Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu.
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights “Hepatitis D-associated hospitalizations in the United States, 2010-2018” Wasuwanich P, Striley CW, Kamili S, Teshale EH, Seaberg EC, Karnsakul W. Journal of Viral Hepatitis, March 2022 vol 29(3): 218-226.
What question(s) does this study address?
Hepatitis D virus is known as a “satellite virus” because it can only infect persons who are also infected with the Hepatitis B virus. Acute Hepatitis D infection can occur following simultaneous infection with both Hepatitis B and Hepatitis D or with Hepatitis D infection among persons who are already chronically infected with Hepatitis B. Hepatitis D infection is considered uncommon in the U.S. However, surveillance data are limited because Hepatitis D virus infection is not a reportable condition, and some studies suggest the prevalence of Hepatitis D infection in the U.S. may be higher than previously estimated. Using data from the National Inpatient Sample (a database of inpatient stays and hospital discharges in the U.S.), the researchers estimated the incidence of Hepatitis D associated hospitalizations and described trends over time. This study compared two groups of patients: those with Hepatitis D and patients with Hepatitis B who did not have Hepatitis D.
What are the major findings of this report/article?
- Out of a total of 324,527,181 estimated hospitalizations in the U.S. between 2010 and 2018, the researchers identified 3,825 hospitalizations with a diagnosis of Hepatitis D and 413,355 hospitalizations with a diagnosis of Hepatitis B without Hepatitis D.
- The hospitalization rate of Hepatitis D was between 6.9 and 20.7 per 10,000,000 and did not change significantly over time.
- Compared to the Hepatitis B-only cohort, the Hepatitis D cohort was more likely to be male, Hispanic, and hospitalized in the Northeast region of the U.S.
- A history of injection drug use was more common in the Hepatitis D cohort compared to the Hepatitis B-only cohort.
- Compared to the Hepatitis B-only cohort, the Hepatitis D cohort had significantly greater frequencies of liver failure and related complications such as ascites and portal hypertension.
What are the implications for the prevention and control of viral hepatitis?
- This is the first study attempting to quantify the burden of Hepatitis D in a national sample of patients hospitalized in the U.S.
- Although Hepatitis D related hospitalizations appear to be relatively uncommon in the U.S., they are associated with serious complications.
- More frequent testing for Hepatitis D along with making Hepatitis D infection a reportable condition would improve estimates of Hepatitis D disease burden in the U.S. and help promote access to new treatments as they emerge.