An Increase in Hepatitis A Virus Infections in the United States, 2013-2018

hepatitis A virus illustration
Hepatitis A viruses, illustration. Hepatitis A is transmitted through infected food or drink. Symptoms include influenza-like symptoms of fever and sickness, along with jaundice.
Data collected by the US Centers for Disease Control and Prevention shows an increase in hepatitis A infections with most incidences occurring among homeless persons and drug users. To a small extent, some outbreaks were caused by imported food that was contaminated.

From 2016 to 2018, the incidence of hepatitis A infection in the United States increased by 294% compared with 2013 to 2015 as a result of outbreaks associated with contaminated food items, among men who have sex with men, and primarily among persons who report drug use or homelessness, according to a report published in the MMWR Morbidity and Mortality Weekly Report.1 

Hepatitis A, the most common cause of viral hepatitis worldwide, is a vaccine-preventable viral infection of the liver that is primarily transmitted through consumption of microscopic amounts of feces.2 Although rates of hepatitis A had decreased by approximately 95% during 1996 to 2001, there has been a recent increase in transmission from 2016 to 2018 in the United States.3,4 Most of these reports were related to outbreaks among drug users and homeless persons.5 However, increases have also occurred among men who have sex with men, and to a much lesser degree, in association with the consumption of imported hepatitis A virus-contaminated food.6,7 As a result, the overall incidence of hepatitis A increased 294% from 2016 to 2018 compared with 2013 to 2015.1 Eighteen states had lower case counts during 2016 to 2018 compared with 2013 to 2015, while 9 states and Washington DC had an increase of approximately 500%.

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Although there are no universal vaccination recommendations for adults in the United States, the Advisory Committee on Immunization Practices (ACIP) recommends vaccination for adults who plan to travel to hepatitis A virus-endemic countries, men who have sex with men, persons who use drugs, persons with chronic liver disease, and recently, for persons experiencing homelessness.8

The authors concluded that, “Continued efforts to increase hepatitis A vaccination coverage among the ACIP-recommended risk groups is vital to halting the current hepatitis A outbreaks and reducing overall hepatitis A incidence in the United States.”1


1. Foster MA, Hofmeister MG, Kupronis BA, et al. Increase in hepatitis A virus infections — United States, 2013–2018. MMWR Morb Mortal Wkly Rep. 2019;68(18):413-415.

2. Franco E, Meleleo C, Serino L, Sorbara D, Zaratti L. Hepatitis A: epidemiology and prevention in developing countries. World J Hepatol. 2012;4:68-73.

3. CDC. Viral Hepatitis Surveillance, United States 2016. Accessed May 15, 2019.

4. CDC. National Notifiable Infectious Diseases: Weekly Tables. December 2018. Accessed May 15, 2019.

5. Foster M, Ramachandran S, Myatt K, et al. Hepatitis A virus outbreaks associated with drug use and homelessness—California, Kentucky, Michigan, and Utah, 2017. MMWR Morb Mortal Wkly Rep. 2018;67:1208-1210.

6. Viray MA, Hofmeister MG, Johnston DI, et al. Public health investigation and response to a hepatitis A outbreak from imported scallops consumed raw—Hawaii, 2016. Epidemiol Infect. 2018;147:1-8.

7. Latash J, Dorsinville M, Del Rosso P, et al. Notes from the field: increase in reported hepatitis A infections among men who have sex with men—New York City, January–August 2017. MMWR Morb Mortal Wkly Rep. 2017;66:999-1000.

8. Doshani M, Weng M, Moore KL, Romero JR, Nelson NP. Recommendations of the Advisory Committee on Immunization Practices for use of hepatitis A vaccine for persons experiencing homelessness. MMWR Morb Mortal Wkly Rep. 2019;68:153-156.