Abstract
Few diseases match the global impact of hepatitis A in terms of affected individuals. The disease is mainly transmitted by oral-fecal route with a very high attack rate and asymptomatic individuals, mainly young children, posing as transmission hosts. Improved sanitary conditions in many parts of the world have caused changes in the epidemiological situation: a shift can be observed towards HAV infection occurring later in life, when the likelihood of symptomatic disease is much higher. As the number of susceptible individuals in adolescence and early adulthood in countries with intermediate endemicity increases, the risk of epidemics with large numbers of clinically apparent infections is rising. Highly protective inactivated vaccines have become available in the last years as an effective protective measure against HAV. Immunization programs for children and adolescents in areas with decreasing incidence of hepatitis A appear advisable. Without doubt, hepatitis A is a disease with considerable global impact. It accounts for 20‐25% of clinical hepatitis worldwide. 1 The worldwide reported incidence of this disease is averaging 1.4 million cases/year but estimates for the true incidence are commonly placed 3‐10 times higher. 2 The problem of underreporting is particularly great: a considerable percentage of patients remain unnotified due to the frequently mild course of clinical disease. Within the United States, acute hepatitis is most commonly caused by hepatitis A virus (HAV): it accounts for approximately 47% of all cases. 3 In the period from 1984 until 1993,between 43,012 and 64,075 cases of acute hepatitis were reported annually, 4 with many more remaining unreported. Hepatitis A virus (HAV) is
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