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pdfVIRAL HEPATITIS
SURVEILLANCE
REPORT
UNITED STATES, 2019
DIVISION OF
VIRAL HEPATITIS
Published May 2021
VIRAL HEPATITIS
SURVEILLANCE
REPORT
UNITED STATES, 2019
Viral Hepatitis Surveillance Report — United States, 2019 is published by the Division of Viral Hepatitis, National
Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), US
Department of Health and Human Services, Atlanta, Georgia.
Data are presented for the cases of viral hepatitis infection from 1 January 2019 through 31 December 2019. Viral
Hepatitis Surveillance Report — United States, 2019 is not copyrighted and may be used and reproduced without
permission. Citation of the source is, however, appreciated.
Suggested citation
Centers for Disease Control and Prevention. Viral Hepatitis Surveillance Report – United States, 2019.
https://www.cdc.gov/hepatitis/statistics/2019surveillance/index.htm. Published May 2021. Accessed [date].
On the web
https://www.cdc.gov/hepatitis/statistics/2019surveillance/index.htm
Acknowledgements
Publication of this report would not have been possible without the contributions of the state and territorial health
departments, viral hepatitis surveillance programs, and public health laboratories that provided surveillance data to CDC.
DIVISION OF VIRAL HEPATITIS
TABLE OF CONTENTS
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
NATIONAL PROFILE OF VIRAL HEPATITIS, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
TECHNICAL NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
SUMMARY 2019 Viral Hepatitis Acute Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
HEPATITIS A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Figure 1.1. Number of reported hepatitis A virus infection cases and estimated infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Table 1.1. Number and rates of reported cases of hepatitis A virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . . . . . . . . . . 14
Figure 1.2. Rates of reported hepatitis A virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Figure 1.3. Rates of reported hepatitis A virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Figure 1.4. Rates of reported hepatitis A virus infection, by age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Figure 1.5. Rates of reported hepatitis A virus infection, by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Figure 1.6. Rates of reported hepatitis A virus infection, by race/ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Table 1.2. Number and rates of reported cases of hepatitis A virus infection, by demographic characteristics . . . . . . . . . . . . . . . . . . . . 21
Figure 1.7. Availability of information regarding risk behaviors or exposures associated with reported cases of hepatitis A virus infection . . 23
Table 1.3. Reported risk behaviors or exposures among reported cases of hepatitis A virus infection . . . . . . . . . . . . . . . . . . . . . . . . . 23
Table 1.4. Number and rates of deaths with hepatitis A virus infection listed as a cause of death among residents,
by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
HEPATITIS B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Figure 2.1. Number of reported acute hepatitis B virus infection cases and estimated infections . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Table 2.1. Number and rates of reported cases of acute hepatitis B virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . . . . . . . 27
Figure 2.2. Rates of reported acute hepatitis B virus infection, by state . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Figure 2.3. Rates of reported acute hepatitis B virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Figure 2.4. Rates of reported acute hepatitis B virus infection, by age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Figure 2.5. Rates of reported acute hepatitis B virus infection, by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Figure 2.6. Rates of reported acute hepatitis B virus infections, by race/ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Table 2.2. Number and rates of reported cases of acute hepatitis B virus infection, by demographic characteristics . . . . . . . . . . . . . . . . 34
Figure 2.7. Availability of information regarding risk behaviors or exposures associated with reported cases of
acute hepatitis B virus infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Table 2.3. Reported risk behaviors or exposures among reported cases of acute hepatitis B virus infection . . . . . . . . . . . . . . . . . . . . . 36
Table 2.4. Number of newly reported cases of perinatal hepatitis B virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . . . . . . . 37
Table 2.5. Number and rates of newly reported cases of chronic hepatitis B virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . 38
Table 2.6. Number and rates of newly reported cases of chronic hepatitis B virus infection, by demographic characteristics . . . . . . . . . . . 39
Table 2.7. Number and rates of deaths with hepatitis B virus infection listed as a cause of death among residents, by state or jurisdiction . . . . . . 40
Figure 2.8. Rates of deaths with hepatitis B virus infection listed as a cause of death among residents, by jurisdiction . . . . . . . . . . . . . . 42
Table 2.8. Number and rates of deaths with hepatitis B virus infections listed as a cause of death among residents,
by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
3
TABLE OF CONTENTS
HEPATITIS C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Figure 3.1. Number of reported acute hepatitis C virus infection cases and estimated infections . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Table 3.1. Number and rates of reported cases of acute hepatitis C, by state or jurisdiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Figure 3.2. Rates of reported acute hepatitis C virus infections, by state . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Figure 3.3. Rates of reported acute hepatitis C virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Figure 3.4. Rates of reported acute hepatitis C virus infection, by age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Figure 3.5. Rates of reported acute hepatitis C virus infection, by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Figure 3.6. Rates of reported acute hepatitis C virus infection, by race/ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Table 3.2. Number and rates of reported cases of acute hepatitis C, by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 54
Figure 3.7. Availability of information regarding risk behaviors or exposures associated with reported cases of
acute hepatitis C virus infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Table 3.3. Reported risk behaviors or exposures among reported cases of acute hepatitis C virus infection . . . . . . . . . . . . . . . . . . . . . 56
Table 3.4. Number of newly reported cases of perinatal hepatitis C virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . . . . . . . 57
Table 3.5. Number and rates of newly reported cases of chronic hepatitis C virus infection, by state or jurisdiction . . . . . . . . . . . . . . . . 58
Table 3.6. Number and rates of newly reported cases of chronic hepatitis C virus infection, by demographic characteristics . . . . . . . . . . . 59
Figure 3.8. Number of newly reported chronic hepatitis C virus infection cases, by sex and age . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Table 3.7. Number and rates of deaths with hepatitis C listed as a cause of death among residents, by state or jurisdiction . . . . . . . . . . . 61
Figure 3.9. Rates of death with hepatitis C virus infection listed as a cause of death among residents, by jurisdiction . . . . . . . . . . . . . . . 63
Table 3.8. Number and rates of deaths with hepatitis C virus infection listed as a cause of death among residents,
by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Table A.1. Number of reported acute viral hepatitis infection cases and estimated infections with 95% bootstrap confidence intervals . . . . 66
SUPPLEMENTAL REPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Table S.1. Outcomes of infants born in 2018 to hepatitis B infected persons and managed by the
CDC Perinatal Hepatitis B Prevention Program through the end of 2019, 64 US Jurisdictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Figure S.1. Outcomes of infants born to hepatitis B infected persons and managed by the
CDC Perinatal Hepatitis B Prevention Program, by birth cohort year — 56 US Jurisdictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
4
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
BACKGROUND
Hepatitis A is a vaccine-preventable liver
disease caused by the hepatitis A virus (HAV). HAV is
usually transmitted person-to-person through the fecal–
oral route or through consumption of contaminated
food or water. The majority of adults and older children
with hepatitis A have symptoms that usually resolve ≤2
months after infection; children aged <6 years usually
do not have symptoms, or they have an unrecognized
infection. Signs and symptoms associated with hepatitis
A can include ≥1 of the following: fever, fatigue, nausea,
vomiting, loss of appetite, abdominal pain, dark urine, and
clay-colored stools. Hepatitis A is a self-limited disease
that does not result in chronic infection. Treatment for
HAV infection might include rest, adequate nutrition, and
fluids. Hospitalization might be required for more severe
cases. The best way to prevent hepatitis A is by being
vaccinated(1).
Hepatitis B is a vaccine-preventable liver
disease caused by the hepatitis B virus (HBV). HBV
is transmitted when blood, semen, or another body
fluid from a person infected with the virus enters the
body of someone who is uninfected. This can happen
through sexual contact; sharing needles, syringes, or
other drug-injection equipment; or from mother to
baby at birth. For some persons, hepatitis B is an acute,
or short-term, illness; for others, it can become a longterm, chronic infection. Chronic hepatitis B can lead
to serious health problems, including cirrhosis, liver
cancer, and death. Treatments are available, but no cure
exists for hepatitis B. The best way to prevent hepatitis
B is by being vaccinated(2,3).
Hepatitis C is a liver disease caused by the
hepatitis C virus (HCV). HCV is a bloodborne virus.
Today in the United States, the majority of persons
become infected with HCV by sharing needles or
other equipment used in injecting drugs(4). For certain
persons, hepatitis C is a short-term illness, but for
>50% of persons who become infected with the HCV, it
becomes a long-term, chronic infection(5). Like chronic
hepatitis B, chronic hepatitis C is a serious disease that
can result in cirrhosis, liver cancer, and death. Persons
might not be aware of their infection because they are
not clinically ill. However, since 2013, a highly effective,
well-tolerated curative treatment has been available
for hepatitis C, but no vaccine for preventing hepatitis
C is yet available(6). The best way to prevent hepatitis C
is by avoiding behaviors that can spread the disease,
especially injecting drugs.
Key facts about hepatitis A, hepatitis B, and hepatitis C
Characteristic
Main route(s) of
transmission
Incubation Period
Symptoms of
Acute Infection
Hepatitis A
Hepatitis B
Hepatitis C
Fecal-oral
Blood, sexual
Blood
15–50 days
(average: 28 days)
60–150 days
(average: 90 days)
14–182 days
(average range: 14–84 days)
Symptoms are similar and can include ≥1 of the following: jaundice, fever, fatigue, loss
of appetite, nausea, vomiting, abdominal pain, joint pain, dark urine, clay-colored stools,
diarrhea (hepatitis A only)
Perinatal
transmission
No
Yes
Yes
Vaccine available
Yes
Yes
No
Supportive care
Yes, not curative
Yes, curative
Treatment
5
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
NATIONAL PROFILE OF VIRAL
HEPATITIS, 2019
The Centers for Disease Control and Prevention (CDC)
collects, analyzes, and disseminates viral hepatitis
surveillance data. Each week, staff at health departments
submit case reports of viral hepatitis to CDC through
the National Notifiable Diseases Surveillance System
(NNDSS). The annual surveillance report, published by
the CDC, summarizes information about reported cases
of hepatitis A, hepatitis B, and hepatitis C and deaths
with any of these hepatitides listed as a cause of death
in CDC’s National Vital Statistics System (NVSS). These
surveillance data are used by public health partners to
help focus prevention efforts, plan services, allocate
resources, develop policy, and detect and respond to
clusters of viral hepatitis infection. These actions support
the goal of CDC’s Division of Viral Hepatitis 2020 - 2025
Strategic Plan(7) for establishing comprehensive national
viral hepatitis surveillance for public health action.
The 2019 Viral Hepatitis Surveillance Report contains
21 tables and 25 figures, and there are some notable
additions to the 2018 Viral Hepatitis Surveillance
Report(8). For the first time, the Surveillance Report
describes demographic characteristics of persons
with chronic hepatitis B and chronic hepatitis C by age
group, sex, race/ethnicity, and US Department of Health
and Human Services regions. Additionally, the number
and rates of viral hepatitis cases by urbanicity status is
included for hepatitis A, acute and chronic hepatitis B, and
acute and chronic hepatitis C infections. Finally, outcome
data from CDC’s Perinatal Hepatitis B Prevention
Program for infants born during 2018 to persons with
HBV infection are reported from 64 jurisdictions.
Hepatitis A
During 2019, a total of 18,846 hepatitis A cases were
reported to CDC, corresponding to 37,700 estimated
infections (95% confidence interval [CI]: 26,400–
41,500) after adjusting for case underascertainment
and underreporting (see Technical Notes)(9). The
reported case count corresponds to a rate of 5.7 cases
per 100,000 population, a 1,325% increase from the
reported rate of 0.4 cases per 100,000 population
during 2015. This increase was primarily driven by
widespread person-to-person outbreaks of hepatitis
A that have been unprecedented since introduction of
the hepatitis A vaccine. These outbreaks are primarily
occurring among persons who use drugs and those
experiencing homelessness, resulting in prolonged
community outbreaks in multiple states(10) that have
been difficult to control. Approximately 75% of hepatitis
A cases reported to CDC during 2019 occurred among
persons aged 20–49 years, and 73% occurred among
non-Hispanic White persons. Among the 10,991
(58%) reported cases that included risk information
for injection drug use, 5,017 (46%) reported injection
drug use. A total of 9,380 patients were hospitalized
(64% hospitalization rate among the 14,619 cases with
hospitalization information available).
Data from death certificates filed in the vital records
offices of the 50 states and the District of Columbia
revealed that the age-adjusted death rate associated
with hepatitis A during 2019 among US residents was
0.04 deaths per 100,000 population, which is 4 times the
rate of 0.01 deaths per 100,000 population during 2015.
Hepatitis B
Reported cases of acute hepatitis B virus infection
decreased after routine vaccination of children was
recommended in 1991, and the number of cases
became relatively stable during 2010–2019. During
2019, a total of 3,192 acute hepatitis B cases were
reported to CDC, resulting in 20,700 estimated
infections (95% CI: 11,800–50,800) after adjusting
for case underascertainment and underreporting
(see Technical Notes)(9). The reported case count
6
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
corresponded to a rate of 1.0 per 100,000 population.
Approximately 80% of acute hepatitis B cases
reported to CDC during 2019 occurred among persons
aged 30–59 years. The rate of acute hepatitis B was
highest among non-Hispanic White persons (1.0 case
per 100,000 population), compared with other racial/
ethnicity groups. Among the 1,780 (56%) reported
cases that included risk information for injection
drug use, 631 (35%) reported injection drug use. A
total of 1,427 patients with acute hepatitis B were
hospitalized (64% hospitalization rate among 2,234
cases with hospitalization information available).
A total of 13,859 new cases of chronic hepatitis B were
reported to CDC during 2019, corresponding to a rate
of 5.9 cases per 100,000 population; 47% occurred
among persons aged 30–49 years. The rate of new
chronic hepatitis B was highest among Asian/Pacific
Islander persons (18.9 cases per 100,000 population),
which was >10 times the rate among non-Hispanic
White persons (1.8 cases per 100,000 population).
A total of 17 perinatal hepatitis B cases were reported
through NNDSS to CDC during 2019. Among the 9,950
infants born during 2018 and managed by 64 jurisdictions
in the Perinatal Hepatitis B Prevention Program
(see Supplement), 97% had received recommended
prophylaxis at birth; 87% had completed 3 doses of
vaccine by age 12 months; and 69% had received
recommended post-vaccination serologic testing. Among
those with post-vaccination testing (6,828), 23 (0.3%)
were cases of perinatal hepatitis B transmission.
Data from death certificates filed in the vital records
offices of the 50 states and the District of Columbia
demonstrated that the age-adjusted death rate
associated with hepatitis B during 2019 among US
residents was 0.42 deaths per 100,000 population,
approximately the same as the rate of 0.43 deaths per
100,000 population during 2018.
Hepatitis C
During 2019, a total of 4,136 acute hepatitis C cases
were reported to CDC, corresponding to 57,500
estimated infections (95% CI: 45,500–196,000)
after adjusting for case underascertainment and
underreporting (see Technical Notes)(9). The reported
acute hepatitis C case count corresponds to a rate
of 1.3 cases per 100,000 population, a 63% increase
from the reported rate of 0.8 cases per 100,000
population during 2015. Approximately 63% of
acute hepatitis C cases reported to CDC during 2019
were among persons aged 20–39 years. The rate
of acute hepatitis C was highest among American
Indian/Alaska Native persons (3.6 cases per 100,000
population), compared with other racial/ethnicity
groups. Among the 1,952 (47%) reported acute cases
that included risk information for injection drug use,
1,302 (67%) reported injection drug use. A total of
1,041 patients with acute hepatitis C were hospitalized
(48% hospitalization rate among 2,156 cases with
hospitalization information available).
A total of 123,312 new cases of chronic hepatitis C
were reported to CDC during 2019, corresponding to
a rate of 56.7 cases per 100,000 population. The rate
of newly reported chronic hepatitis C was highest
among persons aged 30–39 years (109.1 cases
per 100,000 population), followed by persons aged
50–59 years (79.6 cases per 100,000 population),
compared with other age categories. These rates
are consistent with the previously reported bimodal
distribution of newly reported chronic hepatitis C
affecting multiple generations(11). The rate of newly
reported chronic hepatitis C cases was highest
among American Indian/Alaska Native persons (86.7
cases per 100,000 population), compared with other
racial/ethnicity categories.
A total of 217 perinatal hepatitis C cases were
reported to CDC during 2019, the second year that
standardized surveillance for perinatal hepatitis C was
conducted by states and case notifications submitted
to CDC. Data from death certificates filed in the vital
records offices of the 50 states and the District of
Columbia indicated that the age-adjusted death
rate for hepatitis C during 2019 was 3.33 deaths per
100,000 population, representing a 32% decrease
from the mortality rate during 2015 (4.91 deaths per
100,000 population).
7
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
TECHNICAL NOTES
Case Ascertainment and
Case Reporting
For health department staff to report cases of viral
hepatitis to CDC, systems and processes must be in
place that ensure each case is detected. Because of
varying state laws, resources, and infrastructure, not all
health departments report all cases of acute or chronic
viral hepatitis to CDC. Additionally, diagnosing every
acute case is impossible, because symptoms might be
either so mild that the person does not seek care or too
vague to prompt a health care provider to suspect and
test for viral hepatitis.
Case reporting begins when a local or state health
department receives a positive laboratory report,
indicating a person has a viral hepatitis infection.
Because initial reporting provides limited information
and clinical symptoms are frequently needed for
classifying cases as acute, reported cases might require
extensive follow-up to obtain full information for
establishing case status and case classification.
Health departments prioritize cases for follow-up by
using their own protocols and might submit cases
to CDC with incomplete or missing information.
Additionally, the volume of laboratory reports for chronic
viral hepatitis infections might be so large that not all
health departments are able to consistently detect and
report all chronic cases to CDC; for example, during
2019, only 14 states (Florida, Georgia, Indiana, Kentucky,
Louisiana, Massachusetts, New Jersey, North Carolina,
Oklahoma, Ohio, Tennessee, Utah, Washington, and
West Virginia) received federal funding for supporting
viral hepatitis surveillance. Also, because case
notifications for the 2019 reporting year were open for
submission through December 10, 2020, the COVID-19
pandemic possibly affected a health department’s ability
to investigate and report cases in its jurisdiction. Data
regarding chronic hepatitis B and hepatitis C infections
are included in this report where available; however,
these are newly identified chronic viral hepatitis cases
and do not measure prevalence.
