2020 Surveillance Report

September 15, 2022

Dear Colleague:

Today, the Centers for Disease Control and Prevention (CDC) published Viral Hepatitis Surveillance Report— United States, 2020. This report includes surveillance and mortality data related to hepatitis A, hepatitis B, and hepatitis C, as well as outcome data from CDC’s Perinatal Hepatitis B Prevention Program. CDC also released the 2022 Viral Hepatitis National Progress Report, which provides an update on progress toward achieving established goals for the prevention of viral hepatitis transmission, disease, and associated mortality. These reports are published exclusively in digital format to improve accessibility for our partners and the public.

During 2020 there were major disruptions in access to medical care, testing, and routine viral hepatitis public health activities due to the COVID-19 pandemic. Because of the COVID-19 pandemic, the 2020 data included in this surveillance report should be interpreted with caution.

According to this year’s surveillance report, the United States experienced a 47% decrease in the rate of hepatitis A cases during 2020 compared to 2019. This follows four successive years of increasing rates due to widespread and prolonged outbreaks driven by person-to-person transmission primarily among adults who use drugs or report experiencing homelessness. This decline may be due to resolving outbreaks in several states during 2020. Despite this substantial decline, an 80% reduction from the estimated number of infections during 2020 is needed to meet our goal of 4,000 estimated infections during 2025. This reduction can best be achieved by strengthening health department outbreak detection and response, implementing updated CDC recommendations for hepatitis A vaccination to reach medically underserved populations, and continuing routine childhood vaccinations.

Reported cases of acute hepatitis B also declined from 2019 to 2020. The 30% decrease in the corresponding rate of acute hepatitis B was likely impacted by disruptions to health care access and public health surveillance systems during the COVID-19 pandemic and may not be observed in subsequent years once testing and health department case investigations resume regular operations. In 2020, we did not meet two of our four hepatitis B-related progress indicators— reducing hepatitis B-related deaths nationally and among Asian and Pacific Islander persons. To meet these goals, we need to expand access to hepatitis B testing and appropriate treatment for all populations.

Since 2013, increases in injection drug use related to the nation’s drug crisis have contributed to annual increases in newly reported cases of hepatitis C. During 2020, there was a 15% increase in the rate of reported cases of acute hepatitis C from 2019. Although the COVID-19 pandemic disrupted health care access and reduced the number of persons tested for HCV infection, the anticipated reduction in reported cases was offset by a change to the acute hepatitis C case definition introduced in 2020.  We encourage you to learn more about the state of HCV treatment coverage through our recent CDC Morbidity and Mortality Weekly Report: Vital Signs: Hepatitis C Treatment Among Insured Adults — United States, 2019–2020.

The data published in these reports are critical to inform our strategies, celebrate our successes, and identify opportunities for improvement. We must continue to employ the many public health tools currently available to eliminate viral hepatitis as a public health threat in the United States. CDC will continue to take action to prevent new infections, reduce morbidity and mortality, and eliminate health disparities associated with viral hepatitis. Achieving elimination goals will require significant resources and a strong national commitment to work together across federal, state, and local governments, nongovernmental organizations, public health partners, and people with viral hepatitis. Thank you for your continued efforts and tireless support.

Sincerely,

/Carolyn Wester/

Carolyn Wester, MD, MPH
Director
Division of Viral Hepatitis
National Center for HIV, Viral Hepatitis, STD and TB Prevention
Centers for Disease Control and Prevention
https://www.cdc.gov/hepatitis/

/Jonathan Mermin/

Jonathan Mermin, MD, MPH (RADM, USPHS)
Director
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
https://www.cdc.gov/nchhstp/default.htm
Stay connected: @DrMerminCDC & Connections