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Outbreaks in certain areas and certain populations are the main driver.
Hepatitis A cases rose almost 300% from 2016-2018 compared with 2013-2015, in part due to large outbreaks in the homeless population and among people who use drugs, CDC researchers found.
There was a 294% increase in reported hepatitis A infections, with nine states and Washington D.C. reporting approximately 500% increases, reported Monique A. Foster, MD, of the CDC, and colleagues, writing in the Morbidity and Mortality Weekly Report.
This recent increase is especially striking, given that the authors found that rates of hepatitis A infection had declined 95% from 1996-2011. But they also noted the changing epidemiology of hepatitis A virus (HAV), which is no longer associated with asymptomatic children, thanks to CDC recommendations that children receive the hepatitis A vaccine.
“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,” the authors wrote.
States experiencing an increase of over 500% in reported hepatitis A infections were West Virginia, Tennessee, Kentucky, Ohio, Indiana, Missouri, Arkansas, and Utah. The authors also noted that 18 states had lower case counts during 2016-2018 compared with 2013-2015.
The 2019 immunization schedule for adults added homelessness as an indication for routine hepatitis A vaccination, although Foster and colleagues noted that “there is no universal vaccination recommendation for adults in the U.S.” In addition to homelessness, people who inject drugs, people with chronic liver disease, MSM, and travelers to HAV-endemic countries are all risk groups who should be vaccinated against hepatitis A.