All viral hepatitis conditions with no reported cases or
characterized as Not Reportable or Data Unavailable
for 2019 in a jurisdiction’s final signed report to CDC’s
National Center for Surveillance, Epidemiology, and
Laboratory Services (CSELS) were reported according to
the following notation used by CSELS(12):
— : No reported cases. The reporting
jurisdiction did not submit any cases to CDC.
N : Not reportable. The disease or condition
was not reportable by law, statute, or regulation in
the reporting jurisdiction.
U : Unavailable. The data are unavailable.
For 2019, CSELS additionally reported “The following
23 jurisdictions may have incomplete data, due to the
coronavirus disease 2019 (COVID-19) pandemic: Alaska,
California, Connecticut, District of Columbia, Florida,
Idaho, Indiana, Kansas, Massachusetts, Minnesota,
Missouri, Montana, Nebraska, New Hampshire, New York
(excluding New York City), New York City, North Dakota,
Ohio, Oklahoma, South Carolina, Tennessee, Texas, and
West Virginia.”(12)
Urbanicity: Urban and rural categorization was made
according to CDC’s 2013 National Center for Health
Statistics urban-rural classification scheme for
counties and county-equivalent entities. Large central
metropolitan, large fringe metropolitan, medium
metropolitan, and small metropolitan counties were
grouped as urban. Micropolitan and noncore counties
were grouped as rural.
US Department of Health and Human Services
regions provide a standardized structure for grouping
jurisdictions into larger geographic areas. Ten regional
offices directly serve state and local organizations.
8
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Region
Regional Office
State/Jurisdiction
1
Boston
Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont
2*
New York
New Jersey, New York, Puerto Rico, Virgin Islands
3
Philadelphia
Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia
4
Atlanta
Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee
5
Chicago
Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin
6
Dallas
Arkansas, Louisiana, New Mexico, Oklahoma, Texas
7
Kansas City
Iowa, Kansas, Missouri, Nebraska
8
Denver
Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming
9*
San Francisco
Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern
Mariana Islands, Federated States of Micronesia, Guam, Marshall Islands, Republic of Palau
10
Seattle
Alaska, Idaho, Oregon, Washington
*US territories are not included in this report.
Case Definitions
To ensure consistent reporting across states, the Council
for State and Territorial Epidemiologists, in collaboration
with CDC, developed case definitions for viral hepatitis A,
hepatitis B, and hepatitis C. The case definitions facilitate
standardized reporting by using uniform criteria and
differentiating between acute, chronic, and perinatal cases.
When new technologies are developed for laboratory
testing or better clinical data become available, the case
definitions are updated. Changes in case definitions should
be considered when examining temporal trends. For more
information regarding 2019 case definitions, visit the
National Notifiable Diseases Surveillance System’s website.
No changes to case definitions were implemented for
acute or chronic viral hepatitis during 2019.
Estimating Incidence of
Acute Viral Hepatitis
To account for underascertainment and underreporting,
a probabilistic model for estimating the true incidence
of acute hepatitis A, hepatitis B, and hepatitis C from
reported cases has been published previously(9).
The model includes the probabilities of symptoms,
referral to care and treatment, and rates of reporting
to local and state health departments. The published
multipliers have since been corrected by CDC to indicate
that each reported case of acute hepatitis A represents
2.0 estimated infections (95% bootstrap CI: 1.4–2.2);
each reported case of acute hepatitis B represents 6.5
estimated infections (95% bootstrap CI: 3.7–15.9); and
each reported case of acute hepatitis C represents 13.9
estimated infections (95% bootstrap CI: 11.0–47.4).
Mortality Surveillance
The NVSS provides information regarding deaths that
occur in the United States. NVSS data in this report are
from the 2015–2019 Multiple Cause of Death files in
the CDC WONDER online database(13). These data are
based on information from all death certificates filed in
the vital records offices of the 50 states and the District
of Columbia through the Vital Statistics Cooperative
Program. Deaths of nonresidents (e.g., nonresident
aliens, nationals living abroad, or residents of US
territories) and fetal deaths are excluded.
Perinatal Hepatitis B
Prevention Program
Surveillance
Outcome data regarding infants born to mothers
with HBV infection are reported by the CDC Perinatal
Hepatitis B Prevention Program. This program funds 64
jurisdictions to identify pregnant women infected with
HBV and to case-manage their infants to improve receipt
of postexposure prophylaxis, hepatitis B vaccine series
completion, and post-vaccination serologic testing. Data
in this report are from the reporting period for
9
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
the 2018 birth cohort, followed from January 1, 2018,
through December 31, 2019, and only includes infants
managed by the program. Infants have variable lengths of
follow-up time, depending on their date of birth.
More information is available at the Perinatal Hepatitis B
Prevention Program website.
References
1. Nelson NP, Weng MK, Hofmeister MG, et al. Prevention of hepatitis A virus infection in the United States:
recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep
2020;69(No. RR-5):1–38. doi: http://dx.doi.org/10.15585/mmwr.rr6905a1
2. Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States:
recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67(No. RR1):1–31. doi: http://dx.doi.org/10.15585/mmwr.rr6701a1
3. Centers for Disease Control and Prevention (CDC). Hepatitis B questions and answers for health professionals. Atlanta,
GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm
4. Zibbell JE, Asher AK, Patel RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid
epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health 2018;108:175–81.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846578/pdf/AJPH.2017.304132.pdf
5. Centers for Disease Control and Prevention. Notes from the field: hepatitis C virus infections among young
adults—rural Wisconsin, 2010. MMWR Morb Mortal Wkly Rep 2012;61:358. https://www.cdc.gov/mmwr/
preview/mmwrhtml/mm6119a7.htm
6. Seifert LL, Perumpail RB, Ahmed A. Update on hepatitis C: direct-acting antivirals. World J Hepatol 2015;7:2829–33.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670954/pdf/WJH-7-2829.pdf
7. Centers for Disease Control and Prevention (CDC). Division of Viral Hepatitis 2025 Strategic Plan, CDC; 2020.
https://www.cdc.gov/hepatitis/pdfs/DVH-StrategicPlan2020-2025.pdf
8. Centers for Disease Control and Prevention. Viral Hepatitis Surveillance — United States, 2018. https://www.cdc.
gov/hepatitis/statistics/2018surveillance/index.htm
9. Klevens RM, Liu, S, Roberts H, et al. Estimating acute viral hepatitis infections from nationally reported cases.
Am J Public Health 2014;104:482. PMC3953761. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953761/pdf/
AJPH.2013.301601.pdf
10. Centers for Disease Control and Prevention (CDC). Widespread person-to-person outbreaks of hepatitis A across
the United States. Atlanta, GA: US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/
hepatitis/outbreaks/2017March-HepatitisA.htm
11. Ryerson AB, Schillie S, Barker, et al. Vital signs: newly reported acute and chronic hepatitis C cases—United States,
2009–2018. MMWR Morb Mortal Wkly Rep 2020;69:399–404. https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC7147907/pdf/mm6914a2.pdf
12. Centers for Disease Control and Prevention. National Notifiable Diseases Surveillance System, 2019 Annual Tables
of Infectious Disease Data. Atlanta, GA. CDC Division of Health Informatics and Surveillance. https://wonder.cdc.
gov/nndss/nndss_annual_tables_menu.asp
13. CDC WONDER dataset documentation and technical methods can be accessed at https://wonder.cdc.gov/
wonder/help/mcd.html#
10
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
SUMMARY 2019
Viral Hepatitis Acute Infections
Hepatitis A
18,846
Acute Cases
Reported in 2019
37,700
Acute Infections
Estimated in 2019
(26,400 – 41,500)*
Hepatitis B
3,192
Acute Cases
Reported in 2019
20,700
Acute Infections
Estimated in 2019
(11,800 – 50,800)*
Hepatitis C
4,136
Acute Cases
Reported in 2019
57,500
Acute Infections
Estimated in 2019
(45,500 – 196,000)*
*95% Bootstrap Confidence Interval
11
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
HEPATITIS A, 2019
18,846
Acute
cases
reported
5.7
Reported
cases per
100,000
population
37,700*
Acute
infections
estimated
AT A GLANCE
HEPATITIS A in 2019
Hepatitis A incidence increased 1,325% from 2015 through 2019. The increase
in 2019 was because of unprecedented person-to-person outbreaks in 31 states
primarily among people who use drugs and people experiencing homelessness.
GROUPS MOST AFFECTED
BY HEPATITIS A IN 2019
By Age†
By Sex†
Males: 7.3 cases
20–29 years : 7.9 cases per 100,000 people
30–39 years: 14.5 cases per 100,000 people
per 100,000 people
40–49 years: 10.4 cases per 100,000 people
By Race/Ethnicity†
White, Non-Hispanic: 6.8 cases
By Risk
per 100,000 people
Among the 10,991 reported cases
with IDU information available,
* 95% Bootstrap Confidence Interval: (26,400–41,500)
† Indicates groups at or above the US rate in 2019
Injection Drug Use (IDU):
5,017 (46%) reported IDU
12
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 1.1. Number of reported hepatitis A virus infection cases and
estimated infections* — United States, 2012–2019
Hepatitis A
2012
2013
2014
2015
2016
2017
2018
2019
Reported cases
1,562
1,781
1,239
1,390
2,007
3,366
12,474
18,846
Estimated infections
3,100
3,600
2,500
2,800
4,000
6,700
24,900
37,700
Source: CDC, National Notifiable Diseases Surveillance System.
* The number of estimated viral hepatitis infections was determined by multiplying the number of reported cases that met the classification criteria for a confirmed case
by a factor that adjusted for underascertainment and underreporting. The 95% bootstrap confidence intervals for the estimated number of infections are displayed in
the Appendix.
During 2012–2015, the number of reported cases of hepatitis A ranged from approximately 1,200 to 1,800 cases
yearly. The number of reported cases of hepatitis A began to increase during 2016, when 2 foodborne outbreaks were
reported, and person-to-person outbreaks of hepatitis A, primarily among persons who use drugs and those experiencing
homelessness, were first reported. Since then, person-to-person outbreaks have been reported in multiple states,
resulting in substantial increases in hepatitis A. During 2019, the number of reported cases was 18,846, which corresponds
to 37,700 estimated infections after adjusting for case underascertainment and underreporting. The number of reported
cases during 2019 corresponds to a 51% increase from 2018 and is >13 times the number reported during 2015, before
the person-to-person outbreaks were first reported.
Source: Klevens RM, Liu, S, Roberts H, et al. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health 2014;104:482.
PMC3953761. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953761/pdf/AJPH.2013.301601.pdf
13
2019 VIRAL HEPATITIS
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Table 1.1. Number and rates* of reported cases† of hepatitis A virus infection,
by state or jurisdiction — United States, 2015–2019
State or Jurisdiction
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Total
Source: CDC, National
Notifiable Diseases
Surveillance System.
* Rates per
100,000
population.
2015
2016
2017
2018
2019
No.
23
4
54
10
179
25
9
2
U
108
30
6
9
57
19
16
7
16
5
8
19
34
51
21
2
9
2
6
11
2
59
6
123
45
5
36
11
28
43
4
16
2
14
147
8
3
50
26
8
9
3
Rate*
0.5
0.5
0.8
0.3
0.5
0.5
0.3
0.2
U
0.5
0.3
0.4
0.5
0.4
0.3
0.5
0.2
0.4
0.1
0.6
0.3
0.5
0.5
0.4
0.1
0.1
0.2
0.3
0.4
0.2
0.7
0.3
0.6
0.4
0.7
0.3
0.3
0.7
0.3
0.4
0.3
0.2
0.2
0.5
0.3
0.5
0.6
0.4
0.4
0.2
0.5
No.
19
2
32
13
229
22
16
1
4
115
44
285
7
71
18
16
5
9
12
8
37
64
112
15
2
16
3
21
14
8
74
4
99
52
2
36
11
15
62
4
21
1
7
139
12
5
190
31
15
7
—
Rate*
0.4
0.3
0.5
0.4
0.6
0.4
0.4
0.1
0.6
0.6
0.4
20
0.4
0.6
0.3
0.5
0.2
0.2
0.3
0.6
0.6
0.9
1.1
0.3
0.1
0.3
0.3
1.1
0.5
0.6
0.8
0.2
0.5
0.5
0.3
0.3
0.3
0.4
0.5
0.4
0.4
0.1
0.1
0.5
0.4
0.8
2.3
0.4
0.8
0.1
—
No.
23
—
59
7
947
65
17
6
3
261
24
8
4
73
21
9
6
71
8
7
29
52
670
30
3
27
3
4
19
7
71
4
218
29
—
45
9
20
69
6
21
1
6
129
159
2
46
28
6
16
18
Rate*
0.5
—
0.8
0.2
2.4
1.2
0.5
0.6
0.4
1.2
0.2
0.6
0.2
0.6
0.3
0.3
0.2
1.6
0.2
0.5
0.5
0.8
6.7
0.5
0.1
0.4
0.3
0.2
0.6
0.5
0.8
0.2
1.1
0.3
—
0.4
0.2
0.5
0.5
0.6
0.4
0.1
0.1
0.5
5.1
0.3
0.5
0.4
0.3
0.3
3.1
No.
38
1
77
254
189
31
15
7
11
548
84
4
5
93
964
10
14
3,560
37
9
52
364
299
16
13
243
—
6
41
12
70
23
165
103
—
1,687
5
23
99
7
30
1
654
88
135
3
82
35
2,247
15
5
Rate*
0.8
0.1
1.1
8.4
0.5
0.5
0.4
0.7
1.6
2.6
0.8
0.3
0.3
0.7
14.4
0.3
0.5
79.7
0.8
0.7
0.9
5.3
3
0.3
0.4
4
—
0.3
1.4
0.9
0.8
1.1
0.8
1
—
14.4
0.1
0.5
0.8
0.7
0.6
0.1
9.7
0.3
4.3
0.5
1
0.5
124.4
0.3
0.9
No.
242
2
584
203
256
333
17
36
15
3,392
844
1
75
185
1,398
9
10
1,318
687
45
88
204
70
76
128
359
15
15
102
309
610
104
391
154
4
1,802
13
27
696
6
662
8
2,160
159
20
12
309
181
467
31
12
Rate*
4.9
0.3
8
6.7
0.6
5.8
0.5
3.7
2.1
15.8
7.9
0.1
4.2
1.5
20.8
0.3
0.3
29.5
14.8
3.3
1.5
3
0.7
1.3
4.3
5.8
1.4
0.8
3.3
22.7
6.9
5
2
1.5
0.5
15.4
0.3
0.6
5.4
0.6
12.9
0.9
31.6
0.5
0.6
1.9
3.6
2.4
26.1
0.5
2.1
1,390
0.4
2,007
0.6
3,366
1
12,474
3.8
18,846
5.7
† Reported cases that met the classification criteria for
a confirmed case. For the case definition, see https://
ndc.services.cdc.gov/conditions/hepatitis-a-acute/.
—: No reported cases. The
reporting jurisdiction did not
submit any cases to CDC.
U: Unavailable.
The data were
unavailable.
14
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
The rate of reported hepatitis A in the United States was 5.7 per 100,000 population during 2019, approximately 1.5 times
the rate reported during 2018 and >14 times the rate reported during 2015, before the widespread person-to-person
outbreaks were first reported. The 5 states with the highest number of reported cases during 2019 (Florida, Tennessee,
Ohio, Indiana, and Kentucky) account for >10,000 reported cases of hepatitis A, approximately half the national burden
during 2019. These states were heavily affected by the person-to-person hepatitis A outbreaks during that year.
15
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 1.2. Rates* of reported hepatitis A† virus infection, by state or
jurisdiction — United States, 2018–2019
During 2019, the rates of reported hepatitis
A ranged from a high of 31.6 cases per
100,000 population in Tennessee to a low
of 0.1 cases per 100,000 population in
Hawaii. Changes in rates during 2018 and
2019 were influenced by the time that
person-to-person outbreaks occurred
within jurisdictions. The largest increase
in rates was observed in New Hampshire,
with a rate during 2019 (22.7 cases per
100,000 population), 25 times the rate
US Rate (2019): 5.7
reported during 2018 (0.9 cases per 100,000
population). In contrast, the largest decrease
in a rate was observed in Utah, where the
2019 rate decreased by 86%, as the personto-person outbreak was resolving.
Source: CDC, National
Notifiable Diseases
Surveillance System.
* Rates per
100,000
population.
† Reported cases that met the classification criteria for a
confirmed case. For the case definition, see
https://ndc.services.cdc.gov/conditions/hepatitis-a-acute/.
Only states with rates for 2018 and 2019 are
shown. No hepatitis A cases were reported
from Montana and North Dakota in 2018.
16
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 1.3. Rates of reported hepatitis A virus infection, by state or
jurisdiction — United States, 2019
Color
Key
Cases per 100,000
Population
State or Jurisdiction
0.0-0.6
AK, CA, CT, HI, IA, KS, ND, OK, OR, RI, TX, UT, WI
0.7-1.4
MI, MN, MT, NE, SD
1.5-3.0
DC, IL, MA, MD, NC, NY, VT, WA, WY
3.1-5.5
AL, DE, ID, ME, MS, NM, NV, PA, VA
The state-specific rates of hepatitis
A varied throughout the country,
ranging from a high of 31.6 cases
per 100,000 population in Tennessee
to a low of 0.1 cases per 100,000
5.6-14.8
14.9-31.6
AR, AZ, CO, GA, LA, MO, NJ, SC
FL, IN, KY, NH, OH, TN, WV
Source: CDC, National Notifiable Diseases Surveillance System.
population in Hawaii. Seven states
heavily affected by person-toperson outbreaks were in the highest
category and included Florida, Indiana,
Kentucky, New Hampshire, Ohio,
Tennessee, and West Virginia; 5 of
these states are located in or near the
Appalachian region. Lower incidence
rates were observed in the central US
and the West Coast.
