The burden of Hepatitis A outbreaks in the United States: Health outcomes, economic costs, and management strategies


Hepatitis A (HepA) vaccines are recommended for United States (US) adults at risk of HepA. Ongoing 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, healthcare 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/33 studies) and liver transplantation (n=5/33); reported case fatality rates ranged from 0-10.8%. Hospitalization rates reported in studies investigating person-to-person outbreaks ranged from 41.6-84.8%. 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.

Authors E K Horn, O Herrera-Restrepo, A M Acosta, A Simon, B Jackson, E Lucas
Journal The Journal of Infectious Diseases
Therapeutic Areas Infectious Diseases and Vaccines
Centers of Excellence Strategic Market Access
Year 2024
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