{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T09:17:23Z","timestamp":1781083043786,"version":"3.54.1"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T00:00:00Z","timestamp":1619049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Hepatitis A virus (HAV) infection causes an acute enteric hepatitis associated with substantial morbidity and mortality, particularly in older individuals. Incidence of HAV infection is low in the United States, mostly related to consumption of contaminated food. Starting in 2017, Indiana reported a large HAV outbreak. We sought to characterize the risk\u2010exposures, clinical features and outcomes of HAV and examine the differences based on underlying cirrhosis and age. Adults \u226518\u00a0years diagnosed with HAV between January 2017 and April 2019 at two large healthcare systems in Indiana were identified. Demographic data, risk\u2010exposures, clinical features, laboratory data and clinical outcomes were collected for analysis. The HAV cohort constituted 264 individuals with mean age of 41\u2010years, 62% male and 94% Caucasian. Risk\u2010exposures identified were illicit drug use (74%), food\u2010borne (15%), person\u2010to\u2010person (11%) and incarceration (11%). Mortality rate was 2%, acute liver failure (ALF) was seen in 4% and acute on chronic liver failure (ACLF) was seen in 30% (6 of 20 with underlying cirrhosis). Admission MELD score was the only factor associated with ALF [OR\u00a0=\u00a01.17 (1.08\u20131.2), <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.0001], on multivariable logistic regression analysis. Higher proportion of individuals with underlying cirrhosis developed acute kidney injury (AKI) (26% vs. 9%, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03), ascites (45% vs. 11%, <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.0001) and hepatic encephalopathy (35% vs. 4%, <jats:italic>p\u00a0<\/jats:italic>&lt;\u00a00.0001). In conclusion, illicit drug use was the predominant risk\u2010exposure in the current HAV outbreak, which was associated with 2% mortality rate, and those with cirrhosis had worse outcomes (AKI, ascites and HE), of whom 30% developed ACLF.<\/jats:p>","DOI":"10.1111\/jvh.13504","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T01:45:58Z","timestamp":1616636758000},"page":"964-971","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Insight into an acute hepatitis A outbreak in Indiana"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1993-5223","authenticated-orcid":false,"given":"Niharika","family":"Samala","sequence":"first","affiliation":[{"name":"Department of Medicine Division of Gastroenterology and Hepatology Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wassim","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Department of Medicine Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Poole","sequence":"additional","affiliation":[{"name":"Graduate School of Medicine Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani","family":"Shamseddeen","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Gastroenterology and Hepatology Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"S Are","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Gastroenterology and Hepatology Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"S Orman","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Gastroenterology and Hepatology Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavish R.","family":"Patidar","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Gastroenterology and Hepatology Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Vuppalanchi","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Gastroenterology and Hepatology Indiana University School of Medicine  Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,22]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"WHO report. World Health Organization: Hepatitis A. Published online October 19 2015.https:\/\/www.who.int\/immunization\/diseases\/hepatitisA\/en\/"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0264-410X(92)90576-6"},{"issue":"7","key":"e_1_2_8_4_1","first-page":"1","article-title":"Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"55","author":"Advisory Committee on Immunization Practices (ACIP)","year":"2006","journal-title":"MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.2.194"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2018.1489189"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2015.10.009"},{"key":"e_1_2_8_8_1","unstructured":"CDC Report. Centers for Disease Control: Viral Hepatitis: Acute Hepatitis A.https:\/\/www.cdc.gov\/hepatitis\/outbreaks\/2017March\u2010HepatitisA.htm"},{"key":"e_1_2_8_9_1","unstructured":"Indiana State Department of Health.Indiana Hepatitis A Outbreak.https:\/\/www.in.gov\/isdh\/27791.htm"},{"key":"e_1_2_8_10_1","volume-title":"Widespread Person\u2010to\u2010Person Outbreaks of Hepatitis A across the United States","year":"2020"},{"key":"e_1_2_8_11_1","volume-title":"Community Outbreak of HIV Infection Linked to Injection Drug Use of Oxymorphone \u2014. Indiana, 2015","year":"2015"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2018.10.007"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1515195"},{"key":"e_1_2_8_14_1","volume-title":"The Consumption And Consequences Of Alcoholc, Tobaco, And Drugs In Indiana: A State Epidemiological Profile 2017: Indiana State Epidemiological Outcomes Workgroup","year":"2017"},{"issue":"2","key":"e_1_2_8_15_1","first-page":"201","article-title":"Is hepatitis A more severe in patients with chronic hepatitis B and other chronic liver diseases?","volume":"90","author":"Keeffe EB","year":"1995","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_8_16_1","volume-title":"G Y. Clinical Spectrum and Natural History of Viral Hepatitis A in the 1988 Shangai Epidemic, Viral Hepatitis and Liver Disease"},{"issue":"24","key":"e_1_2_8_17_1","first-page":"1772","article-title":"Hepatitis associated with hepatitis A superinfection in patients with chronic hepatitis C","volume":"338","author":"Leino T","year":"1998","journal-title":"N Engl J Med"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199801293380503"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz467"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0264-410X(92)90533-P"},{"key":"e_1_2_8_21_1","volume-title":"Positive test results for acute hepatitis A virus infection among persons with no recent history of acute hepatitis \u2010\u2010\u2010 United States, 2002\u2010\u20102004","year":"2005"},{"key":"e_1_2_8_22_1","volume-title":"Centers for disease control and prevention: Hepatitis A, Acute 2019 Case Definition"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.25551"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0801209"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2014-308874"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(93)90101-6"},{"key":"e_1_2_8_28_1","unstructured":"Choroplethr Packages for R\u2010software.https:\/\/arilamstein.com\/packages\/"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1086\/513757"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6743a3"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2018.07.031"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21439"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199806113382413"},{"issue":"1","key":"e_1_2_8_34_1","first-page":"12","article-title":"Hepatitis A prevalence among injection drug users","volume":"19","author":"Wells R","year":"2006","journal-title":"Clin Lab Sci J Am Soc Med Technol"}],"container-title":["Journal of Viral Hepatitis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.13504","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jvh.13504","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.13504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T10:07:34Z","timestamp":1693562854000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jvh.13504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,22]]},"references-count":33,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1111\/jvh.13504"],"URL":"https:\/\/doi.org\/10.1111\/jvh.13504","archive":["Portico"],"relation":{},"ISSN":["1352-0504","1365-2893"],"issn-type":[{"value":"1352-0504","type":"print"},{"value":"1365-2893","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,22]]},"assertion":[{"value":"2021-01-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}