17
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 1.4. Rates of reported hepatitis A virus infection, by age group —
United States, 2004–2019
Age (years)
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
0-9
1.9
1.4
1.1
0.7
0.5
0.3
0.3
0.2
0.2
0.1
0.1
0.1
0.1
0.1
0.1
0.3
10-19
2.0
1.6
1.3
0.9
0.8
0.6
0.5
0.4
0.4
0.3
0.3
0.2
0.3
0.2
0.6
0.6
20-29
2.3
1.9
1.5
1.4
1.0
1.0
0.8
0.6
0.7
0.7
0.5
0.6
0.9
1.4
6.1
7.9
30-39
1.8
1.5
1.2
1.2
0.9
0.8
0.6
0.5
0.5
0.7
0.5
0.6
0.9
2.1
9.8
14.5
40-49
1.6
1.3
1.2
0.9
0.9
0.6
0.5
0.4
0.5
0.6
0.3
0.4
0.8
1.5
6.6
10.4
50-59
1.7
1.4
1.1
0.9
0.9
0.5
0.5
0.4
0.6
0.6
0.4
0.5
0.7
1.3
3.5
6.2
≥60
2.1
1.4
1
0.9
0.9
0.7
0.6
0.5
0.6
0.7
0.5
0.5
0.6
0.7
1.4
2.3
Source: CDC, National Notifiable Diseases Surveillance System.
The rates of hepatitis A decreased in approximately all age groups during 2004–2009 and remained constant until outbreaks
of hepatitis A began to be reported during 2016. The substantial increase in the rates of hepatitis A observed in recent years
has been apparent in almost all age groups, except persons aged <20 years, which is consistent with the introduction of the
hepatitis A vaccine in 1996 and the gradual expansion to universal childhood vaccination recommendations in 2006. During
2019, the highest rates were observed among persons aged 20–49 years, largely influenced by widespread hepatitis A
outbreaks occurring among persons who use drugs and those experiencing homelessness.
18
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 1.5. Rates of reported hepatitis A virus infection, by sex — United
States, 2004–2019
Sex
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Male
2.1
1.7
1.3
1.1
0.9
0.7
0.6
0.5
0.5
0.6
0.4
0.5
0.7
1.4
4.7
7.3
Female
1.8
1.3
1.1
0.9
0.8
0.6
0.5
0.4
0.5
0.6
0.4
0.4
0.5
0.7
3.0
4.2
Source: CDC, National Notifiable Diseases Surveillance System.
An increase in the reported rates of hepatitis A since person-to-person outbreaks were first reported during 2016 has
been observed among both males and females. During 2019, the rate of reported hepatitis A virus infection was 7.3 cases
per 100,000 population for males (>14 times the corresponding rate during 2015) and 4.2 cases per 100,000 population
among females (>10 times the corresponding rate during 2015).
19
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 1.6. Rates of reported hepatitis A virus infection, by race/ethnicity —
United States, 2004–2019
Race/
Ethnicity
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
American Indian/
Alaska Native
0.8
0.6
0.5
0.7
0.8
0.3
0.2
0.7
0.2
0.3
0.2
0.2
0.1
0.5
0.5
2.2
Asian/
Pacific Islander
2.9
1.7
1.4
1.1
1.3
1.1
1.0
0.8
0.6
0.6
0.7
0.6
1.5
0.6
0.5
0.7
Black,
non-Hispanic
1.0
0.8
0.6
0.4
0.4
0.4
0.3
0.3
0.2
0.2
0.2
0.2
0.3
0.7
1.2
2.5
White,
non-Hispanic
1.1
0.9
0.7
0.7
0.6
0.4
0.4
0.3
0.4
0.5
0.3
0.3
0.4
1.0
4.3
6.8
Hispanic
2.7
2.7
2.3
1.4
1.0
0.8
0.7
0.5
0.5
0.5
0.4
0.4
0.5
0.8
0.7
1.5
Source: CDC, National Notifiable Diseases Surveillance System.
During 2019, rates of hepatitis A ranged from a low of 0.7 cases per 100,000 population among Asian/Pacific Islander
persons to a high of 6.8 cases per 100,000 population among non-Hispanic White persons. Rates increased among
all racial/ethnicity categories during 2018–2019. The largest increase occurred among American Indian/Alaska Native
persons, among whom the 2019 rate was >4 times the rate during 2018. However, the relatively smaller number of cases
reported among American Indian/Alaska Native persons can result in wider fluctuations in annual rates. Compared with
the preoutbreak period of 2015, the rates for reported hepatitis A increased most dramatically among non-Hispanic White
persons, with a rate in 2019 that was >22 times the corresponding rate during 2015.
20
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 1.2. Number and rates* of reported cases† of hepatitis A virus infection,
by demographic characteristics — United States 2015–2019
2015
Characteristic
2016
2017
2018
2019
No.
Rate*
No.
Rate*
No.
Rate*
No.
Rate*
No.
Rate*
1,390
0.4
2,007
0.6
3,366
1.0
12,474
3.8
18,846
5.7
0–9
48
0.1
47
0.1
40
0.1
54
0.1
127
0.3
10–19
97
0.2
131
0.3
86
0.2
231
0.6
231
0.6
20–29
287
0.6
392
0.9
659
1.4
2,763
6.1
3,582
7.9
30–39
233
0.6
391
0.9
893
2.1
4,268
9.8
6,400
14.5
40–49
164
0.4
333
0.8
621
1.5
2,658
6.6
4,177
10.4
50–59
205
0.5
297
0.7
554
1.3
1,509
3.5
2,635
6.2
≥60
353
0.5
409
0.6
509
0.7
987
1.4
1,691
2.3
Male
726
0.5
1,107
0.7
2,209
1.4
7,497
4.7
11,824
7.3
Female
662
0.4
897
0.5
1,149
0.7
4,952
3.0
6,997
4.2
American Indian/
Alaska Native
5.0
0.2
3.0
0.1
13
0.5
15
0.5
60
2.2
Asian/Pacific Islander
114
0.6
299
1.5
124
0.6
104
0.5
139
0.7
Black, non-Hispanic
71
0.2
137
0.3
303
0.7
508
1.2
1,072
2.5
White, non-Hispanic
701
0.3
865
0.4
1,979
1.0
8,670
4.3
13,709
6.8
Hispanic
219
0.4
293
0.5
471
0.8
413
0.7
916
1.5
1,198
0.4
1,769
0.6
3,055
1.1
7,657
2.7
14,637
5.2
181
0.4
182
0.4
180
0.4
3,153
6.8
3,372
7.3
60
0.4
105
0.7
91
0.6
410
2.8
593
4.0
2: New York
182
0.6
173
0.6
289
1.0
235
0.8
1,001
3.5
3: Philadelphia
122
0.4
309
1.0
159
0.5
2,498
8.1
1,611
5.2
4: Atlanta
254
0.4
269
0.4
438
0.7
5,030
7.6
8,900
13.3
5: Chicago
193
0.4
259
0.5
855
1.6
3,074
5.9
3,562
6.8
6: Dallas
179
0.4
179
0.4
157
0.4
407
1.0
1,166
2.7
7: Kansas City
38
0.3
58
0.4
46
0.3
273
1.9
393
2.8
8: Denver
45
0.4
40
0.3
246
2.1
172
1.4
392
3.2
250
0.5
560
1.1
1,033
2.0
311
0.6
943
1.8
67
0.5
55
0.4
52
0.4
64
0.5
285
2.0
Total§
Age (years)
Sex
Race/ethnicity
Urbanicity¶
Urban
Rural
HHS Region: Regional Office
#
1: Boston
9: San Francisco
10: Seattle
Source: CDC, National Notifiable
Diseases Surveillance System.
§
* Rates per 100,000
population.
¶
† For the case definition, see
https://ndc.services.cdc.gov/
conditions/hepatitis-a-acute/.
Numbers reported in each category might not add up to the total number of reported cases in a year because of cases with
missing data or, in the case of race/ethnicity, cases categorized as “Other.”
Urbanicity was categorized according to the 2013 National Center for Health Statistics (NCHS) urban-rural classification
scheme for counties and county-equivalent entities (https://www.cdc.gov/nchs/data_access/urban_rural.htm). Large central
metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan counties were grouped as urban.
Micropolitan and noncore counties were grouped as rural.
US Department of Health and Human Services (HHS) regions were categorized according to the grouping of states and US
territories assigned under each of the 10 HHS regional offices (https://www.hhs.gov/about/agencies/iea/regional-offices/
index.html). For the purposes of this report, regions with US territories (Regions 2 and 9) contain data from states only.
#
21
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
This table summarizes the epidemiology of hepatitis A in the United States during recent years, highlighting the
populations most affected by outbreaks of hepatitis A occurring among persons who use drugs and persons experiencing
homelessness. During 2019, rates of reported hepatitis A were highest among persons aged 20–49 years, males, nonHispanic White persons, and in the US Department of Health and Human Services Region 4 (Alabama, Florida, Georgia,
Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee). Using urbanicity categories defined by the National
Center for Health Statistics, compared with the preoutbreak period of 2015, the rates of hepatitis A in 2019 increased 13
times in urban settings and 18 times in rural settings. Among all hepatitis A cases reported during 2019, 75% occurred
among persons aged 20–49 years; 73% occurred among non-Hispanic White persons; 78% occurred in urban areas; and
47% occurred in Health and Human Services Region 4.
22
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
HEPATITIS A
RISK BEHAVIORS AND EXPOSURES
Figure 1.7. Availability of information
regarding risk behaviors or
exposures*† associated with reported
cases of hepatitis A virus infection —
United States, 2019
Risk
identified*
No risk
identified
6,635
(35.2%)
6,191
(32.9%)
6,020
(31.9%)
Risk data
missing
Table 1.3. Reported risk behaviors or exposures†# among reported
cases of hepatitis A virus infection — United States, 2019
Risk behaviors/exposures
Risk identified*
No risk identified
Risk data missing
5,017
5,974
7,855
Sexual contact §
693
6,928
11,225
Household contact (non-sexual) §
563
7,058
11,225
Other contact §
773
6,848
11,225
Men who have sex with men ¶
201
2,479
9,144
International travel
159
9,836
8,851
Injection drug use
Source: CDC, Nationally Notifiable Diseases
Surveillance System.
* Case reports with at least one of the following risk
behaviors/exposures reported 2–6 weeks prior to
symptom onset or documented seroconversion
if asymptomatic: 1) injection drug use; 2) sexual,
household, or other contact; 3) men who have sex
with men; 4) travel to hepatitis A-endemic region.
† Reported cases may include more than one risk behavior/exposure.
Risk behaviors/exposures data from one state was classified as ‘missing’ because of errors in
reporting.
#
Cases with more than one type of contact reported were categorized according to a hierarchy:
1) sexual contact; 2) household contact (nonsexual); and 3) other contact with hepatitis A case.
§
¶
A total of 11,824 hepatitis A cases were reported among males in 2019.
Health departments might conduct investigations of newly reported hepatitis A cases to ascertain risk behaviors and
exposures associated with infection. However, investigations might not be possible for all cases if patients are lost to
follow-up or if health departments lack adequate resources for investigating all cases reported in their jurisdiction.
Among the 18,846 case reports of hepatitis A received by CDC for 2019, data regarding risk behaviors or exposures
were missing for 6,191 (32.9%) cases. At least one risk behavior or exposure was reported for 6,635 (32.5%) cases
during the 2–6 weeks before illness onset.
Among risk behaviors or exposures identified, injection drug use was most commonly reported (46% of the 10,991
cases for which injection drug use information was available). Because of limitations on variables included in the
surveillance system during 2019, multiple risk behaviors or exposures associated with hepatitis A could not be wellcharacterized, including homelessness, incarceration, noninjection drug use, and high-risk sexual practices that
increase the risk for fecal–oral exposure to hepatitis A virus.
23
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 1.4. Number and rates* of deaths with hepatitis A virus infection listed
as a cause of death† among residents, by demographic characteristics —
United States, 2015–2019
2015
Characteristic
2016
2017
2018
2019
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
67
0.01
(0.01–0.02)
70
0.01
(0.00–0.01)
91
0.02
(0.02-0.03)
171
0.05
(0.04-0.06)
225
0.04
(0.03–0.05
5
UR§
6
UR§
9
UR§
33
0.02
(0.01-0.02)
24
0.01
(0.01-0.02)
45–64
25
0.03
(0.02-0.04)
33
0.04
(0.03-0.06)
35
0.04
(0.03-0.06)
72
0.09
(0.07-0.11)
118
0.14
(0.12-0.17)
≥65
37
0.08
(0.05-0.11)
31
0.06
(0.04-0.09)
47
0.09
(0.07-0.12)
66
0.13
(0.10-0.16)
83
0.15
(0.12-0.19)
Male
38
0.02
(0.01-0.03)
38
0.01
(0.01-0.02)
63
0.03
(0.02-0.03)
115
0.07
(0.06-0.08)
159
0.09
(0.07-0.10)
Female
29
0.01
(0.00-0.01)
32
0.01
(0.01-0.02)
28
0.00
(0.00-0.00)
56
0.02
(0.02-0.03)
66
0.04
(0.03-0.05)
White,
non-Hispanic
45
0.01
(0.00-0.01)
50
0.02
(0.01-0.02)
69
0.02
(0.02-0.03)
150
0.06
(0.05-0.07)
194
0.09
(0.07-0.10)
Other or not
stated
22
S¶
20
S¶
22
S¶
21
S¶
31
S¶
Total
Age (years)
0–44
Sex
Race/ethnicity
Source: CDC, National Center for Health Statistics, Multiple Cause of Death 1999–2019 on CDC WONDER online database. Data are from the 2015–2019 Multiple
Cause of Death files and are based on information from all death certificates filed in the vital records offices of the 50 states and the District of Columbia through
the Vital Statistics Cooperative Program. Deaths of nonresidents (e.g., nonresident aliens, nationals living abroad, residents of Puerto Rico, Guam, the Virgin Islands,
and other US territories) and fetal deaths are excluded. Numbers are slightly lower than previously reported for 2015–2016 because of NCHS standards that restrict
displayed data to US residents. Accessed at http://wonder.cdc.gov/mcd-icd10.html on January 8, 2021. CDC WONDER data set documentation and technical methods
can be accessed at https://wonder.cdc.gov/wonder/help/mcd.html#.
* Rates for race/ethnicity, sex, and the overall total are age-adjusted per 100,000 US standard population during 2000 by using the following age group distribution (in
years): <1, 1–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84, and ≥85. For age-adjusted death rates, the age-specific death rate is rounded to 1 decimal
place before proceeding to the next step in the calculation of age-adjusted death rates for NCHS Multiple Cause of Death on CDC WONDER. This rounding step might
affect the precision of rates calculated for small numbers of deaths. Missing data are not included.
† Cause of death is defined as 1 of the multiple causes of death and is based on the International Classification of Diseases, 10th Rev. (ICD-10) codes B15 (hepatitis A).
§
UR Unreliable rate: Rates where death counts were <20 were not displayed because of the instability associated with those rates.
S¶ Suppressed: CDC WONDER did not have the functionality to calculate rates for the “Other or not stated” race/ethnicity group.
Hepatitis A is a self-limited disease that does not result in chronic infection and rarely results in death. In 2019, a total of
225 deaths with hepatitis-A virus infection listed were reported among US residents in the US Multiple Cause of Death
data from the National Center for Health Statistics, resulting in an age-adjusted death rate of 0.04 per 100,000 population.
The 2019 hepatitis A-associated mortality rate was highest among persons aged ≥45 years, compared with 0–44 years,
and the mortality rate among males was >2 times the rate among females. Because of the low number of reported deaths,
further stratification by age, race/ethnicity categories, state, and Health and Human Services region was impossible
because of the instability associated with the rates.
24
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
ACUTE HEPATITIS B, 2019
3,192
Acute
cases
reported
1.0
Reported
cases per
100,000
population
20,700*
Acute
infections
estimated
AT A GLANCE
ACUTE HEPATITIS B in 2019
Rates of acute hepatitis B remained low in children and adolescents, likely because
of childhood vaccinations. However, more
than half of acute hepatitis B
cases reported to CDC in 2019 were among persons aged 30–49 years.
GROUPS MOST AFFECTED
BY ACUTE HEPATITIS B IN 2019
By Age†
30–39 years : 1.8 cases per 100,000 people
40–49 years: 2.7 cases per 100,000 people
By Sex†
Males: 1.3 cases
per 100,000 people
50–59 years: 1.6 cases per 100,000 people
By Race/Ethnicity†
White, non-Hispanic: 1.0 cases
By Risk
per 100,000 people
Among the 1,780 reported cases
with IDU information available,
* 95% Bootstrap Confidence Interval: (11,800–50,800)
† Indicates groups at or above the US rate in 2019
Injection Drug Use (IDU):
631 (35%) reported IDU
25
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 2.1. Number of reported acute hepatitis B virus infection cases and
estimated infections* — United States, 2012–2019
Acute Hepatitis B
2012
2013
2014
2015
2016
2017
2018
2019
Reported acute cases
2,895
3,050
2,791
3,370
3,218
3,409
3,322
3,192
Estimated acute infections
18,800
19,800
18,100
21,900
20,900
22,200
21,600
20,700
Source: CDC, National Notifiable Diseases Surveillance System.
* The number of estimated viral hepatitis infections was determined by multiplying the number of reported cases that met the classification criteria for a confirmed case
by a factor that adjusted for underascertainment and underreporting. The 95% bootstrap confidence intervals for the estimated number of infections are displayed in
the Appendix.
The number of acute hepatitis B cases reported each year in the United States has remained relatively stable during
2012–2019, with a low of 2,791 reported during 2014 and a high of 3,409 cases reported during 2017. During 2019,
the number of reported cases was 3,192, which corresponds to 20,700 estimated infections after adjusting for case
underascertainment and underreporting.
