Reports of hepatitis A infections increased by nearly 300% in the U.S. between 2016 and 2018 compared with 2013 to 2015, primarily due to outbreaks associated with contaminated food items, men who have sex with men, and people who report drug use or homelessness, according to the CDC.
Monique A. Foster, MD, and colleagues from the National Center for HIV, Viral Hepatitis, STD, and TB Prevention at the CDC, wrote that hepatitis A outbreaks previously occurred every 10 to 15 years and were associated with asymptomatic children.
“With the widespread adoption of universal childhood vaccination recommendations, asymptomatic children are no longer the main drivers of hepatitis A outbreaks,” they wrote. “Although the overall incidence rate of HAV infections has decreased within all age groups, a large population of susceptible, unvaccinated adults who were not infected by being exposed to the virus during childhood remain vulnerable to infection by contaminated foods ... and recently, on a much larger scale, through behaviors that increase risk for infection in certain vulnerable populations, such as drug use.”
During the 2016 to 2018 period, the CDC tested 4,282 specimens. Of these, 91% had detectable HAV RNA, most of which were genotype IA.
The overall increase in reported hepatitis A cases was 294%, while Arkansas, Hawaii, Indiana, Kentucky, Missouri, Ohio, Tennessee, Utah, West Virginia, and Washing D.C. had an increase of approximately 500%.
While there is no universal vaccination recommendation for all adults in the U.S., the Advisory Committee on Immunization Practices recommends vaccination for adults who plan to travel to HAV-endemic countries, men who have sex with men, people who use drugs, people with chronic liver disease, and people experiencing homelessness.
“Decreasing new infections from hepatitis A virus can be achieved and sustained by maintaining a high level of population immunity through vaccination,” Foster and colleagues wrote. “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.” – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.