With the widespread adoption of universal childhood vaccination recommendations ( ), asymptomatic children are no longer the main drivers of hepatitis A outbreaks ( 3, 9). In the past, outbreaks of hepatitis A virus infections occurred every 10–15 years and were associated with asymptomatic children ( 8). The number of hepatitis A infections reported to CDC increased during 2016–2018, along with the number of specimens from infected persons submitted to CDC for additional testing. In comparison, 4,282 specimens were tested by CDC during 2016–2018, of which 3,877 (91%) had detectable HAV RNA 565 (15%), 3,255 (84%), and 57 (<1%) of these specimens were genotype IA, IB, or IIIA, respectively. During 2013–2015, 226 specimens underwent additional testing, of which 197 (87%) had detectable HAV RNA of the RNA-positive specimens, 76 (39%), 121 (61%), and 0 (0%) tested positive for a genotype IA, IB, or IIIA viral strain, respectively. During 2013–2018, 4,508 HAV anti-immunoglobulin M–positive specimens underwent additional testing at CDC. Nine states and Washington, DC had an increase of approximately 500%. Eighteen states had lower case counts during 2016–2018 compared with 2013–2015. Overall, reports of hepatitis A cases increased 294% during 2016–2018 compared with 2013–2015 ( Figure). Serum specimens from CSTE confirmed cases submitted to the CDC laboratory were tested for HAV RNA by polymerase chain reaction, and isolated virus was amplified to characterize a 315–base-pair fragment of the VP1/P2B region, which defines the genotype of the virus. Cases reported to CDC through NNDSS during 2013–2018 were used to calculate percent change (2013–2015 versus 2016–2018) by state and mapped using RStudio software (version RStudio, Inc.). Hepatitis A infections among persons who meet the Council of State and Territorial Epidemiologists (CSTE) hepatitis A case definition ( ) are notified to CDC through the National Notifiable Diseases Surveillance System (NNDSS). Adherence to the Advisory Committee on Immunization Practices (ACIP) recommendations to vaccinate populations at risk can help control the current increases and prevent future outbreaks of hepatitis A in the United States ( 7). During 2016–2018, CDC tested 4,282 specimens, of which 3,877 (91%) had detectable HAV RNA 565 (15%), 3,255 (84%), and 57 (<1%) of these specimens were genotype IA, IB, or IIIA, respectively. Overall, reports of hepatitis A cases increased 294% during 2016–2018 compared with 2013–2015. In addition, increases of HAV infections have also occurred among men who have sex with men (MSM) and, to a much lesser degree, in association with consumption of imported HAV-contaminated food ( 5, 6). Since 2017, the vast majority of these reports were related to multiple outbreaks of infections among persons reporting drug use or homelessness ( 4). states and territories, indicating a recent increase in transmission ( 2, 3). Rates of hepatitis A had declined by approximately 95% during 1996–2011 however, during 2016–2018, CDC received approximately 15,000 reports of HAV infections from U.S. Hepatitis A virus (HAV) is primarily transmitted fecal-orally after close contact with an infected person ( 1) it is the most common cause of viral hepatitis worldwide, typically causing acute and self-limited symptoms, although rarely liver failure and death can occur ( 1).
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