National Progress Report 2020 Goal: Reduce the rate of reported hepatitis A virus (HAV) infections to 0.30 per 100,000 population

Incidence rate* of reported HAV infections

Bar chart for years 2010-2020, charting rate per 100,000, .54 for 2010, .45 for 2011, .50 for 2012, .56 for 2013, .39 for 2014, .43 for 2015, .62 for 2016 and projected downward to .3 by 2020.

Source: CDC, National Notifiable Diseases Surveillance System (data run May 25, 2018)
*Rate per 100,000 U.S. population

Summary of Findings

The incidence rate of reported HAV infections has increased since 2014. With a 2016 annual incidence rate of 0.62 cases per 100,000 U.S. population, the 2016 target of 0.36 per 100,000 was not met. The incidence rate of hepatitis A is subject to variation, in large part due to hepatitis A outbreaks. For example, in 2013, a large HAV outbreak occurred among persons who consumed imported pomegranate seeds in several southwestern states and Hawaii. In 2016, two hepatitis A outbreaks occurred, both attributed to imported foods: one to frozen strawberries and one to raw scallops.

Reduction needed to meet 2020 goal: A 51.6% reduction from the incidence rate reported in 2016 is needed to meet the 2020 goal of 0.30 cases per 100,000 U.S. population.

This reduction can best be achieved by

  • Updating CDC recommendations for hepatitis A vaccination (including post‑exposure prophylaxis) to target emerging at-risk populations.
  • Assisting state and local health departments and other federal partners in outbreak detection and response.
  • Promoting evidence-based strategies to increase vaccination as recommended by the Community Preventive Services Task ForceExternal.
  • Analyzing available data and other strategic information to detect at-risk populations and gaps in vaccination coverage.
  • Continuing to promote routine childhood vaccination schedules and vaccination of adults at increased risk for hepatitis A according to Advisory Committee on Immunization Practices (ACIP) Vaccine Recommendations and Guidelines.

Technical Notes

Data Sources: CDC, National Notifiable Diseases Surveillance System (NNDSS) and CDC/NCHS/US Census Bureau, Bridged-race Population Estimates

Numerator: Number of HAV infections reported annually

Denominator: Total population in reporting states

Indicator Notes: (1) The NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable-disease-related health information. Surveillance for viral hepatitis through NNDSS is based on case definitions developed and approved by the Council of State and Territorial Epidemiologists (CSTE) and CDC. Reported cases of acute viral hepatitis A are required to meet specific clinical and laboratory criteria. Only laboratory-confirmed cases of acute viral hepatitis are presented in this report. Hepatitis A is reportable in all jurisdictions. Health-care providers, hospitals, and/or laboratories report cases to the local or state health department, and states voluntarily submit reports or notify CDC of newly diagnosed cases of hepatitis A that meet the surveillance case definition. Case rates per 100,000 U.S. population are calculated based on the resident population of the United States during a particular data-collection year. For census years (e.g., 2010), population counts enumerated as of April 1 are used. For all other years, population estimates as of July 1 are used.

Goal Setting: The 2020 goal of 0.30 per 100,000 U.S. population is consistent with the Healthy People 2020 ObjectiveExternal (IID-23) and CDC’s Viral Hepatitis Strategic Plan, 2016-2020Cdc-pdf[PDF – 17 pages]. Annual targets assume a constant (linear) rate of change from the observed baseline (2014) to the 2020 goal.

Limitations: Viral hepatitis is largely underreported in NNDDS. Based on a simple, probabilistic model for estimating the proportion of patients who were symptomatic, received testing, and were reported to health officials in 2016, actual numbers of cases are estimated to be 2.0 times those reported to CDC (2). Rates may vary over time based on changes in public and provider awareness, changes in laboratory and diagnostic techniques, and changes in the definition of the condition.

References

  1. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2016. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2018. Available at: https://www.cdc.gov/hepatitis/statistics/2016surveillance/pdfs/2016HepSurveillanceRpt.pdfCdc-pdf.
  2. Klevens RM, Liu S, Roberts H, Jiles RB, Holmberg SD. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health. 2014;104(3):482-7.