Source: Klevens RM, Liu, S, Roberts H, et al. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health 2014;104:482.
PMC3953761. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953761/pdf/AJPH.2013.301601.pdf
26
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 2.1. Number and rates* of reported cases† of acute hepatitis B virus
infection, by state or jurisdiction — United States, 2015–2019
State or Jurisdiction
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Total
Source: CDC, National
Notifiable Diseases
Surveillance System.
* Rates per
100,000
population.
2015
2016
2017
2018
2019
No.
101
3
25
36
160
28
6
8
U
432
119
14
8
55
133
16
19
162
87
9
40
25
56
19
50
35
4
3
25
—
85
2
80
165
2
409
37
24
61
U
30
2
243
159
10
3
69
34
272
5
U
Rate*
2.1
0.4
0.4
1.2
0.4
0.5
0.2
0.8
U
2.1
1.2
1.0
0.5
0.4
2.0
0.5
0.7
3.7
1.9
0.7
0.7
0.4
0.6
0.3
1.7
0.6
0.4
0.2
0.9
—
0.9
0.1
0.4
1.6
0.3
3.5
0.9
0.6
0.5
U
0.6
0.2
3.7
0.6
0.3
0.5
0.8
0.5
14.7
0.1
U
No.
59
6
14
49
115
28
7
3
U
558
100
—
6
37
146
10
21
222
48
53
27
31
45
21
31
40
1
8
22
—
59
1
103
170
2
299
32
20
43
U
34
2
204
156
5
2
56
45
268
9
U
Rate*
1.2
0.8
0.2
1.6
0.3
0.5
0.2
0.3
U
2.7
1.0
—
0.4
0.3
2.2
0.3
0.7
5.0
1.0
4.0
0.4
0.5
0.5
0.4
1.0
0.7
0.1
0.4
0.7
—
0.7
0.0
0.5
1.7
0.3
2.6
0.8
0.5
0.3
U
0.7
0.2
3.1
0.6
0.2
0.3
0.7
0.6
14.6
0.2
U
No.
82
9
26
46
126
32
10
9
U
588
106
—
6
27
170
12
24
236
73
77
34
51
61
23
44
31
3
10
30
—
57
1
81
190
—
285
41
23
69
U
40
2
215
106
18
1
61
45
212
14
2
Rate*
1.7
1.2
0.4
1.5
0.3
0.6
0.3
0.9
U
2.8
1.0
—
0.3
0.2
2.5
0.4
0.8
5.3
1.6
5.8
0.6
0.7
0.6
0.4
1.5
0.5
0.3
0.5
1.0
—
0.6
0.0
0.4
1.8
—
2.4
1.0
0.6
0.5
U
0.8
0.2
3.2
0.4
0.6
0.2
0.7
0.6
11.7
0.2
0.3
No.
48
7
23
47
105
21
10
7
U
617
179
3
6
25
169
14
16
260
57
52
53
46
77
16
40
18
1
3
23
4
64
2
56
220
2
310
6
18
61
U
45
1
192
102
36
3
58
51
132
14
2
Rate*
1.0
0.9
0.3
1.6
0.3
0.4
0.3
0.7
U
2.9
1.7
0.2
0.3
0.2
2.5
0.4
0.5
5.8
1.2
3.9
0.9
0.7
0.8
0.3
1.3
0.3
0.1
0.2
0.8
0.3
0.7
0.1
0.3
2.1
0.3
2.7
0.2
0.4
0.5
U
0.9
0.1
2.8
0.4
1.1
0.5
0.7
0.7
7.3
0.2
0.3
No.
75
6
28
39
111
17
3
12
U
595
114
1
7
43
170
24
11
188
73
58
41
37
64
16
49
33
1
—
23
5
78
4
85
187
—
311
17
17
91
U
42
5
208
69
29
9
57
52
76
8
3
Rate*
1.5
0.8
0.4
1.3
0.3
0.3
0.1
1.2
U
2.8
1.1
0.1
0.4
0.3
2.5
0.8
0.4
4.2
1.6
4.3
0.7
0.5
0.6
0.3
1.6
0.5
0.1
—
0.7
0.4
0.9
0.2
0.4
1.8
—
2.7
0.4
0.4
0.7
U
0.8
0.6
3.0
0.2
0.9
1.4
0.7
0.7
4.2
0.1
0.5
3,370
1.1
3,218
1.0
3,409
1.1
3,322
1.0
3,192
1.0
† Reported cases that met the classification
criteria for a confirmed case. For the case
definition, see https://ndc.services.cdc.gov/
conditions/hepatitis-b-acute/.
—: No reported cases.
The reporting jurisdiction
did not submit any cases
to CDC.
N: Not reportable. The disease or condition
was not reportable by law, statute, or
regulation in the reporting jurisdiction.
U: Unavailable. The data were unavailable.
27
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
The capacity for notifying CDC of acute hepatitis B virus infection cases varies considerably on the basis of laws, resources,
and infrastructure for conducting viral hepatitis surveillance in each jurisdiction. The national rate of acute hepatitis B was
1.0 reported cases per 100,000 population during 2019. Maine had the highest reported rate of acute hepatitis B during
2019 (4.3 cases per 100,000 population). Five states with the highest number of reported acute cases (Florida, Ohio,
Tennessee, Kentucky, and North Carolina) accounted for approximately half of the national burden of acute hepatitis B
cases reported during 2019.
28
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 2.2. Rates* of reported acute hepatitis B† virus infection, by state —
United States, 2018–2019
During 2019, the rates of reported acute
hepatitis B ranged from a high of 4.3 cases
per 100,000 population in Maine to a low
of 0.1 in Connecticut, Hawaii, Montana, and
Wisconsin. The largest increase in rates from
2018 to 2019 was observed in South Dakota,
whereas the largest decrease in rates from
2018 to 2019 was observed in Connecticut.
Because of varying resources to conduct
viral hepatitis surveillance and the relatively
smaller number of acute hepatitis B virus
cases reported in certain jurisdictions, wide
fluctuations in annual rates occur.
US Rate (2019): 1.0
Source: CDC, National
Notifiable Diseases
Surveillance System.
* Rates per
100,000
population.
† Reported cases that met the classification criteria for
a confirmed case. For the case definition, see https://
ndc.services.cdc.gov/conditions/hepatitis-b-acute/.
Only states with rates for 2018 and 2019 are shown. State/
jurisdiction and year for no reported cases: Nebraska
(2019), North Dakota (2019); for unavailable data: District of
Columbia (2018, 2019), Rhode Island (2018, 2019).
29
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 2.3. Rates of reported acute hepatitis B virus infection, by state or
jurisdiction — United States, 2019
Color
Key
Cases per 100,000
Population
State or Jurisdiction
0.0-0.2
CT, HI, MT, NM, TX, WI
0.3-0.4
AZ, CA, CO, ID, IL, KS, MN, NH, NY, OK, OR
0.5-0.8
AK, IA, MA, MD, MI, MO, NV, PA, SC, SD, VA, WA, WY
0.9-1.1
GA, NJ, UT
1.2-2.5
AL, AR, DE, IN, LA, MS, NC, VT
2.6-4.3
FL, KY, ME, OH, TN, WV
The state-specific rates of reported
acute hepatitis B varied throughout
the country during 2019. The states
in the highest rate category (2.6 to
4.3 cases per 100,000 population)
Data not available
DC, ND, NE, RI
include Florida, Kentucky, Maine,
Ohio, Tennessee, and West Virginia.
States with rates of acute hepatitis
B higher than the national rate (1.0
cases per 100,000 population) were
located in the eastern part of the
country, particularly in or near the
Appalachian region.
Source: CDC, National Notifiable Diseases Surveillance System.
30
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 2.4. Rates of reported acute hepatitis B virus infection, by age group
— United States, 2004–2019
Age (years)
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
0–19
0.2
0.2
0.1
0.1
0.1
0.1
0.1
0
0
0
0
0
0
0
0
0
20–29
3.5
2.9
2.3
2.0
1.8
1.2
1.1
1.0
0.9
0.8
0.6
0.8
0.6
0.6
0.6
0.5
30–39
4.0
3.7
3.4
3.0
2.7
2.3
2.3
2.0
2.2
2.4
2.2
2.6
2.4
2.3
2.0
1.8
40–49
3.4
3.1
2.8
2.7
2.6
2.2
2.0
1.9
1.9
2.1
2.0
2.4
2.2
2.5
2.6
2.7
50–59
2.3
2.0
1.8
1.8
1.5
1.4
1.5
1.1
1.1
1.1
1.2
1.4
1.5
1.6
1.6
1.6
≥60
1.1
0.8
0.8
0.8
0.7
0.7
0.7
0.5
0.4
0.4
0.4
0.5
0.5
0.6
0.6
0.6
Source: CDC, National Notifiable Diseases Surveillance System.
During 2011–2019, rates of reported acute hepatitis B steadily increased among persons aged 40–49 and 50–59 years.
In contrast, rates continued to remain low among children and adolescents aged 0–19 years. During 2015–2019, rates
of reported acute hepatitis B have decreased by 86% among persons aged 20–29 years, likely explained, in part, because
of the implementation of childhood hepatitis B vaccine recommendations in 1991. As the cohort of persons aged 20–29
years has grown older, rates of acute hepatitis B among persons aged 30–39 years began to consistently decrease
beginning in 2015.
Source: Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on
Immunization Practices. MMWR Recomm Rep 2018;67(No. RR-1):1–31.
31
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 2.5. Rates of reported acute hepatitis B virus infection, by sex —
United States, 2004–2019
Sex
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Male
2.7
2.3
2.1
1.9
1.7
1.4
1.4
1.2
1.2
1.2
1.1
1.3
1.2
1.3
1.3
1.3
Female
1.5
1.4
1.1
1.1
1.0
0.8
0.8
0.7
0.7
0.7
0.6
0.8
0.8
0.8
0.8
0.7
Source: CDC, National Notifiable Diseases Surveillance System.
The rates of reported acute hepatitis B are higher among males than among females. Since 2011, rates have remained
relatively stable, ranging from 1.1 to 1.3 cases per 100,000 among males and from 0.6 to 0.8 cases per 100,000 among
females. This represents a decade of stable rates after a decrease from 2004 rates of 2.7 cases per 100,000 among
males and 1.5 cases per 100,000 among females.
32
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 2.6. Rates of reported acute hepatitis B virus infections, by race/
ethnicity — United States, 2004–2019
Race/Ethnicity
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
American Indian/
Alaska Native
1.5
1.6
1.5
1.4
1.8
1.0
1.1
0.5
0.7
0.7
0.8
0.7
0.5
0.7
0.9
0.6
Asian/Pacific
Islander
1.3
1.3
1.2
0.9
0.8
0.7
0.6
0.4
0.4
0.3
0.3
0.4
0.3
0.3
0.3
0.3
Black,
non-Hispanic
2.9
3.0
2.3
2.3
2.2
1.7
1.7
1.4
1.1
0.9
0.8
1.0
0.9
1.0
1.0
0.9
White,
non-Hispanic
1.2
1.1
1.0
1.0
0.9
0.8
0.8
0.8
0.8
0.9
0.9
1.1
1.0
1.1
1.0
1.0
Hispanic
1.0
1.1
1.1
1.0
0.8
0.7
0.6
0.4
0.4
0.4
0.3
0.3
0.3
0.3
0.4
0.4
Source: CDC, National Notifiable Diseases Surveillance System.
Rates of reported acute hepatitis B decreased among all racial/ethnicity groups during 2004–2014 but have remained
largely unchanged in recent years. During 2019, rates of reported acute hepatitis B ranged from a low of 0.3 cases per
100,000 among Asian/Pacific Islander persons to a high of 1.0 case per 100,000 among non-Hispanic White persons.
Of note, the relatively small number of cases reported among certain racial/ethnicity categories can result in wider
fluctuations in annual rates.
33
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 2.2. Number and rates* of reported cases† of acute hepatitis B virus
infection, by demographic characteristics — United States 2015–2019
2015
Characteristic
2016
2017
2018
2019
No.
Rate*
No.
Rate*
No.
Rate*
No.
Rate*
No.
Rate*
3,370
1.1
3,218
1.0
3,409
1.1
3,322
1.0
3,192
1.0
19
0.0
18
0.0
16
0.0
27
0.0
13
0.0
20–29
348
0.8
286
0.6
271
0.6
249
0.6
218
0.5
30–39
1,094
2.6
1,000
2.4
998
2.3
868
2.0
801
1.8
40–49
961
2.4
906
2.2
1,028
2.5
1,052
2.6
1,067
2.7
50–59
615
1.4
655
1.5
700
1.6
675
1.6
675
1.6
≥60
312
0.5
342
0.5
395
0.6
450
0.6
418
0.6
Male
2,080
1.3
1,957
1.2
2,095
1.3
2,050
1.3
2,021
1.3
Female
1,280
0.8
1,252
0.8
1,301
0.8
1,260
0.8
1,169
0.7
American Indian/
Alaska Native
18
0.7
14
0.5
19
0.7
25
0.9
15
0.6
Asian/Pacific Islander
67
0.4
56
0.3
64
0.3
55
0.3
63
0.3
Black, non-Hispanic
398
1.0
386
0.9
411
1.0
405
1.0
382
0.9
White, non-Hispanic
2,150
1.1
2,059
1.0
2,197
1.1
2,084
1.0
2,045
1.0
175
0.3
194
0.3
196
0.3
222
0.4
215
0.4
2,607
1.0
2,329
0.8
2,333
0.8
2,519
0.9
2,504
0.9
631
1.4
495
1.1
490
1.1
589
1.3
519
1.2
43
0.3
93
0.7
139
1.0
115
0.8
112
0.8
2: New York
165
0.6
162
0.6
138
0.5
120
0.4
163
0.6
3: Philadelphia
450
1.5
397
1.3
385
1.3
311
1.0
277
0.9
4: Atlanta
1,302
2.0
1,378
2.1
1,501
2.3
1,601
2.4
1,458
2.2
5: Chicago
677
1.3
557
1.1
580
1.1
611
1.2
612
1.2
6: Dallas
321
0.8
286
0.7
267
0.6
214
0.5
202
0.5
7: Kansas City
73
0.5
79
0.6
77
0.5
51
0.4
68
0.6
8: Denver
46
0.4
38
0.3
57
0.5
63
0.5
55
0.5
224
0.4
151
0.3
182
0.4
154
0.3
163
0.3
69
0.5
77
0.6
83
0.6
82
0.6
82
0.6
Total§
Age (years)
0–19
Sex
Race/ethnicity
Hispanic
Urbanicity
¶
Urban
Rural
HHS Region: Regional Office
#
1: Boston
9: San Francisco
10: Seattle
Source: CDC, National Notifiable
Diseases Surveillance System.
§
* Rates per 100,000 population.
¶
† Reported cases that met
the classification criteria for a
confirmed case. For the case
definition, see https://ndc.
services.cdc.gov/conditions/
hepatitis-b-acute/.
Numbers reported in each category might not add up to the total number of reported cases in a year because of cases with missing
data or, in the case of race/ethnicity, cases categorized as “Other.”
Urbanicity was categorized according to the 2013 National Center for Health Statistics (NCHS) urban-rural classification scheme
for counties and county-equivalent entities (https://www.cdc.gov/nchs/data_access/urban_rural.htm). Large central metropolitan,
large fringe metropolitan, medium metropolitan, and small metropolitan counties were grouped as urban. Micropolitan and noncore
counties were grouped as rural.
US Department of Health and Human Services (HHS) regions were categorized according to the grouping of states and US
territories assigned under each of the 10 HHS regional offices (https://www.hhs.gov/about/agencies/iea/regional-offices/
index.html). For the purposes of this report, regions with US territories (Region 2 and Region 9) contain data from states only.
#
34
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
This table summarizes the epidemiology of acute hepatitis B in the United States in recent years. During 2019, rates
of acute hepatitis B were highest among persons aged 30–59 years, males, non-Hispanic White persons, and in US
Department of Health and Human Services Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, and Tennessee). Using urbanicity categories defined by the National Center for Health Statistics, the rates
of reported acute hepatitis B remained higher in rural settings, compared with urban settings during 2015–2019. Among
all acute hepatitis B cases reported during 2019, 80% occurred among persons aged 30–59 years; 64% occurred among
non-Hispanic White persons; 78% occurred in urban areas; and 46% occurred in Health and Human Services Region 4.
35
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
HEPATITIS B
RISK BEHAVIORS AND EXPOSURES
Figure 2.7. Availability of information
regarding risk behaviors or
exposures*† associated with reported
cases of acute hepatitis B virus
infection — United States, 2019
Risk
identified*
No risk
identified
1,055
(33.1%)
1,183
(37.1%)
954
(29.9%)
Risk data
missing
Table 2.3. Reported risk behaviors or exposures*† among reported
cases of acute hepatitis B virus infection — United States, 2019
Source: CDC, Nationally Notifiable Diseases
Surveillance System.
Risk
identified*
No risk
identified
Risk data
missing
Injection drug use
631
1,149
1,412
Multiple sexual partners
241
801
2,150
Surgery
120
1,139
1,933
Sexual contact §
92
807
2,293
Needlestick
73
1,121
1,998
Men who have sex with men ¶
79
374
1,568
* Case reports with at least one of the following
risk behaviors/exposures reported 6 weeks to 6
months prior to symptom onset or documented
seroconversion if asymptomatic: 1) injection drug
use; 2) multiple sexual partners; 3) underwent
surgery; 4) men who have sex with men; 5) sexual
contact with suspected/confirmed hepatitis B case;
6) sustained a percutaneous injury; 7) household
contact with suspected/confirmed hepatitis B case;
8) occupational exposure to blood; 9) dialysis; and
10) transfusion. Reported cases may include more
than one risk behavior/exposure.
Household contact (non-sexual) §
17
882
2,293
† Risk behaviors/exposures data from one state was
classified as ‘missing’ because of errors in reporting.
