Editing Hepatitis (section)

== Society and culture ==

=== Economic burden ===
Overall, hepatitis accounts for a significant portion of healthcare expenditures in both developing and developed nations, and is expected to rise in several developing countries.<ref name="Udompap, Kim & Kim">{{Cite journal|last1=Udompap|first1=Prowpanga|last2=Kim|first2=Donghee|last3=Kim|first3=W. Ray|date=2015-11-01|title=Current and Future Burden of Chronic Nonmalignant Liver Disease|journal=Clinical Gastroenterology and Hepatology|volume=13|issue=12|pages=2031–2041|doi=10.1016/j.cgh.2015.08.015|issn=1542-7714|pmc=4618163|pmid=26291665}}</ref><ref name="Reducing the neglected burden">{{Cite journal|last1=Lemoine|first1=Maud|last2=Eholié|first2=Serge|last3=Lacombe|first3=Karine|title=Reducing the neglected burden of viral hepatitis in Africa: Strategies for a global approach|journal=Journal of Hepatology|volume=62|issue=2|pages=469–476|doi=10.1016/j.jhep.2014.10.008|pmid=25457207|year=2015|doi-access=free}}</ref> While hepatitis A infections are self-limited events, they are associated with significant costs in the United States.<ref name="Current Childhood Vaccination Strategies">{{Cite journal|last1=Koslap-Petraco|first1=Mary Beth|last2=Shub|first2=Mitchell|last3=Judelsohn|first3=Richard|title=Hepatitis A: Disease Burden and Current Childhood Vaccination Strategies in the United States|journal=Journal of Pediatric Health Care|volume=22|issue=1|pages=3–11|doi=10.1016/j.pedhc.2006.12.011|pmid=18174084|year=2008}}</ref> It has been estimated that [[Direct cost|direct and indirect costs]] are approximately $1817 and $2459 respectively per case, and that an average of 27 work days is lost per infected adult.<ref name="Current Childhood Vaccination Strategies"/> A 1997 report demonstrated that a single hospitalization related to hepatitis A cost an average of $6,900 and resulted in around $500 million in total annual healthcare costs.<ref>{{Cite web|url=https://www.who.int/csr/disease/hepatitis/HepatitisA_whocdscsredc2000_7.pdf?ua=1|title=Hepatitis A|last1=Previsani|first1=Nicoletta|last2=Lavanchy|first2=Daniel|date=2000|website=World Health Organization Global Alert and Response|publisher=World Health Organization|access-date=March 5, 2016}}</ref> Cost effectiveness studies have found widespread vaccination of adults to not be feasible, but have stated that a combination hepatitis A and B vaccination of children and at risk groups (people from endemic areas, healthcare workers) may be.<ref>{{Cite journal|last1=Anonychuk|first1=Andrea M.|last2=Tricco|first2=Andrea C.|last3=Bauch|first3=Chris T.|last4=Pham|first4=Ba'|last5=Gilca|first5=Vladimir|last6=Duval|first6=Bernard|last7=John-Baptiste|first7=Ava|last8=Woo|first8=Gloria|last9=Krahn|first9=Murray|date=2008-01-01|title=Cost-effectiveness analyses of hepatitis A vaccine: a systematic review to explore the effect of methodological quality on the economic attractiveness of vaccination strategies|journal=PharmacoEconomics|volume=26|issue=1|pages=17–32|issn=1170-7690|pmid=18088156|doi=10.2165/00019053-200826010-00003|s2cid=46965673}}</ref>

Hepatitis B accounts for a much larger percentage of health care spending in endemic regions like Asia.<ref>{{Cite journal|last1=Chan|first1=Henry Lik-Yuen|last2=Jia|first2=Jidong|date=2011-01-01|title=Chronic hepatitis B in Asia—new insights from the past decade|journal=Journal of Gastroenterology and Hepatology|language=en|volume=26|pages=131–137|doi=10.1111/j.1440-1746.2010.06544.x|pmid=21199524|s2cid=23548529|issn=1440-1746|doi-access=free}}</ref><ref name="Economics of treating in Asia">{{Cite journal|last1=Dan|first1=Yock Young|last2=Aung|first2=Myat Oo|last3=Lim|first3=Seng Gee|date=2008-09-01|title=The economics of treating chronic hepatitis B in Asia|journal=Hepatology International|volume=2|issue=3|pages=284–295|doi=10.1007/s12072-008-9049-2|issn=1936-0533|pmc=2716880|pmid=19669256}}</ref> In 1997 it accounted for 3.2% of South Korea's total health care expenditures and resulted in $696 million in direct costs.<ref name="Economics of treating in Asia" /> A large majority of that sum was spent on treating disease symptoms and complications.<ref>{{Cite journal|last=Lavanchy|first=D.|date=2004-03-01|title=Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures|journal=Journal of Viral Hepatitis|volume=11|issue=2|pages=97–107|issn=1352-0504|pmid=14996343|doi=10.1046/j.1365-2893.2003.00487.x|s2cid=163757}}</ref> Chronic hepatitis B infections are not as endemic in the United States, but accounted for $357 million in hospitalization costs in the year 1990.<ref name="Udompap, Kim & Kim" /> That number grew to $1.5 billion in 2003, but remained stable as of 2006, which may be attributable to the introduction of effective drug therapies and vaccination campaigns.<ref name="Udompap, Kim & Kim" /><ref name="Reducing the neglected burden" />

