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Am J Prev Med. 2003 Nov;25(4):343-6.

Costs of a hepatitis A outbreak affecting homosexual men: Franklin County, Ohio, 1999.

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National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-45, Atlanta, GA 30333, USA.



Hepatitis A is one of the most commonly reported, vaccine-preventable diseases in the United States. Many cases occur in association with community-wide outbreaks, but societal costs to the community are seldom documented.


Hepatitis A case-patients available for a follow-up interview as part of an outbreak investigation were asked about hospitalization, healthcare costs, missed work, and lost wages associated with their illness, as well as healthcare insurance coverage and sick-leave reimbursement. Average costs were calculated by case-patient age, gender, and hospitalization status for lost wages, and by age and hospitalization status for medical costs, and then assigned to case-patients not re-interviewed to provide an estimate of overall costs. Health departments provided outbreak-associated costs.


Between the weeks of November 2, 1998, and May 17, 1999, a total of 136 cases of hepatitis A were reported. Of the 89 (65.4%) case-patients available for interview, 74 (83%) were male; of those, 47 (64%) identified themselves as men who have sex with men (MSM). The average cost of the outbreak per case-patient was $2894 US dollars, of which 51% was associated with lost wages, 40% with medical costs, and 9% with health department costs. Case-patients incurred 44% of total outbreak costs; employers, 29%; healthcare insurers, 18%; and health departments, 9%.


In this community-wide hepatitis A outbreak, case-patients incurred the largest portion of costs, followed by employers, healthcare insurers, and health departments.

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