Dialysis patient
34
1,258
1,900
Occupational
2
1,536
1,654
Transfusion
4
1,269
1,919
Risk behaviors/exposures
§
Cases with more than one type of contact reported
were categorized according to a hierarchy: (1) sexual
contact; (2) household contact (nonsexual).
A total of 2,021 acute hepatitis B cases were
reported among males in 2019.
¶
Health departments might conduct investigations of newly reported acute hepatitis B cases to ascertain risk behaviors
and exposures associated with infection. However, investigations might not be possible for all cases if patients are lost
to follow-up or if health departments lack adequate resources for investigating all cases reported in their jurisdiction.
Among the 3,192 case reports of acute hepatitis B received by CDC for 2019, data regarding risk behaviors and
exposures were missing for 1,183 (37.1%) cases. At least one risk behavior or exposure was reported for 1,055 (33.1%)
cases during the 6 weeks to 6 months before illness onset. More than one risk can be reported for each case.
Among risk behaviors and exposures identified, injection drug use was most commonly reported (35% of the 1,780
cases for which injection drug use information was available), followed by multiple sexual partners (23% of the 1,042
cases for which information regarding multiple sexual partners was available).
Hepatitis B transmission associated with surgery, dialysis, or transfusion is extremely rare in the United States; thus,
the reporting of these exposures might represent recent exposure to these health care procedures.
36
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 2.4. Number
of newly reported
cases* of perinatal
hepatitis B virus
infection, by state
or jurisdiction —
United States, 2019
Source: CDC, National Notifiable Diseases
Surveillance System.
State or Jurisdiction
Perinatal Hepatitis B
Alabama
2
During 2019, a total of 10
Alaska
—
states reported 17 cases of
Arizona
—
perinatal hepatitis B that met
Arkansas
—
the classification criteria for
California
4
Colorado
—
a confirmed case. California
Connecticut
—
Delaware
—
District of Columbia
U
Florida
1
Georgia
—
Hawaii
—
National Notifiable Diseases
Idaho
—
Surveillance System are case
Illinois
—
managed by the Perinatal
Indiana
—
Hepatitis B Prevention
Iowa
—
Program.
Kansas
—
Kentucky
—
Louisiana
—
Maine
1
Maryland
—
Massachusetts
—
Michigan
—
Minnesota
—
Mississippi
1
Missouri
—
Montana
—
Nebraska
—
Nevada
—
New Hampshire
—
New Jersey
—
New Mexico
—
New York
2
North Carolina
1
North Dakota
—
Ohio
—
Oklahoma
—
Oregon
—
Pennsylvania
2
Rhode Island
U
South Carolina
—
South Dakota
—
Tennessee
1
Texas
—
Utah
—
* Reported cases that met the classification
criteria for a confirmed case. For case
definition, see https://ndc.services.cdc.gov/
conditions/hepatitis-b-perinatal-virusinfection/.
Vermont
—
—: No reported cases. The reporting
jurisdiction did not submit any cases to
CDC.
U: Unavailable. The data were unavailable.
Virginia
2
Washington
—
West Virginia
—
Wisconsin
—
Wyoming
—
Total
17
had the highest number
of newly reported cases of
perinatal hepatitis B (n = 4)
during 2019. Of note, not all
perinatal cases reported to
37
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 2.5. Number
and rates* of
newly reported
cases† of chronic
hepatitis B virus
infection, by state
or jurisdiction —
United States,
2019
State or Jurisdiction
—
In the United States, chronic
Alaska
22
3.0
hepatitis B is one of the
Arizona
98
1.3
leading causes of cirrhosis,
Arkansas
N
—
which is a major cause
California
—
—
Colorado
203
3.5
of liver cancer. This table
Connecticut
N
—
Delaware
95
9.8
District of Columbia
U
—
Florida
2,283
10.6
Georgia
1,271
12.0
Hawaii
U
—
cases of newly reported
Idaho
60
3.4
chronic hepatitis B do not
Illinois
543
4.3
represent all prevalent
Indiana
275
4.1
hepatitis B infections, which
Iowa
47
1.5
cannot be captured in the
Kansas
25
0.9
Kentucky
N
—
National Notifiable Diseases
Louisiana
305
6.6
—: No reported cases. The reporting
jurisdiction did not submit any cases
to CDC.
N: Not reportable. The disease or
condition was not reportable by law,
statute, or regulation in the reporting
jurisdiction.
U: Unavailable. The data were
unavailable.
rates of newly identified
chronic hepatitis B cases
during 2019, by state
or jurisdiction. Of note,
Surveillance System.
57
4.2
623
10.3
Massachusetts
244
3.5
Michigan
280
2.8
Minnesota
274
4.9
Mississippi
N
—
Missouri
467
7.6
Montana
21
2.0
Nebraska
65
3.4
Tennessee). The highest rate
Nevada
U
—
of newly reported chronic
New Hampshire
U
—
hepatitis B was in Georgia
New Jersey
332
3.7
(12.0 cases per 100,000
New Mexico
31
1.5
population), whereas the
1,355
7.0
North Carolina
522
5.0
lowest rates were in Kansas
North Dakota
44
5.8
Ohio
777
6.6
Oklahoma
191
4.8
93
2.2
Pennsylvania
926
7.2
Rhode Island
U
—
173
3.4
Oregon
†For case definition, see
https://ndc.services.cdc.gov/
conditions/hepatitis-b-chronic/.
displays the number and
Maryland
New York
* Rates per 100,000 population.
Rate*
—
Maine
Source: CDC, National Notifiable
Diseases Surveillance System.
No.
Alabama
South Carolina
South Dakota
Tennessee
15
1.7
735
10.8
Texas
N
—
Utah
79
2.5
Vermont
21
3.4
Virginia
548
6.4
Washington
482
6.3
West Virginia
200
11.2
Wisconsin
54
0.9
Wyoming
23
4.0
13,859
5.9
Total
Of the 13,859 cases
of chronic hepatitis B
reported during 2019,
approximately half of the
cases were from 6 states
(Florida, New York, Georgia,
Pennsylvania, Ohio, and
and Wisconsin (0.9 cases per
100,000 population).
38
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 2.6.
Number and
rates* of newly
reported
cases† of
chronic
hepatitis
B virus
infection, by
demographic
characteristics
— United
States, 2019
2019
Characteristic
Total
§
No.
Rate
13,859
5.9
During 2019, the rate of newly
reported chronic hepatitis B was
highest among persons aged
30–49 years and accounted
Age (years)
for 47% of all chronic hepatitis
0–19
265
0.5
20–29
1,703
5.4
30–39
3,490
11.3
40–49
3,020
10.7
50–59
2,562
8.4
≥60
2,809
5.1
B cases reported during 2019.
Approximately 89% of all newly
reported chronic hepatitis B cases
occurred in urban areas, as defined
by the National Center for Health
Statistics, and approximately
one-third were reported from US
Department of Health and Human
Services Region 4 (Alabama,
Florida, Georgia, Kentucky,
Sex
Male
7,985
7.0
Female
5,853
4.9
Race/ethnicity
Mississippi, North Carolina, South
Carolina, and Tennessee).
Although the rate of reported
acute hepatitis B among Asian/
American Indian/Alaska Native
24
1.0
Pacific Islander persons (Figure
2.6) was the lowest among all
Source: CDC, National Notifiable
Diseases Surveillance System.
Asian/Pacific Islander
2,119
18.9
racial/ethnicity groups, the rate of
* Rates per 100,000 population.
Black, non-Hispanic
2,198
6.7
newly reported chronic hepatitis B
White, non-Hispanic
2,807
1.8
Islander persons (18.9 reported
444
1.4
cases per 100,000 population),
† Reported cases that met the
classification criteria for a confirmed
case. For the case definition,
see https://ndc.services.cdc.gov/
conditions/hepatitis-b-chronic/.
Numbers reported in each
category might not add up to the
total number of reported cases in a
year because of cases with missing
data or, in the case of race/ethnicity,
cases categorized as “Other.”
§
Urban-rural region was
categorized according to the 2013
National Center for Health Statistics
(NCHS) urban-rural classification
scheme for counties and countyequivalent entities (https://www.cdc.
gov/nchs/data_access/urban_rural.
htm). Large central metropolitan,
large fringe metropolitan,
medium metropolitan, and small
metropolitan counties were grouped
as urban. Micropolitan and noncore
counties were grouped as rural.
¶
#
US Department of Health and
Human Services Regions (HHS)
were categorized according to
the grouping of states and US
territories assigned under each of
the 10 HHS regional offices (https://
www.hhs.gov/about/agencies/iea/
regional-offices/index.html). For
the purposes of this report, regions
with US territories (Regions 2 and 9)
contain data from states only.
was highest among Asian/Pacific
Hispanic
>10 times the rate among non-
Urbanicity¶
Hispanic White persons. Because
Urban
12,372
6.3
Rural
1,249
3.5
HHS Region: Regional Office
1: Boston
3.6
2: New York
1,687
6.0
3: Philadelphia
2,392
7.9
4: Atlanta
4,984
9.1
5: Chicago
2,203
4.2
6: Dallas
527
4.9
7: Kansas City
604
4.3
8: Denver
385
3.1
98
1.3
657
4.6
10: Seattle
hepatitis B virus infections in the
United States are among persons
who are non-US-born, differences
#
322
9: San Francisco
the majority of prevalent chronic
in the rates of newly reported
chronic hepatitis B by race/
ethnicity are likely influenced by
country of birth. However, country
of birth is not routinely collected
in National Notifiable Diseases
Surveillance System.
Source: Patel EU, Thio CL, Boon D, et al.
Prevalence of hepatitis B and hepatitis D virus
infections in the United States, 2011–2016.
Clin Infect Dis 2019;69:709–12. doi: https://doi.
org/10.1093/cid/ciz001
39
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 2.7. Number and rates* of deaths with hepatitis B virus infection listed as a
cause of death† among residents, by state or jurisdiction — United States, 2015–2019
State or Jurisdiction
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Total
2015
2016
2017
2018
2019
No.
15
S¶
30
12
355
23
17
S¶
S¶
108
43
13
S¶
30
21
S¶
S¶
26
36
S¶
25
46
35
31
20
20
S¶
S¶
18
S¶
48
S¶
115
40
S¶
58
34
35
44
S¶
22
S¶
54
130
10
S¶
25
48
21
18
S¶
Rate*
UR§
UR§
0.36
UR§
0.82
0.40
UR§
UR§
UR§
0.40
0.37
UR§
UR§
0.21
0.27
UR§
UR§
0.54
0.63
UR§
0.38
0.54
0.29
0.45
0.61
0.25
UR§
UR§
UR§
UR§
0.45
UR§
0.50
0.34
UR§
0.44
0.77
0.67
0.27
UR§
0.35
UR§
0.70
0.43
UR§
UR§
0.26
0.53
0.89
UR§
UR§
No.
19
S¶
29
10
337
23
S¶
S¶
11
98
35
26
S¶
40
26
16
15
36
26
S¶
31
32
27
25
22
13
S¶
S¶
23
S¶
39
S¶
138
42
S¶
44
43
27
41
S¶
38
S¶
55
149
S¶
S¶
23
47
11
19
S¶
Rate*
UR§
UR§
0.34
UR§
0.78
0.39
UR§
UR§
UR§
0.36
0.30
1.50
UR§
0.28
0.32
UR§
UR§
0.72
0.49
UR§
0.43
0.37
0.18
0.42
0.64
UR§
UR§
UR§
0.66
UR§
0.34
UR§
0.60
0.37
UR§
0.34
0.95
0.54
0.25
UR§
0.60
UR§
0.71
0.51
UR§
UR§
0.24
0.55
UR§
UR§
UR§
No.
19
S¶
19
22
346
32
S¶
S¶
12
129
34
15
S¶
30
29
15
11
35
30
S¶
31
36
28
21
23
19
S¶
S¶
13
S¶
43
S¶
123
36
S¶
55
40
29
35
S¶
26
S¶
63
150
11
S¶
29
47
14
21
S¶
Rate*
UR§
UR§
UR§
0.60
0.80
0.51
UR§
UR§
UR§
0.45
0.28
UR§
UR§
0.19
0.34
UR§
UR§
0.75
0.53
UR§
0.43
0.47
0.22
0.30
0.67
UR§
UR§
UR§
UR§
UR§
0.43
UR§
0.50
0.29
UR§
0.42
0.95
0.52
0.20
UR§
0.39
UR§
0.83
0.51
UR§
UR§
0.30
0.56
UR§
0.31
UR§
No.
19
S¶
31
17
304
26
13
S¶
S¶
109
40
14
S¶
31
16
19
12
47
36
S¶
37
28
33
33
20
24
S¶
10
20
S¶
41
S¶
115
35
S¶
42
54
23
34
11
26
S¶
50
119
S¶
S¶
28
53
23
19
S¶
Rate*
UR§
UR§
0.34
UR§
0.67
0.39
UR§
UR§
UR§
0.41
0.35
UR§
UR§
0.20
UR§
UR§
UR§
0.98
0.60
UR§
0.52
0.36
0.25
0.51
0.61
0.31
UR¶
UR§
0.51
UR¶
0.39
UR¶
0.47
0.27
UR§
0.32
1.16
0.45
0.22
UR§
0.42
UR§
0.61
0.40
UR§
UR§
0.28
0.57
1.26
UR§
UR§
No.
12
S¶
30
16
327
35
S¶
S¶
S¶
111
44
21
S¶
25
21
11
13
37
31
S¶
39
22
23
48
25
19
S¶
S¶
16
S¶
34
S¶
113
39
S¶
49
45
42
37
S¶
17
S¶
63
135
S¶
S¶
20
50
18
S¶
S¶
Rate*
UR§
UR§
0.34
UR§
0.70
0.49
UR§
UR§
UR§
0.40
0.35
1.17
UR§
0.17
0.26
UR§
UR§
0.77
0.55
UR§
0.53
0.24
0.17
0.70
0.72
UR§
UR§
UR§
UR§
UR§
0.29
UR§
0.48
0.29
UR§
0.36
0.98
0.78
0.25
UR§
UR§
UR§
0.87
0.43
UR§
UR§
0.18
0.54
UR§
UR§
UR§
1,707
0.46
1,690
0.45
1,727
0.46
1,649
0.43
1,662
0.42
Source: CDC, National Center for Health Statistics, Multiple Cause of Death 1999–2019 on CDC WONDER Online Database. Data are from the 2015–2019 Multiple Cause of Death files and are based on information from all
death certificates filed in the vital records offices of the 50 states and the District of Columbia through the Vital Statistics Cooperative Program. Deaths of nonresidents (e.g., nonresident aliens, nationals living abroad, residents
of Puerto Rico, Guam, the Virgin Islands, and other US territories) and fetal deaths are excluded. Numbers are slightly lower than previously reported for 2015–2016 because of NCHS standards that restrict displayed data to US
residents. Accessed at http://wonder.cdc.gov/mcd-icd10.html on January 11, 2021. CDC WONDER data set documentation and technical methods can be accessed at https://wonder.cdc.gov/wonder/help/mcd.html#.
* Rates are age-adjusted per 100,000 US standard population during 2000 by using the following age group distribution (in years): <1, 1–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84, and ≥85. For ageadjusted death rates, the age-specific death rate is rounded to 1 decimal place before proceeding to the next step in the calculation of age-adjusted death rates for NCHS Multiple Cause of Death on CDC WONDER. This
rounding step might affect the precision of rates calculated for small numbers of deaths. Missing data are not included.
† Cause of death is defined as 1 of the multiple causes of death and is based on the International Classification of Diseases, 10th Rev. (ICD-10) codes B16, B17.0, B18.0, B18.1 (hepatitis B).
UR Unreliable rate: Rates where death counts were <20 were not displayed because of the instability associated with those rates.
§
¶
S Suppressed: Subnational data representing <10 deaths (0–9) are suppressed or CDC WONDER did not have the functionality to calculate rates.
40
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Hepatitis B is associated with premature death, elevated rates of death from all causes, and elevated rates of death from
liver-related causes, including hepatocellular carcinoma. Although death certificate data can help characterize deaths in
the United States associated with hepatitis B, underreporting of hepatitis B as the underlying or contributing cause of
death is known to occur. During 2019, the reported number of deaths was suppressed in 17 jurisdictions with <10 deaths,
and rates were suppressed for another 8 states with <20 deaths.
Among jurisdictions with death rates available, the highest hepatitis B-associated death rate was observed in Hawaii
(1.17 cases per 100,000 population), and the lowest rate was observed in Illinois and Michigan (0.17 cases per 100,000
population). In total, 14 states had hepatitis B-associated death rates higher than the national average. Four states with
the highest number of deaths reported (California, Texas, New York, and Florida) accounted for more than 40% of all
hepatitis B-associated deaths reported during 2019.
Source: Bixler D, Zhong Y, Ly KN, et al; CHeCS Investigators. Mortality among patients with chronic hepatitis B infection: the chronic hepatitis cohort study
(CHeCS). Clin Infect Dis 2019;68:956–63. doi: 10.1093/cid/ciy598. PMID: 30060032. https://pubmed.ncbi.nlm.nih.gov/30060032/
41
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 2.8. Rates* of deaths with hepatitis B virus infection listed as a cause
of death† among residents, by jurisdiction — United States, 2019
Color
Key
Deaths per 100,000
Population
State or Jurisdiction
0.00-0.29
IL, IN, MA, MI, PA, VA
0.30-0.40
AZ, GA, NC, NJ, OH
0.41-0.54
CO, FL, MD, NY, TX, WA
0.55-0.77
CA, KY, LA, MN, MS
0.78-1.17
HI, OK, OR, TN
UR
AK, AL, AR, CT, DC, DE, IA, ID, KS,
ME, MO, MT, ND, NE, NH, NM, NV,
RI, SC, SD, UT, VT, WI, WV, WY
During 2019, the reported number of hepatitis
B-associated deaths was suppressed in 17 jurisdictions
with <10 deaths, and rates were suppressed for another
8 states with <20 deaths. Among states with death
rates available, the states in the lowest category (≤0.29
deaths per 100,000 population) include Illinois, Indiana,
Massachusetts, Michigan, Pennsylvania, and Virginia. The
states in the highest category (0.78 to 1.17 deaths per
100,000 population) include Hawaii, Oklahoma, Oregon,
and Tennessee.
