Hepatitis A Outbreaks in the United States
In recent years, hepatitis A outbreaks have occurred from several different sources:
- Foodborne transmission through ingestion of contaminated food
- Person-to-person transmission through close contact with an infected person, most recently, among people who use drugs, people experiencing homelessness, and men who have sex with men.
In 1996, the Advisory Committee on Immunization Practices (ACIP) first made recommendations to prevent hepatitis A through immunization, focusing primarily on vaccinating people in groups shown to be at high risk for infection and children living in communities with high rates of disease. In 2006, ACIP started recommending routine hepatitis A vaccination of children nationwide. Recent outbreaks have mainly affected adults. Increased vaccination efforts targeting adults in at-risk populations can help limit the size, duration, and spread of person-to-person outbreaks. CDC has provided outbreak-specific considerations for hepatitis A vaccine administration and has updated its overall recommendations on the prevention of hepatitis A virus infection in the United States.
Hepatitis A Cases in the United States
Source: CDC, National Notifiable Diseases Surveillance System (NNDSS)
While the average number of annual hepatitis A virus (HAV) infections reported to CDC in recent years has declined substantially compared to 2000, fluctuations have occurred in the last 20 years due to large outbreaks. After a long downward trend, the first increase between 2012 and 2013 (1,562 and 1,781 reported cases, respectively), was due to a large multi-state outbreak associated with pomegranate arils imported from Turkey. Between 2015 and 2016, the reported cases again increased by 44.4% from 1,390 in 2015 to 2,007 cases in 2016. The 2016 increase was due to two hepatitis A outbreaks, each of which was linked to imported foods. Substantial increases in incident cases of hepatitis A occurred in 2017 and 2018 (3,366 and 12,474 reported cases, respectively) due to ongoing outbreaks reported to CDC among people who use drugs and people experiencing homelessness as well as outbreaks among men who have sex with men.
CDC’s role in responding to hepatitis A outbreaks
State and local health departments typically lead the investigations of local outbreaks of hepatitis A. When requested by the health department, CDC can support health departments in these investigations by:
- Communicating with public health officials from states with reported cases and providing technical assistance;
- Gathering data reported by states on confirmed cases and evaluating and monitoring these data from a national perspective;
- Providing support on vaccine supply and distribution and vaccine response strategy development;
- Testing clinical specimens from suspected hepatitis A cases when requested by states;
- Providing technical assistance and answering questions related to molecular and serologic laboratory testing;
- Providing rapid assistance on the ground during outbreak investigations, often through a formal request by the state health department;
- Alerting clinicians, health care facilities, and public health officials around the country about current outbreaks and providing vaccine policy and clinical guidance for health care providers; and
- Providing information to public and health care providers through a variety of media.
Previous hepatitis A outbreak investigations
- November 2019: Outbreak of hepatitis A virus infections linked to fresh blackberries
- August 2016: Multistate outbreak of hepatitis A linked to frozen strawberries (Final Update)
- August 2016: Outbreak of hepatitis A in Hawaii linked to raw scallops (Final Update)
- May 31, 2013: Multistate hepatitis A virus infections linked to pomegranate seeds from Turkey (Final Update)
For a comprehensive listing of reported foodborne hepatitis A outbreaks, see the National Outbreak Reporting System (NORS) Online Database tool, check the box for “Food,” and under the etiology search option, select “hepatitis.”
- MMWR: Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel. 2018
- MMWR Notes from the Field: Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness — California, Michigan, Kentucky and Utah, 2017
- MMWR Notes from the Field: Increase in Reported Hepatitis A Infections Among Men Who Have Sex with Men — New York City, January–August 2017
- Chapter on Hepatitis A; Manual for the Surveillance of Vaccine-Preventable Diseases