CDC released the 2022 Viral Hepatitis Surveillance Report and 2024 Viral Hepatitis National Progress Report this week, characterizing national trends in hepatitis and progress toward national goals for hepatitis prevention and elimination. These reports demonstrate that viral hepatitis remains a significant public health threat, and that further investment in hepatitis prevention and elimination is needed for the U.S. to achieve our national goals for reducing hepatitis infections, deaths, and inequities.
According to the 2022 surveillance report, cases of hepatitis A (HAV) decreased 88% between 2019 to 2022—after widespread outbreaks in 37 states resulted in significant increases between 2015 and 2019. However, the number of cases reported (2,265) was still twice as high as cases in 2015. Notably, most (83%) of cases occurred in urban areas and nearly 1/3 of people diagnosed with hepatitis A reported injection drug use.
Cases of hepatitis B (HBV) were stable between 2021 and 2022, with 2,126 cases reported, equating to an estimated 13,800 new infections of this under-diagnosed disease. Despite this stability, the rate rose 11% among Black people, which was almost double the rate seen among white people. Rates were highest among people aged 40-59, likely reflecting that younger generations are benefiting from routine childhood vaccination that was first recommended in 1991. Rates were highest in states in or near the Appalachian region, with rates highest in West Virginia, Florida, and Maine, and an approximately one-fourth of cases were among people who inject drugs.
In 2022, the rate of hepatitis C (HCV) decreased 6%—after more than a decade of annual increases. However, the incidence of HCV remains significant, with an estimated 67,400 new infections in 2022 (4,854 cases reported). The spread of HCV is characterized by significant inequities, with increases among American Indian/Alaska Native, Black, and Hispanic people, despite the national decrease. More than two-thirds of cases occurred among people aged 20-49, and more than half of cases are associated with injection drug use (where data were available).
Meanwhile, the 2024 Viral Hepatitis National Progress Report revealed that the U.S. only achieved four of ten national targets for hepatitis prevention and elimination in 2024. Targets for reductions in HBV infections and reductions in HCV deaths were met, while targets for reductions in HAV infections, HBV deaths, and HCV infections were not met. To ensure progress on the unmet targets, CDC recommends:
- Increased testing, vaccination, and treatment
- Developing and implementing new laboratory diagnostics
- Leveraging the power of data systems to improve hepatitis surveillance
- Expanding harm reduction services for people who use drugs
NACCHO applauds these recommendations and emphasizes the important role of local health departments (LHDs) in advancing this work. LHDs play a critical role in hepatitis prevention and elimination, with the majority conducting surveillance and providing or linking to vaccination, testing, treatment, and harm reduction services. However, this work remains significantly underfunded and LHDs need robust and flexible funding to provide hepatitis and harm reduction services, and to advance a syndemic approach to hepatitis, HIV, STIs, and substance use.