People infected with chronic hepatitis C tend to be frequent users of the health care system globally.<ref name="Younossi, Kanwal, Saab, et al">{{Cite journal|last1=Younossi|first1=Z. M.|last2=Kanwal|first2=F.|last3=Saab|first3=S.|last4=Brown|first4=K. A.|last5=El-Serag|first5=H. B.|last6=Kim|first6=W. R.|last7=Ahmed|first7=A.|last8=Kugelmas|first8=M.|last9=Gordon|first9=S. C.|date=2014-03-01|title=The impact of hepatitis C burden: an evidence-based approach|journal=Alimentary Pharmacology & Therapeutics|language=en|volume=39|issue=5|pages=518–531|doi=10.1111/apt.12625|pmid=24461160|s2cid=21263906|issn=1365-2036|doi-access=free}}</ref> It has been estimated that a person infected with hepatitis C in the United States will result in a monthly cost of $691.<ref name="Younossi, Kanwal, Saab, et al" /> That number nearly doubles to $1,227 for people with compensated (stable) cirrhosis, while the monthly cost of people with decompensated (worsening) cirrhosis is almost five times as large at $3,682.<ref name="Younossi, Kanwal, Saab, et al" /> The wide-ranging effects of hepatitis make it difficult to estimate indirect costs, but studies have speculated that the total cost is $6.5 billion annually in the United States.<ref name="Udompap, Kim & Kim" /> In Canada, 56% of HCV related costs are attributable to cirrhosis and total expenditures related to the virus are expected to peak at CAD$396 million in the year 2032.<ref>{{Cite journal|last1=Myers|first1=Robert P.|last2=Krajden|first2=Mel|last3=Bilodeau|first3=Marc|last4=Kaita|first4=Kelly|last5=Marotta|first5=Paul|last6=Peltekian|first6=Kevork|last7=Ramji|first7=Alnoor|last8=Estes|first8=Chris|last9=Razavi|first9=Homie|date=2014-05-01|title=Burden of disease and cost of chronic hepatitis C infection in Canada|journal=Canadian Journal of Gastroenterology & Hepatology|volume=28|issue=5|pages=243–250|issn=2291-2797|pmc=4049256|pmid=24839620|doi=10.1155/2014/317623|doi-access=free}}</ref>

=== 2003 Monaca outbreak ===
The largest outbreak of hepatitis A virus in United States history occurred among people who ate at a now-defunct Mexican food restaurant located in Monaca, Pennsylvania in late 2003.<ref name="green onions">{{Cite journal|last=Centers for Disease Control and Prevention (CDC)|date=2003-11-28|title=Hepatitis A outbreak associated with green onions at a restaurant—Monaca, Pennsylvania, 2003|journal=MMWR. Morbidity and Mortality Weekly Report|volume=52|issue=47|pages=1155–1157|issn=1545-861X|pmid=14647018}}</ref> Over 550 people who visited the restaurant between September and October 2003 were infected with the virus, three of whom died as a direct result.<ref name="green onions" /> The outbreak was brought to the attention of health officials when local [[emergency medicine]] physicians noticed a significant increase in  cases of hepatitis A in the county.<ref>{{Cite news|url=https://www.nytimes.com/2003/11/17/us/community-is-reeling-from-hepatitis-outbreak.html|title=Community Is Reeling From Hepatitis Outbreak|last=Polgreen|first=Lydia|date=November 16, 2003|work=[[The New York Times]]|access-date=March 10, 2016|url-status=live|archive-url=https://web.archive.org/web/20160322235231/http://www.nytimes.com/2003/11/17/us/community-is-reeling-from-hepatitis-outbreak.html|archive-date=March 22, 2016}}</ref> After conducting its investigation, the [[Centers for Disease Control and Prevention|CDC]] attributed the source of the outbreak to the use of contaminated raw [[Scallion|green onion]]. The restaurant was purchasing its green onion stock from farms in Mexico at the time.<ref name="green onions" /> It is believed that the green onions may have been contaminated through the use of contaminated water for crop irrigation, rinsing, or icing or by handling of the vegetables by infected people.<ref name="green onions" /> Green onion had caused similar outbreaks of hepatitis A in the southern United States prior to this, but not to the same magnitude.<ref name="green onions" /> The CDC believes that the restaurant's use of a large communal bucket for chopped raw green onion allowed non-contaminated plants to be mixed with contaminated ones, increasing the number of vectors of infection and amplifying the outbreak.<ref name="green onions" /> The restaurant was closed once it was discovered to be the source, and over 9,000 people were given hepatitis A [[Antibody|immune globulin]] because they had either eaten at the restaurant or had been in close contact with someone who had.<ref name="green onions" />