Source: CDC, National Center for Health Statistics, Multiple Cause of Death 1999–2019 on CDC WONDER Online Database. Data are from the 2015–2019 Multiple Cause
of Death files and are based on information from all death certificates filed in the vital records offices of the fifty states and the District of Columbia through the Vital
Statistics Cooperative Program. Deaths of nonresidents (e.g., nonresident aliens, nationals living abroad, residents of Puerto Rico, Guam, the Virgin Islands, and other U.S.
territories) and fetal deaths are excluded. Numbers are slightly lower than previously reported for 2015–2016 due to NCHS standards which restrict displayed data to
U.S. residents. Accessed at http://wonder.cdc.gov/mcd-icd10.html on January 11, 2021. CDC WONDER dataset documentation and technical methods can be accessed at
https://wonder.cdc.gov/wonder/help/mcd.html.
* Rates are age-adjusted per 100,000 US standard population in 2000 using the following age group distribution (in years): <1, 1–4, 5–14, 15–24, 25–34, 35–44, 45–54,
55–64, 65–74, 75–84, and ≥85. For age-adjusted death rates, the age-specific death rate is rounded to one decimal place before proceeding to the next step in the
calculation of age-adjusted death rates for NCHS Multiple Cause of Death on CDC WONDER. This rounding step may affect the precision of rates calculated for small
numbers of deaths. Missing data are not included.
† Cause of death is defined as one of the multiple causes of death and is based on the International Classification of Diseases, 10th Revision (ICD-10) codes B16, B17.0,
B18.0, B18.1 (hepatitis B).
UR: Unreliable rates. Death counts that were less than 20 were not displayed due to the instability associated with those rates.
42
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 2.8. Number and rates* of deaths with hepatitis B virus infections listed
as a cause of death† among residents, by demographic characteristics —
United States, 2015–2019
2015
Characteristic
2016
2017
2018
2019
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
1,707
0.46
(0.44-0.49)
1,690
0.45
(0.43-0.48)
1,727
0.46
(0.44-0.49)
1,649
0.43
(0.41-0.45)
1,662
0.42
(0.40–0.44)
0–34
30
0.02
(0.01- 0.03)
39
0.03
(0.02-0.04)
29
0.02
(0.01-0.03)
32
0.02
(0.01-0.03)
45
0.03
(0.02–0.04)
35–44
118
0.29
(0.24-0.34)
116
0.29
(0.23-0.34)
106
0.26
(0.21-0.31)
122
0.3
(0.24-0.35)
110
0.26
(0.21–0.31)
45–54
330
0.76
(0.68-0.85)
324
0.76
(0.67-0.84)
323
0.76
(0.68-0.85)
283
0.68
(0.60-0.76)
255
0.62
(0.55–0.70)
55–64
610
1.49
(1.37-1.61)
576
1.39
(1.28-1.50)
548
1.3
(1.20-1.41)
520
1.23
(1.12-1.34)
502
1.18
(1.08–1.29)
65–74
382
1.39
(1.25-1.53)
383
1.34
(1.20-1.47)
417
1.4
(1.27-1.54)
422
1.38
(1.25-1.52)
484
1.54
(1.40–1.67)
≥75
236
1.17
(1.02-1.32)
252
1.22
(1.07-1.37)
303
1.43
(1.27-1.59)
270
1.23
(1.08-1.38)
266
1.18
(1.04–1.32)
1,270
0.7
(0.66-0.74)
1,231
0.67
(0.64-0.71)
1,275
0.7
(0.66-0.74)
1,191
0.65
(0.61-0.69)
1,248
0.66
(0.62–0.70
437
0.21
(0.19-0.23)
459
0.22
(0.20-0.24)
452
0.23
(0.20-0.25)
458
0.22
(0.20-0.24)
414
0.21
(0.19–0.24)
White,
non-Hispanic
805
0.28
(0.26-0.30)
767
0.29
(0.27-0.31)
776
0.28
(0.26-0.30)
760
0.27
(0.25-0.29)
761
0.28
(0.26–0.30)
Black,
non-Hispanic
318
0.75
(0.67-0.84)
315
0.73
(0.65-0.81)
320
0.74
(0.66-0.83)
304
0.7
(0.62-0.79)
291
0.64
(0.56–0.71)
Hispanic
136
0.32
(0.27-0.38)
128
0.3
(0.25-0.36)
109
0.26
(0.21-0.32)
122
0.28
(0.23-0.33)
117
0.27
(0.21–0.32)
Asian/Pacific Islander
419
2.23
(2.01-2.45)
454
2.38
(2.16-2.60)
492
2.45
(2.23-2.67)
439
2.1
(1.90-2.30)
463
2.10
(1.90–2.29)
American Indian/
Alaska Native
13
UR§
16
UR§
17
UR§
6
UR§
20
0.76
(0.46–1.18)
Total
Age (years)
Sex
Male
Female
Race/ethnicity
HHS Region: Regional Office¶
1: Boston
81
0.43
(0.34-0.54)
56
0.28
(0.21-0.37)
60
0.35
(0.27-0.46)
64
0.34
(0.26-0.45)
43
0.22
(0.16–0.30)
2: New York
163
0.48
(0.41-0.56)
177
0.51
(0.43-0.59)
166
0.47
(0.39-0.54)
156
0.44
(0.36-0.51)
147
0.42
(0.35–0.49)
3: Philadelphia
126
0.35
(0.28-0.41)
118
0.32
(0.26-0.38)
128
0.32
(0.27-0.38)
130
0.35
(0.29-0.41)
126
0.32
(0.26–0.38)
4: Atlanta
328
0.43
(0.38-0.48)
345
0.44
(0.39-0.49)
365
0.45
(0.41-0.50)
346
0.45
(0.40-0.50)
348
0.42
(0.38–0.47)
5: Chicago
193
0.32
(0.27-0.36)
181
0.29
(0.25-0.33)
184
0.29
(0.24-0.33)
174
0.28
(0.24-0.33)
173
0.27
(0.23–0.31)
6: Dallas
220
0.5
(0.43-0.56)
230
0.51
(0.44-0.57)
247
0.55
(0.48-0.62)
230
0.47
(0.41-0.53)
230
0.48
(0.42–0.55)
7: Kansas City
44
0.26
(0.19-0.36)
52
0.33
(0.24-0.44)
50
0.29
(0.22-0.39)
65
0.38
(0.29-0.48)
51
0.30
(0.22–0.40)
8: Denver
42
0.35
(0.25-0.47)
35
0.27
(0.19-0.38)
48
0.37
(0.27-0.49)
34
0.25
(0.17-0.35)
47
0.32
(0.23–0.43)
9: San Francisco
416
0.72
(0.65-0.79)
415
0.73
(0.66-0.80)
393
0.69
(0.62-0.76)
369
0.62
(0.56-0.69)
394
0.64
(0.57–0.70)
10: Seattle
94
0.56
(0.45-0.69)
81
0.51
(0.40-0.63)
86
0.52
(0.41-0.64)
81
0.47
(0.37-0.59)
103
0.58
(0.47–0.70)
Source: CDC, National Center for Health Statistics, Multiple Cause of Death 1999–
2019 on CDC WONDER Online Database. Data are from the 2015–2019 Multiple
Cause of Death files and are based on information from all death certificates filed
in the vital records offices of the 50 states and the District of Columbia through
the Vital Statistics Cooperative Program. Deaths of nonresidents (e.g., nonresident
aliens, nationals living abroad, residents of Puerto Rico, Guam, the Virgin Islands,
and other US territories) and fetal deaths are excluded. Numbers are slightly lower
than previously reported for 2015–2016 because of NCHS standards that restrict
displayed data to US residents. Accessed at http://wonder.cdc.gov/mcd-icd10.html
on January 8, 2021. CDC WONDER data set documentation and technical methods
can be accessed at https://wonder.cdc.gov/wonder/help/mcd.html#.
* Rates for race/ethnicity, sex, HHS region, and the overall total are age-adjusted per 100,000 US standard population during 2000 by
using the following age group distribution (in years): <1, 1–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84, and ≥85. For
age-adjusted death rates, the age-specific death rate is rounded to 1 decimal place before proceeding to the next step in the calculation
of age-adjusted death rates for NCHS Multiple Cause of Death on CDC WONDER. This rounding step might affect the precision of rates
calculated for small numbers of deaths. Missing data are not included.
† Cause of death is defined as 1 of the multiple causes of death and is based on the International Classification of Diseases,
10th Rev (ICD-10) codes B16, B17.0, B18.0, B18.1 (hepatitis B).
UR§ Unreliable rate: Rates where death counts were <20 were not displayed because of the instability associated with those rates.
¶
US Department of Health and Human Services (HHS) regions were categorized according to the grouping of states and US territories
assigned under each of the 10 HHS regional offices (https://www.hhs.gov/about/agencies/iea/regional-offices/index.html).
For the purposes of this report, regions with US territories (Regions 2 and 9) contain data from states only.
43
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
This table summarizes the characteristics of hepatitis B-associated deaths among residents in the United States. During
2019, a total of 1,662 hepatitis B-associated deaths among US residents were reported in the US Multiple Cause of Death
data from the National Center for Health Statistics, which corresponds to an age-adjusted death rate of 0.42 cases per
100,000 population. The US age-adjusted death rates have been relatively consistent during 2015–2019. The mortality
rate was highest among Asian/Pacific Islander persons (2.10 deaths per 100,000 population), approximately 7.5 times the
rate among non-Hispanic White persons. The hepatitis B-associated mortality rates were also higher than the national
rate among adults aged ≥45 years, males, and in Health and Human Services Regions 9 (Arizona, California, Hawaii, and
Nevada) and 10 (Alaska, Idaho, Oregon, and Washington).
44
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
ACUTE HEPATITIS C, 2019
4,136
Acute
cases
reported
1.3
Reported
cases per
100,000
population
57,500*
Acute
infections
estimated
AT A GLANCE
ACUTE HEPATITIS C in 2019
increased again in 2019. The
highest rates occurred in persons 20–39 years, consistent
Rates of acute hepatitis C
with age groups most impacted by the nation’s opioid crisis.
GROUPS MOST AFFECTED
BY ACUTE HEPATITIS C IN 2019
By Age†
20–29 years : 2.9 cases per 100,000 people
30–39 years: 3.2 cases per 100,000 people
By Sex†
Males: 1.6 cases
per 100,000 people
40–49 years: 1.7 cases per 100,000 people
By Race/Ethnicity†
By Risk
American Indian/Alaska Native:
Injection Drug Use (IDU):
3.6 cases per 100,000 people
* 95% Bootstrap Confidence Interval: (45,500–196,000)
† Indicates groups at or above the US rate in 2019
Among the 1,952 reported cases
with IDU information available,
1,302 (67%) reported IDU
45
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 3.1. Number of reported acute hepatitis C virus infection cases and
estimated infections* — United States, 2012–2019
Acute Hepatitis C
2012
2013
2014
2015
2016
2017
2018
2019
Reported acute cases
1,778
2,138
2,194
2,436
2,967
3,216
3,621
4,136
Estimated acute infections
24,700
29,700
30,500
33,900
41,200
44,700
50,300
57,500
Source: CDC, National Notifiable Diseases Surveillance System.
*The number of estimated viral hepatitis infections was determined by multiplying the number of reported cases that met the classification criteria for a confirmed
case by a factor that adjusted for underascertainment and underreporting. The 95% bootstrap confidence intervals for the estimated number of infections are
displayed in the Appendix.
The number of acute hepatitis C cases reported in the United States increased every year during 2012–2019. During
2019, a total of 4,136 acute cases were reported, corresponding to 57,500 estimated infections after adjusting for case
underascertainment and underreporting. The number of cases reported during 2019 corresponded to a 14% increase
from the 3,621 cases reported during 2018, and a 133% increase from the 1,778 cases reported during 2012.
Source: Klevens RM, Liu, S, Roberts H, et al. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health 2014;104:482.
PMC3953761. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953761/pdf/AJPH.2013.301601.pdf
46
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 3.1. Number and rates* of reported cases† of acute hepatitis C, by state
or jurisdiction — United States, 2015–2019
State or Jurisdiction
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Total
2015
2016
2017
2018
2019
No.
70
N
U
2
59
40
—
4
U
126
84
—
4
31
138
U
22
119
24
30
38
249
83
37
U
8
15
8
12
N
130
40
121
144
—
122
35
13
129
U
5
—
173
48
30
1
52
63
63
64
U
Rate*
1.4
N
U
0.1
0.2
0.7
—
0.4
U
0.6
0.8
—
0.2
0.2
2.1
U
0.8
2.7
0.5
2.3
0.6
3.7
0.8
0.7
U
0.1
1.5
0.4
0.4
N
1.5
1.9
0.6
1.4
—
1.1
0.9
0.3
1.0
U
0.1
—
2.6
0.2
1.0
0.2
0.6
0.9
3.4
1.1
U
No.
32
N
U
—
60
35
17
25
U
236
93
—
7
21
146
U
15
103
5
25
35
424
107
51
U
24
20
2
16
N
122
18
179
82
1
187
32
19
225
U
10
20
150
40
76
5
43
62
94
103
U
Rate*
0.7
N
U
—
0.2
0.6
0.5
2.6
U
1.1
0.9
—
0.4
0.2
2.2
U
0.5
2.3
0.1
1.9
0.6
6.2
1.1
0.9
U
0.4
1.9
0.1
0.5
N
1.4
0.9
0.9
0.8
0.1
1.6
0.8
0.5
1.8
U
0.2
2.3
2.3
0.1
2.5
0.8
0.5
0.9
5.1
1.8
U
No.
17
N
U
1
103
42
9
4
U
357
100
—
8
39
191
U
19
83
7
21
32
327
152
57
U
49
14
2
35
25
125
16
188
114
1
159
46
35
224
U
13
19
142
35
81
9
62
52
102
94
5
Rate*
0.3
N
U
0
0.3
0.7
0.3
0.4
U
1.7
1.0
—
0.5
0.3
2.9
U
0.7
1.9
0.1
1.6
0.5
4.8
1.5
1.0
U
0.8
1.3
0.1
1.2
1.9
1.4
0.8
0.9
1.1
0.1
1.4
1.2
0.8
1.7
U
0.3
2.2
2.1
0.1
2.6
1.4
0.7
0.7
5.6
1.6
0.9
No.
52
N
U
10
114
46
10
U
U
435
84
—
4
93
266
U
13
164
8
23
38
110
142
60
U
74
8
2
19
25
96
22
236
149
10
282
28
14
249
U
15
19
157
46
120
4
47
101
70
134
22
Rate*
1.1
N
U
0.3
0.3
0.8
0.3
U
U
2.0
0.8
—
0.2
0.7
4.0
U
0.4
3.7
0.2
1.7
0.6
1.6
1.4
1.1
U
1.2
0.8
0.1
0.6
1.8
1.1
1.0
1.2
1.4
1.3
2.4
0.7
0.3
1.9
U
0.3
2.2
2.3
0.2
3.8
0.6
0.6
1.3
3.9
2.3
3.8
No.
87
N
U
58
200
45
7
U
U
616
61
7
17
156
325
10
19
128
8
43
33
161
117
62
U
41
17
4
15
20
99
10
306
150
—
281
23
23
210
U
9
28
202
58
127
6
70
81
79
112
5
Rate*
1.8
N
U
1.9
0.5
0.8
0.2
U
U
2.9
0.6
0.5
1.0
1.2
4.8
0.3
0.7
2.9
0.2
3.2
0.5
2.3
1.2
1.1
U
0.7
1.6
0.2
0.5
1.5
1.1
0.5
1.6
1.4
—
2.4
0.6
0.5
1.6
U
0.2
3.2
3.0
0.2
4.0
1.0
0.8
1.1
4.4
1.9
0.9
2,436
0.8
2,967
1.0
3,216
1.0
3,621
1.2
4,136
1.3
Source: CDC, National Notifiable Diseases Surveillance System.
Klevens RM, Liu, S, Roberts H, et al. Estimating acute viral hepatitis
infections from nationally reported cases. Am J Public Health
2014;104:482. PMC3953761. https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC3953761/pdf/AJPH.2013.301601.pdf
* Rates per
100,000
population.
† Reported cases that met the
classification criteria for a confirmed
case. For the case definition,
see https://ndc.services.cdc.gov/
conditions/hepatitis-c-acute/.
—: No reported
cases. The reporting
jurisdiction did not
submit any cases
to CDC.
N: Not reportable. The disease or condition
was not reportable by law, statute, or
regulation in the reporting jurisdiction.
U: Unavailable. The data were unavailable.
47
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
The capacity of each jurisdiction for notifying CDC of acute hepatitis C cases varies considerably on the basis of laws,
resources, and infrastructure for conducting viral hepatitis surveillance. During 2019, a total of 7 jurisdictions did not
submit acute hepatitis C case notifications to CDC. The national rate of acute hepatitis C was 1.3 reported cases per
100,000 population during 2019, a >60% increase from the rate reported during 2015. Indiana had the highest reported
rate of acute hepatitis C (4.8 cases per 100,000 population), whereas Florida reported the largest number of cases
(n = 616). Seven states with the highest number of reported acute cases (Florida, Indiana, New York, Ohio, Pennsylvania,
Tennessee, and California) accounted for >50% of the national burden of acute hepatitis C during 2019.
48
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 3.2. Rates* of reported acute hepatitis C† virus infections, by state —
United States, 2018–2019
During 2019, the rates of reported acute
hepatitis C ranged from a high of 4.8 cases
per 100,000 population in Indiana to a low
of 0.2 cases per 100,000 population in
Connecticut, Louisiana, Nebraska, South
Carolina, and Texas. The largest increase
in rates was observed in Arkansas, with a
rate during 2019 (1.9 cases per 100,000
population) >6 times the rate reported
during 2018 (0.3 cases per 100,000
population). In contrast, the largest decrease
was observed in Wyoming, where the rate
decreased 77% during 2019, compared
with 2018. Because of varying resources
for conducting viral hepatitis surveillance
and the relatively smaller number of acute
hepatitis C cases reported in certain
US Rate (2019): 1.3
Source: CDC, National Notifiable
Diseases Surveillance System.
