{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:58:09Z","timestamp":1791406689576,"version":"4.3.3"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T00:00:00Z","timestamp":1618790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T00:00:00Z","timestamp":1618790400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>During 2016\u20102020, the United States experienced person\u2010to\u2010person hepatitis A outbreaks that are unprecedented in the vaccine era, during which case\u2013fatality ratios reported by some jurisdictions exceeded those historically associated with hepatitis A.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>To identify factors associated with hepatitis A\u2013related mortality, we performed a matched case\u2013control study (matched on age [\u00b15\u00a0years] and county of residence in a 1:4 ratio) using data collected from health department and hospital medical records of outbreak\u2010associated patients in Kentucky, Michigan, and West Virginia. Controls were hepatitis A outbreak\u2013associated patients who did not die. There were 110 cases (mean age 53.6\u00a0years) and 414 matched controls (mean age 51.9\u00a0years); most cases (68.2%) and controls (63.8%) were male. Significantly (<jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.05) higher odds of mortality were associated with preexisting nonviral liver disease (adjusted odds ratio [aOR], 5.2), history of hepatitis B (aOR, 2.4), diabetes (aOR, 2.2), and cardiovascular disease (aOR, 2.2), as well as initial Model for End\u2010Stage Liver Disease (MELD) score \u2265 30 (aOR, 10.0), aspartate aminotransferase (AST)\/alanine aminotransferase (ALT) ratio &gt; 2 (aOR, 10.3), and platelet count &lt; 150,000\/\u03bcL (aOR, 3.7) among hepatitis A outbreak\u2013associated patients in the independent multivariable conditional logistic regression analyses (each model adjusted for sex).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Preexisting liver disease, diabetes, cardiovascular disease, and initial MELD score \u2265 30, AST\/ALT ratio \u2265 1, and platelet count &lt; 150,000\/\u03bcL among hepatitis A patients were independently associated with higher odds of mortality. Providers should be vigilant for such features and have a low threshold to escalate care and consider consultation for liver transplantation. Our findings support the recommendation of the Advisory Committee on Immunization Practices to vaccinate persons with chronic liver disease, though future recommendations to include adults with diabetes and cardiovascular disease should be considered.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.31645","type":"journal-article","created":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T03:40:30Z","timestamp":1605930030000},"page":"28-40","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":30,"title":["Factors Associated With Hepatitis A Mortality During Person\u2010to\u2010Person Outbreaks: A Matched Case\u2013Control Study\u2014United States, 2016\u20102019"],"prefix":"10.1097","volume":"74","author":[{"given":"Megan G.","family":"Hofmeister","sequence":"first","affiliation":[{"name":"Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Xing","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique A.","family":"Foster","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan J.","family":"Augustine","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cole","family":"Burkholder","sequence":"additional","affiliation":[{"name":"Division of Communicable Diseases,Michigan Department of Health and Human Services,Lansing,MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Collins","sequence":"additional","affiliation":[{"name":"Division of Communicable Diseases,Michigan Department of Health and Human Services,Lansing,MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"McBee","sequence":"additional","affiliation":[{"name":"Bureau for Public Health,West Virginia Department of Health and Human Resources,Charleston,WV"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica D.","family":"Thomasson","sequence":"additional","affiliation":[{"name":"Bureau for Public Health,West Virginia Department of Health and Human Resources,Charleston,WV"},{"name":"Career Epidemiology Field Officer Program,Division of State and Local Readiness,Centers for Disease Control and 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