The changing epidemiology of viral hepatitis in the United States.
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Biomedical subjects
Publications and source records attributed to M B Gregg.
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Since the introduction and widespread use of inactivated and oral poliovirus vaccines, there has been a continued and increasing commitment to worldwide poliomyelitis control. The eradication of poliomyelitis in certain countries, smallpox eradication worldwide, the World Health Organization's (WHO) Expanded Programme on Immunization, and advances in poliovirus vaccine production augur well for worldwide elimination within the next few decades. The success of any such program rests firmly upon scientific feasibility, intensive epidemiologic surveillance, and economic justification. The development of a variety of disease-specific control/prevention programs worldwide have improved communicable disease reporting in many countries and established health-care infrastructure as well. Equally important has been the emergence of the concept of epidemiologic surveillance. The success of poliomyelitis elimination in large parts of the world, the WHO commitment, and the tragic, visible effects of poliomyelitis are sufficiently strong arguments to persuade the countries of the world to make the necessary effort to eliminate poliomyelitis within the next generation.
Morbidity and surveillance data on viral hepatitis cases in the United States since 1970 has revealed plateauing of case rate, continued failure to observe seasonal variation, more general geographic distribution of cases, and persistence, although at progressively lower levels, of highest rates in males 15-29 years of age. Based on results of HBS Ag testing, as much as 24 per cent of hepatitis B may be misdiagnosed by physicians and from 18 to 46 per cent of reported cases can be classified hepatitis B, thus suggesting that hepatitis B may account for up to one-half the recognized viral hepatitis in this country. HBS Ag-negative hepatitis still seems commonly acquired through close personal contact; hepatitis B patients 15-29 years of age also commonly have personal contact association. Parenteral drug abuse and transfusion of blood and blood products continue to play a role in dissemination of hepatitis B, but hepatitis B seems to account for only about one half of all reported transfusion-associated hepatitis. Case fatality rates for reported cases appear to increase with age but are not higher for HBS Ab positive patients than for negative patients.
The epidemiologic field investigation is an important tool used by the Centers for Disease Control (CDC) to provide assistance to State, local, and international public health agencies. The Epidemic Intelligence Service (EIS) of the CDC is an ongoing program that gives physicians and other health professionals opportunities to learn and practice epidemiology. In the period 1946-87, EIS Officers and other professional staff based at CDC headquarters participated in 2,900 epidemiologic field investigations requested by State, local, and international public health agencies. Nearly two-thirds of the investigations involved infectious disease problems, while 13 percent involved noninfectious conditions; for 21.1 percent, the etiology of the problem was unknown when the investigation was initiated. Among the specific subcategories, bacterial causes were the most common, accounting for 864 (29.8 percent) of all investigations. During this 41-year period, an increasing proportion of the field epidemiologic investigations involved public health problems of noninfectious etiology. Trends in the types of investigations done probably represent the influence of such factors as CDC's priorities, organizational structure, and budget; the size of the EIS Program; national health initiatives; and the States' needs and programs.