* Rates per 100,000 population.
† Reported cases that met the classification
criteria for a confirmed case. For the case
definition, see https://ndc.services.cdc.gov/
conditions/hepatitis-c-acute/.
jurisdictions, wide fluctuations in annual
rates might occur.
Only states with rates for 2018 and 2019 are shown. State/jurisdiction and year for no reported
cases: North Dakota (2019), Hawaii (2018); for not reportable condition; Alaska (2018, 2019);
for unavailable data: Arizona (2018, 2019), Delaware (2018, 2019), District of Columbia
49
(2018, 2019), Iowa (2018, 2019), Mississippi (2018, 2019), Rhode Island (2018, 2019).
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 3.3. Rates of reported acute hepatitis C virus infection, by state or
jurisdiction — United States, 2019
Color
Key
Cases per 100,000
Population
State or Jurisdiction
0.0-0.2
CT, LA, NE, SC, TX
0.3-0.6
CA, GA, HI, IA, MD, NM, NV, OK, OR
0.7-1.2
CO, ID, IL, KS, MI, MN, MO, NJ, VA, VT, WA, WY
1.3-1.8
AL, MT, NC, NH, NY, PA
1.9-3.0
AR, FL, KY, MA, OH, TN, WI
3.1-4.8
IN, ME, SD, UT, WV
The state-specific rates of reported acute
hepatitis C varied throughout the country
during 2019. Aside from Utah (4.0 cases
per 100,000 population) and South Dakota
(3.2 cases per 100,000 population), the
Data not available
states with the highest rates of acute
hepatitis C are located in the eastern part
of the country, particularly in or near the
Appalachian region.
AK, AZ, DC, DE, MS, ND, RI
Source: CDC, National Notifiable Diseases Surveillance System.
50
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 3.4. Rates of reported acute hepatitis C virus infection, by age group
— United States, 2004–2019
Age (years)
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
0–19
0.1
0.1
0.1
0.1
0.0
0.0
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
20–29
0.4
0.4
0.5
0.5
0.7
0.7
0.7
1.2
1.7
2.0
2.2
2.4
2.7
2.7
3.0
2.9
30–39
0.4
0.4
0.4
0.5
0.5
0.5
0.6
0.8
1.1
1.4
1.7
1.7
2.2
2.3
2.6
3.2
40–49
0.5
0.4
0.4
0.5
0.5
0.4
0.3
0.4
0.6
0.7
0.7
0.9
1.2
1.1
1.3
1.7
50–59
0.3
0.2
0.3
0.3
0.4
0.2
0.3
0.3
0.4
0.5
0.4
0.6
0.6
0.8
0.9
1.1
≥60
0.1
0.1
0.1
0.1
0.1
0.0
0.1
0.1
0.1
0.1
0.1
0.1
0.2
0.3
0.4
0.5
Source: CDC, National Notifiable Diseases Surveillance System.
Since 2010, rates of reported acute hepatitis C increased among almost all age groups of ≥20 years. The rate of acute
hepatitis C has remained the highest among persons aged 20–39 years, similar to age groups at highest risk for fatal
overdose in the United States and age at initiation of injection drug use among certain US populations. Compared with
2018, the greatest increase in the rates of acute hepatitis C were observed among those aged 40–49 years (31% increase),
followed by those aged 30–39 years (23% increase). For the first time in more than a decade, the rate of acute hepatitis C
decreased slightly among those aged 20–29 years. Rates have consistently been lowest among those aged <20 years or
≥60 years; however, rates have been increasing among those aged ≥60 years since 2015.
Source: Jalal H, Buchanich JM, Sinclair DR, et al. Age and generational patterns of overdose death risk from opioids and other drugs. Nat Med 2020;26:699–704.
doi: 10.1038/s41591-020-0855-y
51
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 3.5. Rates of reported acute hepatitis C virus infection, by sex —
United States, 2004–2019
Sex
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Male
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.4
0.7
0.8
0.8
0.9
1.1
1.2
1.3
1.6
Female
0.2
0.2
0.2
0.3
0.3
0.3
0.3
0.4
0.5
0.7
0.7
0.7
0.8
0.9
1.0
1.0
Source: CDC, National Notifiable Diseases Surveillance System.
The increase in reported rates of acute hepatitis C since 2010 has been observed among both males and females. During
2019, the rate of acute hepatitis C was 1.6 cases per 100,000 population among males (>5.3 times the corresponding rate
during 2010) and 1.0 cases per 100,000 population among females (>3.3 times the corresponding rate during 2010).
52
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 3.6. Rates of reported acute hepatitis C virus infection, by race/
ethnicity — United States, 2004–2019
Race/Ethnicity
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
American Indian/
Alaska Native
0.7
0.3
0.7
0.6
0.8
0.6
1.0
1.1
2.0
1.7
1.3
1.8
3.1
2.9
3.6
3.6
Asian/
Pacific Islander
0.1
0.0
0.1
0.0
0.0
0.0
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.2
Black,
non-Hispanic
0.2
0.1
0.2
0.2
0.2
0.1
0.1
0.1
0.1
0.2
0.2
0.3
0.3
0.5
0.6
0.7
White,
non-Hispanic
0.2
0.2
0.2
0.2
0.3
0.3
0.3
0.5
0.6
0.8
0.8
0.9
1.1
1.2
1.3
1.4
Hispanic
0.1
0.2
0.1
0.1
0.1
0.1
0.1
0.2
0.2
0.2
0.2
0.3
0.3
0.4
0.5
0.6
Source: CDC, National Notifiable Diseases Surveillance System.
During 2019, rates of acute hepatitis C ranged from a low of 0.2 cases per 100,000 population among Asian/Pacific
Islander persons to a high of 3.6 cases per 100,000 population among American Indian/Alaska Native persons. However,
the relatively smaller number of cases reported among these race/ethnicity categories can result in wider fluctuations in
annual rates. Compared with 2010, in 2019 rates were substantially higher among all racial/ethnicity categories; the most
notable relative increases occurred among non-Hispanic Black persons and Hispanic persons.
53
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 3.2. Number and rates* of reported cases† of acute hepatitis C, by
demographic characteristics — United States 2015–2019
2015
Characteristic
2016
2017
2018
2019
No.
Rate*
No.
Rate*
No.
Rate*
No.
Rate*
No.
Rate*
2,436
0.8
2,967
1.0
3,216
1.0
3,621
1.2
4,136
1.3
99
0.1
86
0.1
103
0.1
81
0.1
63
0.1
20–29
999
2.4
1,135
2.7
1,189
2.7
1,310
3.0
1,262
2.9
30–39
682
1.7
868
2.2
937
2.3
1,070
2.6
1,347
3.2
40–49
337
0.9
452
1.2
441
1.1
494
1.3
664
1.7
50–59
240
0.6
264
0.6
332
0.8
366
0.9
442
1.1
77
0.1
141
0.2
185
0.3
295
0.4
358
0.5
Male
1,334
0.9
1,627
1.1
1,775
1.2
2,012
1.3
2,471
1.6
Female
1,093
0.7
1,310
0.8
1,431
0.9
1,605
1.0
1,653
1.0
American Indian/
Alaska Native
39
1.8
70
3.1
67
2.9
83
3.6
83
3.6
Asian/Pacific Islander
16
0.1
25
0.1
23
0.1
29
0.1
36
0.2
Black, non-Hispanic
112
0.3
130
0.3
202
0.5
231
0.6
267
0.7
White, non-Hispanic
1,724
0.9
2,109
1.1
2,227
1.2
2,405
1.3
2,683
1.4
148
0.3
191
0.3
234
0.4
280
0.5
350
0.6
1,812
0.7
2,227
0.8
2,397
0.9
2,782
1.0
3,275
1.2
545
1.3
501
1.2
485
1.1
676
1.6
720
1.7
1: Boston
280
3.2
471
3.8
391
2.8
172
1.2
237
1.7
2: New York
251
0.9
301
1.0
313
1.1
332
1.2
405
1.4
3: Philadelphia
286
1.0
422
1.4
424
1.4
404
1.4
392
1.3
4: Atlanta
721
1.2
706
1.1
826
1.3
1,056
1.7
1,253
2.0
5: Chicago
475
0.9
615
1.2
692
1.3
977
1.9
1,053
2.0
6: Dallas
149
0.4
95
0.2
105
0.2
114
0.3
157
0.4
7: Kansas City
38
0.3
41
0.4
70
0.6
89
0.8
74
0.5
8: Denver
85
0.8
152
1.4
162
1.4
225
1.9
222
1.9
9: San Francisco
71
0.2
76
0.2
138
0.3
133
0.3
222
0.5
10: Seattle
80
0.6
88
0.7
95
0.7
119
0.9
121
0.9
Total§
Age (years)
0–19
≥60
Sex
Race/ethnicity
Hispanic
Urbanicity
¶
Urban
Rural
HHS Region: Regional Office
#
Source: CDC, National Notifiable
Diseases Surveillance System.
§
Numbers reported in each category might not add up to the total number of reported cases in a year because of cases with missing data
or, in the case of race/ethnicity, cases categorized as “Other.”
* Rates per 100,000 population.
¶
Urbanicity was categorized according to the 2013 National Center for Health Statistics (NCHS) urban-rural classification scheme for counties
and county-equivalent entities (https://www.cdc.gov/nchs/data_access/urban_rural.htm). Large central metropolitan, large fringe metropolitan,
medium metropolitan, and small metropolitan counties were grouped as urban. Micropolitan and noncore counties were grouped as rural.
† Reported cases that met
the classification criteria for a
confirmed case. For the case
definition, see https://ndc.
services.cdc.gov/conditions/
hepatitis-c-acute/.
# US Department of Health and Human Services (HHS) regions were categorized according to the grouping of states and US territories
assigned under each of the 10 HHS regional offices (https://www.hhs.gov/about/agencies/iea/regional-offices/index.html). For the
purposes of this report, regions with US territories (Regions 2 and 9) contain data from states only.
54
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
This table summarizes the epidemiology of acute hepatitis C in the United States. During 2019, rates of acute hepatitis
C were highest among persons aged 20–49 years, males, American Indian/Alaska Native persons, and those living in
the US Department of Health and Human Services Regions 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North
Carolina, South Carolina, and Tennessee) and 5 (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin). The geographic
distribution of hepatitis C is similar to the geographic distribution of fatal overdose. By using urbanicity categories
defined by the National Center for Health Statistics, CDC determined that the rates of acute hepatitis C remained higher
in rural settings, compared with urban settings during 2015–2019, continuing a trend of increasing rates of hepatitis
C disproportionately affecting White persons aged ≤30 years in nonurban areas of the United States. Among all acute
hepatitis C cases reported during 2019, 79% occurred among persons aged 20–49 years; 65% occurred among nonHispanic White persons; 79% occurred in urban areas; and 56% occurred in Health and Human Services Regions 4 and 5.
Source:
Jalal H, Buchanich JM, Sinclair DR, et al. Age and generational patterns of overdose death risk from opioids and other drugs. Nat Med 2020;26:699–704. doi:
10.1038/s41591-020-0855-y
Suryaprasad, AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States,
2006–2012. Clin Infect Dis 2014;59:1411–9. doi: 10.1093/cid/ciu643
55
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
HEPATITIS C
RISK BEHAVIORS AND EXPOSURES
Figure 3.7. Availability of information
regarding risk behaviors or
exposures*† associated with reported
cases of acute hepatitis C virus
infection — United States, 2019
Risk
identified*
No risk
identified
1,626
(39.3%)
Risk data
missing
1,873
(45.3%)
637
(15.4%)
Table 3.3. Reported risk behaviors or exposures*† among reported
cases of acute hepatitis C virus infection — United States, 2019
Source: CDC, Nationally Notifiable Diseases
Surveillance System.
Risk
identified*
No risk
identified
Risk data
missing
1,302
650
2,184
Multiple sexual partners
223
594
3,319
Surgery
179
888
3,069
Sexual contact §
142
334
3,660
Needlestick
91
886
3,159
Men who have sex with men ¶
42
315
2,114
* Case reports with at least one of the following
risk behaviors/exposures reported 6 weeks to 6
months prior to symptom onset or documented
seroconversion if asymptomatic: 1) injection drug
use; 2) multiple sexual partners; 3) underwent
surgery; 4) men who have sex with men; 5) sexual
contact with suspected/confirmed hepatitis C case;
6) sustained a percutaneous injury; 7) household
contact with suspected/confirmed hepatitis C case;
8) occupational exposure to blood; 9) dialysis; and
10) transfusion. Reported cases may include more
than one risk behavior/exposure.
Household contact (non-sexual) §
36
440
3,660
† Risk behaviors/exposures data from one state was
classified as ‘missing’ because of errors in reporting.
Dialysis patient
61
1,249
2,826
Occupational
7
1,278
2,851
Transfusion
3
1,105
3,028
Risk behaviors/exposures
Injection drug use
§
Cases with more than one type of contact reported
were categorized according to a hierarchy: (1) sexual
contact; (2) household contact (nonsexual).
A total of 2,471 acute hepatitis C cases were
reported among males in 2019.
¶
Health departments might conduct investigations of newly reported acute hepatitis C cases to ascertain risk behaviors
and exposures associated with infection. However, investigations might not be possible for all cases if patients are lost
to follow-up or if health departments lack adequate resources for investigating all cases reported in their jurisdiction.
Among the 4,136 case reports of acute hepatitis C received by CDC for 2019, data regarding risk behaviors or
exposures were missing for 1,873 (45.3%) cases. At least one risk behavior or exposure was reported for 1,626 (39.3%)
cases during the 6 weeks to 6 months before illness onset. More than one risk can be reported for each case.
Among risk behaviors and exposures identified, injection drug use was most commonly reported (67% of the 1,952
cases for which injection drug use information was available). Hepatitis C virus transmission associated with surgery,
dialysis, or transfusion is extremely rare in the United States; thus, the reporting of these exposures might represent a
history of recent exposure to these health care procedures.
56
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 3.4. Number
of newly reported
cases* of perinatal
hepatitis C virus
infection, by state
or jurisdiction —
United States, 2019
State or Jurisdiction
Perinatal Hepatitis C
Alabama
—
Standardized perinatal
Alaska
2
hepatitis C case notifications
Arizona
—
to CDC began during 2018,
Arkansas
3
with implementation of the
California
15
Colorado
1
National Notifiable Diseases
Connecticut
—
Delaware
U
District of Columbia
—
Florida
20
Georgia
5
Hawaii
—
varies on the basis of
Idaho
—
different factors, including
Illinois
10
local testing and laboratory
Indiana
14
reporting practices
Iowa
—
and resources for case
Kansas
2
Kentucky
—
management and follow-up.
Louisiana
—
Maine
4
Maryland
—
Massachusetts
14
Michigan
11
of health departments
for conducting perinatal
hepatitis C surveillance
As capacity for viral hepatitis
surveillance improves, CDC
anticipates that the number
of perinatal hepatitis C cases
identified and reported to
CDC will increase with time.
5
Mississippi
—
Missouri
—
Montana
—
Nebraska
—
of perinatal hepatitis C.
Nevada
1
The states with the highest
New Hampshire
—
reported number of perinatal
New Jersey
11
hepatitis C cases include
New Mexico
—
Ohio (n = 41), Florida (n = 20),
New York
1
North Carolina
—
and Pennsylvania (n = 20).
North Dakota
—
Ohio
41
Oklahoma
—
—
Pennsylvania
20
Rhode Island
U
Source: CDC, National Notifiable Diseases
Surveillance System.
South Carolina
2
* Reported cases that met the
classification criteria for a confirmed
case. For case definition, see https://ndc.
services.cdc.gov/conditions/hepatitis-cperinatal-infection/.
Tennessee
16
Texas
N
—: No reported cases. The reporting
jurisdiction did not submit any cases
to CDC.
U: Unavailable. The data were unavailable.
definition. The capacity
Minnesota
Oregon
N: Not reportable. The disease or
condition was not reportable by law,
statute, or regulation in the reporting
jurisdiction.
Surveillance System case
South Dakota
states reported 217 cases
2
Utah
2
Vermont
—
Virginia
12
Washington
3
West Virginia
—
Wisconsin
—
Wyoming
—
Total
During 2019, a total of 24
217
57
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 3.5. Number
and rates* of
newly reported
cases† of chronic
hepatitis C virus
infection, by state
or jurisdiction —
United States,
2019
State or Jurisdiction
Alabama
Alaska
In the United States, chronic
hepatitis C is one of the
U
U
leading causes of cirrhosis,
N
a major cause of liver
California
—
—
Colorado
2,554
44.4
cancer. This table displays
Connecticut
1,322
37.1
Delaware
U
U
District of Columbia
U
U
Florida
14,328
66.7
Georgia
4,900
46.2
Hawaii
U
U
Idaho
779
43.6
resources for investigating
Illinois
4,224
33.3
all cases reported in
Indiana
N
N
their jurisdiction, certain
Iowa
1,173
37.2
cases of acute hepatitis C
Kansas
1,195
41.0
Kentucky
N
N
might be misclassified as
Louisiana
3,840
82.6
936
69.6
Maryland
3,163
52.3
Massachusetts
3,092
44.9
Michigan
3,887
38.9
Minnesota
1,021
18.1
a case as acute. Of note,
cases of newly reported
the number and rates of
newly reported chronic
hepatitis C cases during
2019, by state or jurisdiction.
Because health departments
might not have adequate
chronic hepatitis C if health
departments are not able
to identify symptoms or
laboratory abnormalities
necessary for classifying
—
—
Missouri
4,755
77.5
chronic hepatitis C do not
Montana
900
84.2
represent all prevalent
Nebraska
615
31.8
hepatitis C infections, which
U
U
135
9.9
New Jersey
3,358
37.8
New Mexico
2,287
109.1
New York
New Hampshire
6,914
35.5
North Carolina
N
N
North Dakota
501
65.7
Ohio
9,511
81.4
Oklahoma
1,942
49.1
Oregon
2,569
60.9
10,848
84.7
Pennsylvania
Rhode Island
* Rates per 100,000 population.
