Outcomes in Practice

Introduction Approximately 100,000 cases of acute hepatitis A virus (HAV) infection occur annually in the United States. The recent food-borne outbreak of HAV infection associated with a catering facility in Denver, CO, resulted in 43 cases of hepatitis A and total costs (ie, disease control costs, costs of medical treatment, lost productivity of affected individuals, and cost of food discarded by the catering company) of $809,706 [1]. This case illustrates the public health risks and costs of even small epidemics of HAV infection. Active immunization with inactivated HAV vaccines has supplemented hygienic measures and replaced passive immunization with immune globulin as the primary method for the prevention of HAV infection, and recommendations for the use of these hepatitis A vaccines have been issued. Nevertheless, debates concerning the economic implications of implementing these recommendations, as well as debates concerning the timing of extra booster doses of vaccine and the costs associated with universally immunizing children, remain unresolved. While comprehensive immunization would help to reduce the costs associated with HAV infection in the United States, prevention of future epidemics can only be achieved by universal vaccination of children.