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Dear Colleagues: Viral Hepatitis Publications and Hepatitis Awareness Month

In this Dear Colleague letter from the CDC, directors share updates on the state of hepatitis in the United States.

Cross-posted from the Centers for Disease Control (CDC).

Dear Colleagues,

During the month of May, the U.S. Centers for Disease Control and Prevention joins thenation to commemorate Hepatitis Awareness Month and Hepatitis Testing Day on May 19th. Both of these observances are a time for action to raise awareness of hepatitis A, hepatitis B and hepatitis C  as major public health threats in the United States and encourage testing to identify the millions living with these often-silent infections. These observances also provide opportunities to promote other interventions that prevent viral hepatitis, from childhood and adult immunization to safer injection practices among persons who inject drugs.

Viral Hepatitis and COVID-19. We recognize that many of you have been involved in the coronavirus disease 2019 (COVID-19) response in some capacity, and appreciate your efforts to address the pandemic. Where possible while you’re addressing the pandemic, we ask that you remember to communicate that viral hepatitis is a serious disease that can result in liver disease, and people of all ages with liver disease or other underlying medical conditions are at higher risk for serious illness related to COVID-19. To help providers and others understand their risks and know what to do, CDC recently released FAQs regarding What to Know About Liver Disease and COVID-19, as well as adult immunization and childhood immunization guidance to prevent mother-to-child transmission of hepatitis B during the COVID-19 pandemic.

Hepatitis A. While hepatitis A infections had lessened since the introduction of the hepatitis A vaccine, there have been ongoing person-to-person outbreaks of hepatitis A among certain high-risk groups over the past several years. Since the outbreaks were first identified in 2016, 33 states have publicly reported 32,235 new cases as of April 17, 2020. This statistic highlights the importance of making hepatitis A vaccine available to persons at risk.

A high proportion of patients in these hepatitis A person-to-person outbreaks have been hospitalized. A recent study, Hepatitis A Hospitalization Costs, United States, 2017, used Healthcare Cost and Utilization Project data to show that the overall estimated average costs per hepatitis A-related hospitalization in the United States in 2017 was $16,232 (SD $602; 95% CI $15,052–$17,411).

During these person-to-person outbreaks, hepatitis A infections among food handlers raised public alarm and calls for vaccinating food handlers, often prompting health departments to divert limited vaccine resources away from at-risk populations. The Notes from the Field: Assessing the Role of Food Handlers in Hepatitis A Virus Transmission — Multiple States, 2016–2019, analyzed the risk of secondary transmission from hepatitis A-infected food handlers to food establishment patrons by surveying state health departments impacted by person-to-person hepatitis A outbreaks since 2016. Results from the survey show that among almost 23,000 hepatitis A outbreak cases reported from 26 state respondents as of September 13, 2019, <4% occurred among food handlers; secondary infections among patrons accounted for only 0.2% of outbreak cases. The risk for secondary infection from hepatitis A-infected food handlers to food establishment patrons in the ongoing person-to-person hepatitis A outbreaks is <1%.

Hepatitis B. Despite the availability of a vaccine for hepatitis B, there were an estimated 22,200 new cases of hepatitis B in 2017. April 30th was National Adult Hepatitis B Vaccination Awareness Dayexternal icon. This observance day provided an opportunity to discuss overcoming barriers to adult hepatitis B vaccination. Seventy-five per cent (75%) of adults in the United States are NOT protected against hepatitis B, the leading cause of liver cancer worldwide – these statistics bring to the forefront the need to encourage every citizen to check their vaccination status and get vaccinated to protect themselves and their loved ones from this disease.

CDC recommends all adults to get tested for hepatitis c

Hepatitis C. According to the recent CDC Vital Signs on hepatitis C, despite the availability of a cure for hepatitis C, there were an estimated 50,300 new cases of hepatitis C in 2018 and 40% of adults in the United State are unaware of their infection. To address this, CDC released updated hepatitis C screening recommendations in April 2020 to include at least once in a lifetime screening of all adults and screening all pregnant women during every pregnancy. To support and help implement these recommendations, CDC developed new materials and resources for the Know More Hepatitis campaign designed to encourage all adults to get tested. A recent MMWR article, High Prevalence of Hepatitis C Infection Among Adult Patients at Four Urban Emergency Departments–Birmingham, Alabama; Oakland, California; Baltimore, Maryland; and Boston, Massachusetts, 2015-2017, written in collaboration between the University of Alabama at Birmingham and CDC, reports that universal hepatitis C screening in emergency departments demonstrate success in identifying previously undiagnosed infections. This underscores the importance of new CDC recommendations that every adult should be tested at least once in their lifetime for this curable infection.

We hope you find the information shared in this letter useful as we are dedicated to helping keep you well informed of the latest news in viral hepatitis. In addition, CDC recognizes that many of you are supporting efforts to respond to COVID-19 and not able to keep ongoing viral hepatitis activities at normal pace. We appreciate your efforts to stay committed to viral hepatitis in the midst of responding to the COVID-19 pandemic. Your hard work does not go unnoticed.


Carolyn Wester, M.D.
Division of Viral Hepatitis
Centers for Disease Control and Prevention

Jonathan H. Mermin, M.D., MPH
RADM and Assistant Surgeon General, USPHS
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention

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