2016 reproduced courtesy of the Centers for Disease Control and Prevention © 2016.) ( B) Incidence of hepatitis A virus by age group-United States, 2000–2015. ( A) Cases of acute hepatitis A per 100,000 population reported to the National Notifiable Diseases Surveillance System, United States, 1966–2013. Incidence of hepatitis A in the United States. These isolated clinical cases were traditionally associated with travel to endemic areas however, in the past two decades, locally acquired (autochthonous) HEV infection has been increasingly recognized in developed countries, including the United States. HEV infection has two distinct epidemiological profiles: in developing countries HEV genotype (gt)1 (and occasionally gt2 and gt4) presents as sporadic disease and as large outbreaks primarily associated with fecally contaminated drinking water, although in developed countries HEV gt3 presents as sporadic disease ( Teshale et al. 2012 Global Burden of Disease 2015 Mortality and Causes of Death Collaborators 2016). In developing countries, there are an estimated 20 million incident HEV infections annually, 3.3 million of which are symptomatic, resulting in an estimated 26,700 deaths in 2015 ( Rein et al. Hepatitis E virus (HEV), also an enterically transmitted RNA virus, is a significant cause of acute viral hepatitis worldwide. Despite being a vaccine-preventable disease, the changing epidemiology of HAV has led to increased susceptibility in older persons who are more likely to suffer from more severe disease, highlighting the significance of HAV as an important pathogen in terms of public health and its burden on the medical system. 2014 Centers for Disease Control and Prevention, unpubl.). Community-wide outbreaks continue to occur in high-risk populations, such as men who have sex with men (MSM), the homeless, and persons who use illicit drugs, and appear to be more severe in older populations and populations with underlying medical conditions ( Villano et al. Infections in the United States are typically seen in travelers returning from endemic countries, but outbreaks have increasingly been linked to foods imported from endemic countries ( Klevens et al. The incidence of hepatitis A virus (HAV) infection has been declining in the United States since infant vaccination was initially recommended in 1996 (see cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm).
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