Reduce estimated new hepatitis A virus infections by 40% or more

Reduce estimated new hepatitis A virus infections by 40% or more
National Progress Report 2025 Goal
Arrow on yellow, indicating "not met, moved toward annual target"

Status: Moving toward annual target, but annual target was not fully met

Check-mark on green, indicating "Met or exceeded current annual target"

Met or exceeded current annual target

Arrow on yellow, indicating "not met, moved toward annual target"

Moving toward annual target, but annual target was not fully met

X on red, indicating "Not met, no change or moved away from annual target"

Annual target was not met and has not changed or moved away  from annual target

Source: CDC, National Notifiable Diseases Surveillance System.1
* The number of estimated viral hepatitis infections was determined by multiplying the number of reported cases by a factor that adjusted for under ascertainment and underreporting.1,2

Summary of Findings

The number of estimated new hepatitis A virus (HAV) infections has increased since 2014 to a peak of 37,700 in 2019. 2021 marks the second year the incidence of hepatitis A has decreased. The 11,500 estimated infections in 2021 was 1.7 times that of the 2017 baseline, and considerably higher than the 2021 target of 4,900 estimated infections. Of note, the COVID-19 pandemic continued to cause disruptions in access to medical care, testing, and routine viral hepatitis public health activities; therefore, 2021 data should be interpreted with caution. The incidence of hepatitis A is subject to variation from year to year, in large part due to hepatitis A outbreaks. Since late 2016, there have been widespread outbreaks of hepatitis A across the United States, spread through person-to-person contact primarily among persons reporting drug use or homelessness. These community outbreaks have been prolonged and difficult to control in many states, highlighting the importance of administering hepatitis A vaccine in populations that are at increased risk for infection. Food-related outbreaks have occurred among persons in several states and were associated with imported pomegranate seeds in 2013, imported frozen strawberries and raw scallops in 2016, and fresh blackberries in 2019. These food-related outbreaks accounted for far fewer cases, occurred in fewer states, and had much shorter durations than the ongoing outbreaks driven by person-to-person transmission.

Reduction needed to meet 2025 goal:

A 65% reduction from the estimated number of HAV infections in 2021 is needed to meet the 2025 goal of 4,000 estimated infections.

This reduction can best be achieved by:

Technical Notes

Data Sources:
CDC, National Notifiable Diseases Surveillance System (NNDSS)

Number of estimated HAV infections

Not applicable

Indicator Notes:
NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable disease-related health information.1 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 hepatitis A are required to meet specific clinical and laboratory criteria. Estimated infections are based on laboratory-confirmed reports of hepatitis A cases; these estimates are presented in the 2021 Annual Surveillance Report1 along with their 95% Confidence Intervals to show the range of estimated infections accounting for error. Hepatitis A is reportable in all jurisdictions. Healthcare 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 CSTE/CDC surveillance case definition. To account for underascertainment and underreporting, the number of reported cases is multiplied by 2.0. The methods for developing the multiplication factor are documented in Klevens et al. and used by CDC to estimate the number of annual infections.1,2

Goal Setting:
The 2025 goal of 4,000 estimated infections is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and the US Department of Health and Human Services’ 2021–2025 Viral Hepatitis National Strategic Plan. Annual targets assume a constant (linear) rate of change from the observed baseline (2017 data year) to the 2025 goal (2023 data year).

The number of estimated infections is based on a simple, probabilistic model for estimating the proportion of patients who were symptomatic, received testing, and were reported to health officials in each year.2 This constant multiplier may not account for variations over time in underreporting and underascertainment due to changes in public and provider awareness, laboratory and diagnostic techniques, and the definition of the condition.

  1. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2021. Published August 2023. Accessed [date]. 
  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.
  3. Montgomery MP, Eckert M, Hofmeister MG, Foster MA, Weng MK, Augustine R, Gupta N, Cooley LA. Strategies for successful vaccination among two medically underserved populations: Lessons Learned from Hepatitis A Outbreaks. Am J Public Health 2021;111(8):1409–12.