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

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%.

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

References

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. www.cdc.gov/hepatitis/statistics/2016surveillance/pdfs/2016HepSurveillanceRpt.pdf. Accessed May 15, 2019.

4. CDC. National Notifiable Infectious Diseases: Weekly Tables. https://wonder.cdc.gov/nndss/static/2018/52/2018-52-table2H-H.pdf. 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.