2022 Viral Hepatitis National Progress Report Overview

The Centers for Disease Control and Prevention (CDC) strives to prevent viral hepatitis infections and eliminate disease and mortality caused by viral hepatitis. The Viral Hepatitis National Progress Report provides information on progress in the implementation of recommended interventions and the impact these interventions are having on prevention of viral hepatitis transmission, disease, and associated mortality. In 2020, CDC modified the goals and associated targets from previous reports to align them with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and HHS’s Viral Hepatitis National Strategic Plan for 2021-2025.

The ten indicators and accompanying 2025 goals below were compiled specifically for the National Progress Report and are consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan.

Seven standardized viral hepatitis indicators

	Baseline 2017 data year	2020 Observed (Annual Target*)	2025 Goal 2023 data year	Trend	2020 Status
Hepatitis A
Reduce estimated† new hepatitis A virus infections by ≥40%	6,700	19,900 (5,350)	4,000
Hepatitis B
Reduce estimated† new hepatitis B virus infections by ≥20%	22,200	14,000 (20,100)	18,000
Reduce reported rate‡ of new hepatitis B virus infections among persons who inject drugs¶ by ≥25%	1.4	0.7 (1.2)	1.0
Reduce reported rate‡of hepatitis B-related deaths by ≥20%	0.46	0.45 (0.42)	0.37
Reduce reported rate‡ of hepatitis B-related deaths among Asian and Pacific Islander persons by ≥25%	2.45	2.46 (2.15)	1.84
Hepatitis C
Reduce estimated† new hepatitis C virus infections by ≥20%	44,700	66,700 (39,850)	35,000
Reduce reported rate‡ of new hepatitis C virus infections among persons who inject drugs¶ by ≥25%	2.3	2.9 (2.0)	1.7
Reduce reported rate‡ of hepatitis C-related deaths by ≥20%	4.13	3.45 (3.57)	3.00
Reduce reported rate‡ of hepatitis C-related deaths among American Indian and Alaska Native persons by ≥30%	10.24	10.17 (8.71)	7.17
Reduce reported rate‡ of hepatitis C-related deaths among non-Hispanic Black persons by ≥30%	7.03	5.63 (5.98)	4.92
* Annual targets assume a constant (linear) rate of change from the observed baseline (2017) to the 2025 goal (2023 data year). † The number of estimated viral hepatitis infections was determined by multiplying the number of reported cases by a factor that adjusted for underascertainment and underreporting (CDC 2020 Viral Hepatitis Surveillance Report and Klevens, et al, 2014). ‡ Per 100,000 population. ¶ Persons aged 18–40 years were used as a proxy for persons who inject drugs.

During 2020, the COVID-19 pandemic caused major disruptions in access to medical care and routine public health activities. Stay-at-home orders suspended or delayed many routine health care visits, patients avoided seeking medical and preventative services in a health care setting, and many health department staff routinely assigned to viral hepatitis case investigation and surveillance activities were reassigned to work on the COVID-19 pandemic. Positive hepatitis C test results declined by approximately 60% during the first months of the pandemic in 2020, relative to the prior non-pandemic months (1) and the overall age-adjusted death rate in the United States increased by 16.8% compared to 2019. (2) For these reasons, the number and rates of viral hepatitis cases and deaths associated with viral hepatitis for 2020 included in this report should be interpreted with caution.

Key Findings

• There was a decrease in hepatitis A during 2020 due to a decline in the number of outbreak associated cases. The decrease followed five years of increases from widespread outbreaks driven by person-to-person transmission primarily among adults reporting homelessness or who use drugs. (3) These outbreaks demonstrate the importance of surveillance to identify, and vaccination to prevent and respond to hepatitis A.
• The two hepatitis B indicators for new infections met the annual target for 2020; however, the decrease may be attributable to the impact of the COVID-19 pandemic on access to health care, hepatitis testing, and health department capacity to perform viral hepatitis case investigations. The indicators for hepatitis B-related deaths did not meet the annual targets in 2020, after having met them in 2019,  which may reflect the increase in overall deaths during the COVID-19 pandemic. Continued efforts are needed to implement CDC’s new, expanded hepatitis B vaccination recommendations and improve appropriate testing and linkage to care.
• While the COVID-19 pandemic also likely reduced detection and reporting of new hepatitis C virus (HCV) infections, the impact has been tempered by the introduction of a new hepatitis C surveillance case definition in 2020, which was designed to  classify acute hepatitis C cases more accurately for surveillance.  Increases in injection drug use related to the nation’s drug crisis have contributed to annual increases in new HCV infections.  To promote health and reduce ongoing transmission, efforts must continue to connect all people experiencing cases of new or chronic hepatitis C to well-tolerated, short-course curative treatment, and connect people who inject drugs to harm reduction services, including syringe services programs and medication for substance use disorder treatment.
• Continued efforts are needed to identify new and chronic infections and ensure all people with hepatitis C receive treatment. Death rates among non-Hispanic Black and American Indian/Alaska Native populations remain higher than the national rate, with little progress toward the 2025 target for American Indian/Alaska Native persons since 2017.