Preventable Deaths During Widespread Community Hepatitis A Outbreaks — United States, 2016–2022
Megan G. Hofmeister, Neil Gupta, Hepatitis A Mortality Investigators, Hepatitis A Mortality Investigators, Priscilla Lauro, E. Marilea Brock, Alan Le May, Cherie Smith, Olivia Arizmendi, Kerri Brown, Rachel H. Jervis, Ann Q. Shen, Ami Gandhi, Dawn Nims, Nicole Stone, Lauren Maxwell, Jennifer A. Khoury, Amanda K. Odegård, Douglas Thoroughman, Raychel N. Berkheimer, J Johnson, Sean Simonson, Kompan Ngamsnga, Lindsay Bouton, Shauna Onofrey, Sharon Pagnano, Cole Burkholder, Theresa Kittle, John Bos, Kate Cleavinger, Nathan Koffarnus, Salena Savarda, Zuwen Qiu-Shultz, Devin Raman, Hannah Bowen, John J. Dreisig, Katrina Hansen, Patricia Amarilla, Troy Brancard, Mojisola Ojo, Marla Sievers, Justin Albertson, Susan M. Sullivan, Abdoulaye Diédhiou, LaKita D. Johnson, Jun Tang, Jane M. Brittingham, Danita C. Crear, R. L. Garman, Elise M. Huebner, Binoj Peter, Marc Williamson, Bree Barbeau, MaryBeth DeMarco, Kelsey Holloman, Mary Chan, Hilary F. Armstrong, Jean-Jacques Kayembe Kashondo, A. Hudson, Shannon McBee, Melissa A. Scott
Abstract
Hepatitis A is acquired through the fecal-oral route and is preventable by a safe and effective vaccine. Although hepatitis A is generally mild and self-limited, serious complications, including death, can occur. Since 2016, widespread hepatitis A outbreaks have been reported in 37 U.S. states, primarily among persons who use drugs and those experiencing homelessness. Nearly twice as many hepatitis A-related deaths were reported during 2016-2022 compared with 2009-2015. CDC analyzed data from 27 hepatitis A outbreak-affected states* that contributed data during August 1, 2016-October 31, 2022, to characterize demographic, risk factor, clinical, and cause-of-death data among 315 outbreak-related hepatitis A deaths from those states. Hepatitis A was documented as an underlying or contributing cause of death on 60% of available death certificates. Outbreak-related deaths peaked in 2019, and then decreased annually through 2022. The median age at death was 55 years; most deaths occurred among males (73%) and non-Hispanic White persons (84%). Nearly two thirds (63%) of decedents had at least one documented indication for hepatitis A vaccination, including drug use (41%), homelessness (16%), or coinfection with hepatitis B (12%) or hepatitis C (31%); only 12 (4%) had evidence of previous hepatitis A vaccination. Increasing vaccination coverage among adults at increased risk for infection with hepatitis A virus or for severe disease from infection is critical to preventing future hepatitis A-related deaths.