{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:15:45Z","timestamp":1791353745136,"version":"4.3.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Since 2016, the United States has experienced person-to-person hepatitis A outbreaks unprecedented in the vaccine era. The proportion of cases hospitalized in these outbreaks exceeds historical national surveillance data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We described the epidemiology, characterized the reported increased morbidity, and identified factors associated with hospitalization during the outbreaks by reviewing a 10% random sample of outbreak-associated hepatitis A cases in Kentucky, Michigan, and West Virginia\u20143 heavily affected states. We calculated descriptive statistics and conducted age-adjusted log-binomial regression analyses to identify factors associated with hospitalization.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Participants in the random sample (n\u2005=\u2005817) were primarily male (62.5%) with mean age of 39.0 years; 51.8% were hospitalized. Among those with available information, 73.2% reported drug use, 14.0% were experiencing homelessness, 29.7% were currently or recently incarcerated, and 61.6% were epidemiologically linked to a known outbreak-associated case. Residence in Michigan (adjusted risk ratio [aRR] = 1.8), being a man who has sex with men (aRR = 1.5), noninjection drug use (aRR = 1.3), and homelessness (aRR = 1.3) were significantly (P\u2005&amp;lt;\u2005.05) associated with hepatitis A-related hospitalization.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our findings support current Advisory Committee on Immunization Practices recommendations to vaccinate all persons who use drugs, men who have sex with men, and persons experiencing homelessness against hepatitis A.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiaa636","type":"journal-article","created":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T19:14:08Z","timestamp":1601925248000},"page":"426-434","source":"Crossref","is-referenced-by-count":43,"title":["Hepatitis A Person-to-Person Outbreaks: Epidemiology, Morbidity Burden, and Factors Associated With Hospitalization\u2014Multiple States, 2016\u20132019"],"prefix":"10.1093","volume":"223","author":[{"given":"Megan G","family":"Hofmeister","sequence":"first","affiliation":[{"name":"Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Xing","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"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, Georgia, USA"}],"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, Georgia, USA"}],"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, Michigan, USA"}],"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, Michigan, USA"}],"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, West Virginia, USA"}],"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, West Virginia, USA"},{"name":"Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Thoroughman","sequence":"additional","affiliation":[{"name":"Career Epidemiology Field Officer Program, Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"},{"name":"Kentucky Department for Public Health, Frankfort, Kentucky, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark K","family":"Weng","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip R","family":"Spradling","sequence":"additional","affiliation":[{"name":"Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,24]]},"reference":[{"key":"2021021308275752500_CIT0001","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1093\/oxfordjournals.aje.a114093","article-title":"Frequency of illness associated with epidemic hepatitis A virus infections in adults","volume":"122","author":"Lednar","year":"1985","journal-title":"Am J Epidemiol"},{"key":"2021021308275752500_CIT0002","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/S0891-5520(05)70123-9","article-title":"Hepatitis A","volume":"14","author":"Kemmer","year":"2000","journal-title":"Infect Dis Clin North Am"},{"key":"2021021308275752500_CIT0003","first-page":"1","article-title":"Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"45","author":"Centers for Disease Control and 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