The changing epidemiology of hepatitis B in the United States. Need for alternative vaccination strategies

JAMA. 1990 Mar 2;263(9):1218-22.


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.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Female
  • Hepatitis B / epidemiology*
  • Hepatitis B / ethnology
  • Hepatitis B / etiology
  • Hepatitis B / prevention & control
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Population Surveillance
  • Risk Factors
  • Sex Factors
  • United States / epidemiology
  • United States / ethnology
  • Vaccination / methods*