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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.

Abstract
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)

Author Affiliations
From the Hepatitis Branch, Division of Viral and Rickettsial Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga (Drs Alter, Hadler, and Margolis and Mss Miller and Moyer); Jefferson County Department of Health, Birmingham, Ala (Dr Alexander); Pinellas County Department of Health, St Petersburg, Fla (Dr Hu); Denver (Colo) Department of Health and Hospitals (Dr Judson); and Tacoma-Pierce County Department of Health, Tacoma, Wash (Ms Mares). Dr Alexander is now with Beecham Laboratories, Bristol, Tenn.

Footnotes
Reprint requests to Hepatitis Branch, Bldg 6, Room 154 (A-33), Centers for Disease Control, Atlanta, GA 30333 (Dr Alter).

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