection is high. They bring the disease to the United States when they come back from their missions. Laboratory workers are always at risk of contracting the disease when they handle those living with hepatitis A virus (Keystone, 2013). Infections at health facilities have been on the rise since physicians and other patients get the infection from those diagnosed with HAV. Daycare: Employees and children in day-care centers are often at high risk of contracting hepatitis A. About 70% of the children under the age of six years have no symptoms and signs when they are infected (Hennessey et al.
, 2009). Therefore, they can spread the virus without any person noticing. Diapering or inappropriate disposal of diapers from babies who may be infected can spread the infections. Besides, children are notorious for placing everything in their mouths. They may be infected and pass it to other children who play together with them. In 2015, the HAV prevalence among childcare/daycare service employees was estimated at 1.9% and 3.
5% for household member who had contact with daycare/childcare employees (Figure 2.6b). Those handling the children directly are also at risk of contracting the infection. Traveling to developing nations: Those traveling to developing countries and back to the United States are at high risk of HAV infection. In 2015, the prevalence of HAV among travelers outside the United States was 7.6% (Figure 2.6a).
It is advisable that those interested in getting out of the country should be immunized so that they do not contract the disease. Long, Pickering, and Prober (2012) posit that various countries have policies that require visitors to undergo medical checkup before being allowed to cross the borders or settle in the country. It enables them to regulate the spread of diseases such as hepatitis A. Underdeveloped countries often have an inadequate sanitation system, which may significantly influence the spread of the hepatitis A virus. Travelers are advised to maintain high levels of hygiene by avoiding tap water, unpeeled fruits, and washing vegetables. Some parts of the world have a high prevalence of hepatitis A.
Individuals visiting these places are at risk of interacting with infected people. The United States should take measures to control people relocating into the country from a region that had recorded hepatitis A outbreaks within the last few years. Drug use: Intravenous drug use is a major risk factor for hepatitis A. Drug abusers are susceptible to contracting the infection because they frequently share the needles while injecting themselves. Use of dietary supplements or drugs, which may damage the liver can worsen the effect if exposure to the virus happens. Users of illicit intravenous drugs are predisposed to the HAV infection. In 2015, the prevalence rate of HAV among injection and drug user was 3.
5% (Figure 2.6a). Hemophiliacs, as well as other recipients of contaminated therapeutic blood products, are likely to acquire the virus if the blood is not well screened for contamination (Hennessey et al., 2009). Blood transfusion is a significant risk factor for the transmission of hepatitis A virus. The blood donated may be received from an infected person, which contaminates the rest of the stored blood.
Therefore, blood donors, as well as donated blood, should be tested for all possible infections to reduce the incidence of hepatitis A infection. Sexual activity: Intimate contact with the infected individuals can enhance the transmission of hepatitis A virus. Engaging in oral or anal sex often increase the risk of infection. Sexual contact has been a leading cause of the infection among adults in the United States. It contributes significantly to the spread of HAV (Long, Pickering, & Prober, 2012).
In 2015, the prevalence rate of HAV among Men who have sex with men was 8.0% (Figure 2.6a).
Moreover, many youths often find themselves infected because they engage in dangerous sexual behaviors. Those engaging in same-sex are at high risk if one of the partners is infected. Therefore, it is imperative for individuals to use protective methods like use of condoms while engaging in sex or abstain from it. In conclusion, hepatitis A is an infectious disease that affects many Americans. It is often spread by eating or drinking substances contaminated with fecal matter. The United States records more than 50,000 cases of HAV infection every year.
Therefore, hepatitis A is a burden to the country’s economy because HAV prevalence increases the health care costs. The risk factors that influence the spread of hepatitis A include exposure to contaminated food, drug use, and sexual activity, traveling to developing nations, daycare, as well as the occurrence of natural disasters. The United States has strived to regulate the prevalence of the disease by providing vaccination to children and those at high risk of contracting HAV.