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While the prevalence of hepatitis A virus (HAV) infection is relatively low in the general population within developed nations such as the United States (US), numerous reports have documented outbreaks of HAV among men who have sex with men (MSM). With an effective two-dose vaccine available, HAV remains an important vaccine-preventable disease in the United States, and the Centers for Disease Control and Prevention recommend the universal vaccination against HAV of MSM.

Clinical manifestations of HAV are age-related, with increased age at acquisition being associated with more severe disease. For example, only 5-20% of children under 5 years of age develop icteric disease; the majority of these children exhibit many asymptomatic transient infections. However, the occurrence of fatal fulminant hepatitis increases with age at infection, and the occurrence of hepatitis A in older patients as well as those with underlying chronic liver disease (such as chronic hepatitis В or С infection) is associated with increased mortality.
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In addition to clinical morbidity and mortality, HAV exerts an important economic burden. Adults who become ill lose an average of 27 days of work due to the disease. Between 11% and 22% of persons who have hepatitis A infection are hospitalized. Average costs associated with hepatitis A infection range from $1,817 to $2,459 per case for adults. In one common-source outbreak in the US among 43 persons, the estimated total societal cost was approximately $800,000. In 1989, the estimated annual direct and indirect costs of hepatitis A infection in the US were more than $200 million, equivalent to over $300 million in 1997 dollars. In the US, and in other countries of low endemicity, exposure to HAV tends to be at an older age, resulting in increased morbidity and economic impact from this disease.

Unfortunately, little is know about the predictors of HAV vaccine acceptance. Moreover, specific populations such as African American MSM have been neglected in the behavioral literature with respect to understanding vaccination against diseases such as hepatitis B. In order increase vaccination rates, a thorough understanding of vaccine behavior among different racial and ethnic groups is necessary as an antecedent to developing targeted or tailored intervention strategies. In this study, we explored the psychosocial variables that may affect HAV vaccination acceptance within a conventional outreach sample of young African American MSM. Findings from this study may inform intervention efforts to increase HAV vaccination rates among African American MSM, as well as, inform future interventions designed to enhance vaccination within this population should vaccines against the human immunodeficiency virus (HIV) and hepatitis С become available.

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