# The Burden of Hepatitis A Outbreaks in the United States: Health Outcomes, Economic Costs, and Management Strategies

## TL;DR

Hepatitis A outbreaks in the US since 2016 have caused significant health and economic impacts, highlighting the need for better prevention and vaccination efforts.

## Contribution

This study systematically reviews health outcomes, economic costs, and management strategies of HepA outbreaks in the US since 2016.

## Key findings

- Hospitalization rates during HepA outbreaks ranged from 41.6% to 84.8%.
- The average cost of hospitalization due to HepA outbreaks was over $16,000.
- Challenges in outbreak management include reaching at-risk groups and vaccine distrust.

## Abstract

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.

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.

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.

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.

Ongoing hepatitis A outbreaks in the United States are associated with a substantial clinical and economic burden. Prevention strategies and efforts to increase awareness and vaccination coverage are needed to reduce the burden of hepatitis A and prevent future outbreaks.

Graphical Abstract