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New Study Finds Universal Vaccination Against Hepatitis A Would Prevent Disease and Save Lives

Results suggest national childhood immunization policy would be cost-effective

A national hepatitis A immunization policy would prevent a significant number of debilitating cases of the disease and deaths associated with it, according to a new study published in the October issue of Pediatric Infectious Disease Journal.

Researchers examined the benefits of extending immunization nationwide to all healthy children age 2 and older, and found that national vaccination would reduce the number of primary cases of hepatitis A by 54 percent and the number of secondary cases by 76 percent, according to study co-author by David P. Greenberg, MD, director of the Center for Vaccine Research at Children’s Hospital of Pittsburgh.

Researchers also report that such a national immunization policy would be cost-effective. Hepatitis A is a potentially fatal disease, and is a significant drain on the U.S. economy, costing nearly $500 million annually. Despite the availability of safe and effective vaccines, hepatitis A remains the most commonly reported vaccine-preventable disease in the country. Current immunization policies are limited to children in 11 states where the rate of hepatitis A is twice the national average. However, these states account for only half of all reported cases of hepatitis A in the country.

“Our results suggest that universal vaccination of all children would prevent substantial illness and death associated with hepatitis A, averting more than 75,000 cases a year,” Dr. Greenberg said. “In fact, the highest incidence of the disease is among children ages 5 to 14, with nearly one-third of all reported cases occurring among children under the age of 15. Even though young children often do not display any symptoms of hepatitis, they act as a 'reservoir’ for the virus, easily infecting their older siblings and parents, for whom the disease can be far more serious.”

While routine childhood hepatitis A immunization is currently only recommended in regions with incidence rates twice the national average, results of the study show that vaccination would be cost-effective in a wider geographic area. In coming to this conclusion, the authors considered vaccination of the 2000 United States birth cohort. The results were compiled using a Markov model, a decision-analysis tool, to predict hepatitis A infections among potential vaccinees and their personal contacts from ages 2 to 85.

Net vaccination costs were estimated from health system and societal perspectives and were then compared with life-years saved and quality-adjusted life years (QALYs) gained. QALYs are years lived free from suffering hepatitis A consequences. Most childhood vaccines have been evaluated in this fashion, by comparing net health system costs with longevity gains.

On this basis, a national policy of hepatitis A childhood immunization would cost $14,100 per life-year saved, well within the range accepted as cost-effective for other childhood vaccines. By comparison, pneumococcal conjugate vaccine costs $74,800 per life-year saved. Over the lifetimes of the 2000 birth cohort, the study predicted that national hepatitis A childhood immunization would prevent 6,738 hospitalizations, 152 deaths and the loss of 9,612 QALYs.

It is estimated that approximately 270,000 hepatitis A cases occur each year in the United States. Hepatitis A is an infection of the liver, spread via the fecal-oral route, through close personal contact, or the ingestion of contaminated water or food. Symptoms of the disease can be debilitating and include fever, fatigue, loss of appetite, nausea, abdominal discomfort, jaundice and dark urine. Up to 22 percent of adult hepatitis A patients require hospitalization and more than 100 people in this country die every year from consequences of the disease. Infected individuals can unknowingly infect others up to two weeks prior to feeling ill themselves. Hepatitis A is also a significant drain on the nation’s economy, costing $489 million in 1997 alone. The most important economic consequence of hepatitis A is lost worker productivity, accounting for 36 percent of the total cost of hepatitis A to the nation.

“By vaccinating all children against hepatitis A, we would help ease economic burdens associated with the disease,” Dr. Greenberg said. “A national vaccination program would significantly reduce the number of cases of hepatitis A in children. Therefore, we will see fewer adults infected and, as a result, fewer lost work days and a decrease in hospital costs.”

Shortly after the introduction of the hepatitis A vaccine in 1995, the Advisory Committee on Immunization Practices (ACIP) recommended vaccinating persons at increased risk of infection or poor disease outcomes, including travelers to countries with high and intermediate endemicity, illegal drug users and persons with clotting factor disorders or chronic liver disease. Because that only had a moderate effect on overall disease rates, the ACIP expanded their recommendations in 1999 to include routine childhood vaccination against hepatitis A in states, counties and communities with incidence rates twice the national average. Since then, several states have established hepatitis A vaccination requirements for day care and/or elementary school entry.

*The study was supported by an unrestricted research grant from GlaxoSmithKline Vaccines. In addition, GlaxoSmithKline Vaccines provided assistance for communications activities surrounding the study. It was authored by R. Jake Jacobs, Masters in Public Administration at Capitol Outcomes Research, Inc.; Dr. David P. Greenberg, Division of Allergy, Immunology and Infectious Disease, Children’s Hospital of Pittsburgh and of the University of Pittsburgh School of Medicine; Dr. Raymond S. Koff of the University of Massachusetts Medical School, currently Roche Labs; Dr. Sammy Saab, Masters of Public Health of the Department of Medicine and Surgery, University of California, Los Angeles; and Allen S. Meyerhoff, Masters of Science at Capitol Outcomes Research, Inc.

Contacts:
Melanie Tush Finnigan, 412-692-5016, Melanie.Finnigan@chp.edu
Marc Lukasiak, 412-692-5016, Marc.Lukasiak@chp.edu

Last Update
February 19, 2008
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Last Update
February 19, 2008
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