South Carolina
† Reported cases that met the
classification criteria for a confirmed
case. For case definition, see
https://ndc.services.cdc.gov/conditions/
hepatitis-c-chronic/.
South Dakota
U: Unavailable. The data were
unavailable.
130.8
N
Nevada
N: Not reportable. The disease or
condition was not reportable by law,
statute, or regulation in the reporting
jurisdiction.
37.1
957
Arkansas
Mississippi
—: No reported cases. The reporting
jurisdiction did not submit any cases
to CDC.
Rate*
Arizona
Maine
Source: CDC, National Notifiable
Diseases Surveillance System.
No.
1,818
cannot be captured in the
National Notifiable Diseases
Surveillance System.
Of the 123,312 newly
reported cases of chronic
hepatitis C during 2019,
approximately one-third
were from 4 states (Florida,
Pennsylvania, Ohio, and
Tennessee). The highest rate
U
U
3,817
74.1
of newly reported cases of
455
51.4
chronic hepatitis C was in
8,660
126.8
West Virginia (201.0 cases
Texas
N
N
Utah
929
29.0
Vermont
378
60.6
Virginia
5,329
62.4
Washington
4,321
56.7
West Virginia
3,603
201.0
Wisconsin
1,963
33.7
Wyoming
333
57.5
123,312
56.7
Tennessee
Total
per 100,000 population)
followed by Alaska,
Tennessee, and New Mexico
where rates were >100 cases
per 100,000 population.
58
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 3.6.
Number and
rates* of newly
reported
cases† of
chronic
hepatitis
C virus
infection, by
demographic
characteristics
— United
States, 2019
Characteristic
Total
§
2019
No.
Rate
123,312
56.7
1.8
20–29
21,263
72.3
30–39
31,383
109.1
40–49
19,035
72.1
50–59
22,748
79.6
≥60
26,142
50.8
Male
79,012
73.9
Female
43,966
39.7
* Rates per 100,000 population.
† Reported cases that met the
classification criteria for a confirmed
case. For the case definition,
see https://ndc.services.cdc.gov/
conditions/hepatitis-c-chronic/.
Numbers reported in each
category might not add up to the
total number of reported cases in a
year because of cases with missing
data or, in the case of race/ethnicity,
cases categorized as “Other.”
§
Urbanicity was categorized
according to the 2013 National
Center for Health Statistics (NCHS)
urban-rural classification scheme
for counties and county-equivalent
entities (https://www.cdc.gov/
nchs/data_access/urban_rural.
htm). Large central metropolitan,
large fringe metropolitan,
medium metropolitan, and small
metropolitan counties were grouped
as urban. Micropolitan and noncore
counties were grouped as rural.
Services Region 3 (Delaware,
District of Columbia, Maryland,
Pennsylvania, Virginia, and West
Virginia). Chronic hepatitis C data
was unavailable from all states
in Health and Human Services
Region 9. Among all 123,312
newly reported during 2019,
25% occurred among persons
aged 30–39 years; 64% occurred
in urban areas. Race/ethnicity
86.7
755
7.1
Black, non-Hispanic
9,566
31.0
White, non-Hispanic
49,814
34.0
3,913
14.1
Urban
96,039
52.1
Rural
23,022
67.7
5,863
42.5
2: New York
10,272
36.3
3: Philadelphia
22,943
78.6
4: Atlanta
33,523
68.4
5: Chicago
20,606
45.0
6: Dallas
8,069
75.4
7: Kansas City
7,738
54.7
8: Denver
5,672
46.3
U
U
8,626
60.1
Hispanic
Department of Health and Human
among males; and 78% occurred
1,657
Asian/Pacific Islander
in rural areas, and persons in US
cases of chronic hepatitis C
Sex
Race/ethnicity
Source: CDC, National Notifiable
Diseases Surveillance System.
highest among persons aged 30–
Alaska Native persons, those living
951
American Indian/Alaska Native
reported chronic hepatitis C were
39 years, males, American Indian/
Age (years)
0–19
During 2019, the rates of newly
information was only available
for 65,705 (53%) cases of newly
reported chronic hepatitis C; after
excluding cases with missing race/
ethnicity information, 76% of cases
occurred among non-Hispanic
White persons.
Urbanicity¶
¶
US Department of Health and
Human Services (HHS) regions
were categorized according to
the grouping of states and US
territories assigned under each of
the 10 HHS regional offices (https://
www.hhs.gov/about/agencies/iea/
regional-offices/index.html). For
the purposes of this report, regions
with US territories (Regions 2 and 9)
contain data from states only.
#
U: data were unavailable.
HHS Region: Regional Office#
1: Boston
9: San Francisco
10: Seattle
59
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 3.8. Number of newly reported* chronic hepatitis C virus infection
cases†, by sex and age — United States, 2019
Source: CDC, National Notifiable Diseases Surveillance System.
* During 2019, cases of chronic hepatitis C were either not reportable by law, statute, or regulation; not reported; or otherwise unavailable to CDC from Arizona, Arkansas,
California, Delaware, District of Columbia, Hawaii, Indiana, Kentucky, Mississippi, Nevada, North Carolina, Rhode Island, and Texas.
† Only confirmed, newly reported, chronic hepatitis C cases are included. For the complete case definition, see https://ndc.services.cdc.gov/conditions/hepatitis-c-chronic/.
A total of 123,312 new chronic hepatitis C cases were reported during 2019. A higher number of newly reported cases
of chronic hepatitis C was observed among males, compared with females across all age groups. Among both males and
females, a bimodal age distribution was observed with infections highest among persons aged 20–39 years (peak: 29
years) and a second apex around 55–70 years (peak: 59 years).
60
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 3.7. Number and rates* of deaths with hepatitis C listed as a cause of
death† among residents, by state or jurisdiction — United States, 2015–2019
State or Jurisdiction
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Total
2015
2016
2017
2018
2019
No.
187
41
567
183
3,245
362
153
45
101
1,270
396
68
99
399
270
125
141
270
396
57
366
317
512
234
162
275
77
82
173
65
400
195
979
532
32
559
510
514
726
97
294
35
592
1,996
98
43
330
651
107
208
30
Rate*
3.08
4.95
6.90
5.01
7.19
5.51
3.20
3.41
13.93
4.62
3.26
3.70
4.79
2.56
3.26
3.19
4.11
5.09
7.15
3.05
4.84
3.71
3.77
3.40
4.57
3.50
5.76
3.60
4.80
3.28
3.52
8.05
3.89
4.19
3.55
3.70
11.02
9.68
4.18
7.26
4.67
3.33
7.27
6.72
3.47
4.87
3.15
7.06
4.65
2.78
3.95
No.
166
50
500
184
2,917
385
123
47
95
1,222
368
70
115
354
295
109
148
269
383
40
327
261
415
240
183
258
75
78
181
68
378
203
789
511
20
546
538
491
564
89
299
37
482
1,886
85
35
327
517
118
214
38
Rate*
2.63
5.38
5.81
4.91
6.33
5.74
2.52
3.63
13.37
4.26
2.98
3.75
5.40
2.18
3.60
2.67
4.20
5.05
6.60
1.87
4.32
2.98
3.06
3.28
5.08
3.23
5.71
3.25
4.97
3.57
3.24
8.12
3.06
3.92
2.25
3.58
11.46
8.90
3.28
6.57
4.51
3.46
5.89
6.12
2.98
3.72
3.03
5.53
4.85
2.70
4.89
No.
188
38
480
169
2,630
386
130
49
83
1,222
344
67
84
288
269
122
141
306
382
32
340
267
368
235
159
247
68
79
153
57
342
175
701
460
23
541
555
518
563
76
302
29
469
1,888
68
40
290
528
116
145
41
Rate*
2.97
4.38
5.45
4.43
5.58
5.62
2.61
3.80
11.42
4.16
2.66
3.48
3.82
1.72
3.16
3.01
3.83
5.58
6.49
1.60
4.41
3.00
2.61
3.19
4.38
3.06
4.89
3.29
4.00
2.90
2.90
6.70
2.71
3.44
2.88
3.48
11.84
9.24
3.15
5.15
4.51
2.56
5.57
6.03
2.29
4.44
2.68
5.46
4.94
1.82
5.50
No.
167
40
348
150
2,391
387
89
34
70
1,005
326
49
108
279
259
98
130
319
352
34
352
211
384
209
141
244
76
72
140
64
309
163
615
426
23
480
534
466
417
91
259
30
517
1,708
78
30
272
466
108
151
42
Rate*
2.54
5.00
3.84
3.86
4.98
5.48
1.72
2.33
9.40
3.34
2.46
2.42
4.87
1.67
2.98
2.40
3.48
5.77
5.92
1.69
4.44
2.33
2.72
2.81
3.70
3.09
5.36
3.26
3.59
3.36
2.64
6.30
2.40
3.11
2.52
3.16
11.00
8.03
2.37
6.37
3.70
2.80
6.01
5.30
2.59
3.32
2.48
4.76
4.90
1.90
5.84
No.
134
41
277
134
2,114
376
102
26
75
1,025
313
45
93
221
241
116
116
267
347
23
282
192
359
199
144
205
54
59
128
44
224
165
556
402
30
450
533
425
445
57
220
29
491
1,383
69
30
249
441
108
141
42
Rate*
2.06
4.66
3.01
3.45
4.36
5.24
2.03
2.12
10.08
3.31
2.33
2.38
4.07
1.31
2.76
2.82
3.12
5.08
5.70
1.31
3.48
2.09
2.50
2.65
3.85
2.47
4.02
2.41
3.19
2.28
1.89
6.33
2.12
2.82
3.42
2.90
10.75
7.26
2.48
3.79
3.09
2.61
5.77
4.20
2.17
2.95
2.29
4.43
4.92
1.72
5.33
19,566
4.91
18,093
4.42
17,253
4.13
15,713
3.72
14,242
3.33
Source: CDC, National Center for Health Statistics, Multiple Cause of Death 1999–2019 on CDC WONDER Online Database. Data are from the 2015–2019 Multiple Cause of Death files and are based
on information from all death certificates filed in the vital records offices of the 50 states and the District of Columbia through the Vital Statistics Cooperative Program. Deaths of nonresidents (e.g.,
nonresident aliens, nationals living abroad, residents of Puerto Rico, Guam, the Virgin Islands, and other US territories) and fetal deaths are excluded. Numbers are slightly lower than previously
reported for 2015–2016 because of NCHS standards that restrict displayed data to US residents. Accessed at http://wonder.cdc.gov/mcd-icd10.html on January 11, 2021. CDC WONDER data set
documentation and technical methods can be accessed at https://wonder.cdc.gov/wonder/help/mcd.html#.
* Rates are age-adjusted per 100,000 US standard population during 2000 by using the following age group distribution (in years): <1, 1–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74,
75–84, and ≥85. For age-adjusted death rates, the age-specific death rate is rounded to 1 decimal place before proceeding to the next step in the calculation of age-adjusted death rates for NCHS
Multiple Cause of Death on CDC WONDER. This rounding step might affect the precision of rates calculated for small numbers of deaths. Missing data are not included.
† Cause of death is defined as 1 of the multiple causes of death and is based on the International Classification of Diseases, 10th Rev. (ICD-10) codes B17.1, and B18.2 (hepatitis C).
61
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
During 2019, a total of 14,242 hepatitis C-associated deaths were reported in the US Multiple Cause of Death data from
the National Center for Health Statistics. Although death certificate data can help characterize deaths in the United
States associated with hepatitis C, underreporting of hepatitis C as a primary or underlying cause of death does occur.
Treatment of hepatitis C with direct-acting antiviral agents and sustained viral response is associated with reductions
in mortality among persons with chronic hepatitis C. During 2019, the age-adjusted mortality rate was 3.33 deaths per
100,000 population, an approximate 32% decrease from the corresponding rate during 2015. The highest mortality rates
were observed in Oklahoma and the District of Columbia (10.75 and 10.08 deaths per 100,000 population, respectively),
whereas the lowest rates were observed in Illinois and Maine (both 1.31 deaths per 100,000 population). Three states
(California, Texas, and Florida) had the highest number of hepatitis C-associated deaths reported, accounting for >30% of
all the deaths reported nationally during 2019.
Source:
Spradling PR, Zhong Y, Moorman AC, et al. The persistence of underreporting of hepatitis C as an underlying or contributing cause of death, 2011–2017. Clin
Infect Dis 2021;ciab108. doi: 10.1093/cid/ciab108. Epub ahead of print.
Sahakyan, Y, Lee-Kim V, Bermner KE, et al. Impact of direct-acting antiviral regimens on mortality and morbidity outcomes in patients with chronic hepatitis C:
systematic review and meta-analysis. J Viral Hepat 2021. doi: https://doi.org/10.1111/jvh.13482
62
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure 3.9. Rates* of death† with hepatitis C virus infection listed as a cause
of death among residents, by jurisdiction — United States, 2019
Color
Key
Deaths per 100,000
Population
State or Jurisdiction
0.00-2.30
AL, CT, DE, IL, MA, ME, NH, NJ, NY, UT, VA, WI
2.31-2.80
GA, HI, IN, MI, MN, MO, NE, PA, SD
2.81-3.50
AR, AZ, FL, IA, KS, MD, NC, ND, NV, OH, SC, VT
3.51-5.00
AK, CA, ID, MS, MT, RI, TX, WA, WV
5.01-10.75
CO, DC, KY, LA, NM, OK, OR, TN, WY
The state-specific mortality rates varied
throughout the country during 2019 but are
highest in the Central, Western, and certain
Appalachian states, which reflects a different
epidemiologic picture from acute hepatitis
Source: CDC, National Center for Health Statistics, Multiple Cause of Death 1999–2019 on CDC WONDER Online
Database. Data are from the 2015–2019 Multiple Cause of Death files and are based on information from all
death certificates filed in the vital records offices of the fifty states and the District of Columbia through the Vital
Statistics Cooperative Program. Deaths of nonresidents (e.g., nonresident aliens, nationals living abroad, residents
of Puerto Rico, Guam, the Virgin Islands, and other U.S. territories) and fetal deaths are excluded. Numbers are
slightly lower than previously reported for 2015–2016 due to NCHS standards which restrict displayed data to
US residents. Accessed at http://wonder.cdc.gov/mcd-icd10.html on January 11, 2021. CDC WONDER dataset
documentation and technical methods can be accessed at https://wonder.cdc.gov/wonder/help/mcd.html.
* Rates are age-adjusted per 100,000 US standard population in 2000 using the following age group distribution
(in years): <1, 1–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84, and ≥85. For age-adjusted death
rates, the age-specific death rate is rounded to one decimal place before proceeding to the next step in the
calculation of age-adjusted death rates for NCHS Multiple Cause of Death on CDC WONDER. This rounding step
may affect the precision of rates calculated for small numbers of deaths. Missing data are not included.
C rates (Figure 3.3). The states in the highest
mortality rate category (5.01 to 10.75
deaths per 100,000 population) include
Colorado, District of Columbia, Kentucky,
Louisiana, New Mexico, Oklahoma, Oregon,
Tennessee, and Wyoming. The states in the
lowest mortality rate category (≤2.30 deaths
per 100,000 population) include Alabama,
Connecticut, Delaware, Illinois, Maine,
Massachusetts, New Hampshire, New Jersey,
New York, Utah, Virginia, and Wisconsin.
† Cause of death is defined as one of the multiple causes of death and is based on the International Classification
of Diseases, 10th Revision (ICD-10) codes B17.1, and B18.2 (hepatitis C).
63
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Table 3.8. Number and rates* of deaths with hepatitis C virus infection listed
as a cause of death† among residents, by demographic characteristics —
United States, 2015–2019
2015
Characteristic
2016
2017
2018
2019
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
No.
Rate*
(95% CI)
19,566
4.91
(4.84-4.98)
18,093
4.42
(4.36-4.49)
17,253
4.13
(4.07-4.20)
15,713
3.72
(3.66-3.78)
14,242
3.33
(3.28–3.39)
0–34
196
0.13
(0.11-0.15)
164
0.11
(0.09-0.13)
180
0.12
(0.10-0.14)
212
0.14
(0.12-0.16)
170
0.11
(0.10–0.13)
35–44
592
1.46
(1.34-1.58)
532
1.31
(1.20-1.43)
507
1.24
(1.13-1.35)
499
1.21
(1.10-1.31)
472
1.13
(1.03–1.24)
45–54
3,659
8.47
(8.20-8.75)
3,026
7.07
(6.82-7.32)
2,556
6.03
(5.80-6.27)
2,040
4.90
(4.69-5.11)
1,676
4.10
(3.90–4.30)
55–64
9,678
23.68
(23.20-24.15)
9,011
21.73
(21.28-22.18)
8,275
19.70
(19.28-20.13)
7,297
17.26
(16.87-17.66)
6,304
14.85
(14.48–15.22)
65–74
4,009
14.55
(14.10-15.00)
4,071
14.22
(13.78-14.66)
4,397
14.81
(14.38-15.25)
4,429
14.52
(14.10-14.95)
4,499
14.29
(13.87–14.71)
≥75
1,431
7.08
(6.71-7.45)
1,288
6.25
(5.91-6.59)
1,329
6.28
(5.94-6.61)
1,235
5.63
(5.32-5.94)
1,117
4.95
(4.66–5.24)
Male
14,043
7.27
(7.15-7.40)
12,815
6.48
(6.36-6.59)
12,287
6.12
(6.01-6.23)
11,242
5.53
(5.42-5.63)
10,229
4.96
(4.86–5.05)
Female
5,523
2.71
(2.63-2.78)
5,278
2.54
(2.47-2.61)
4,966
2.32
(2.26-2.39)
4,471
2.09
(2.02-2.15)
4,013
1.83
(1.77–1.89
White,
non-Hispanic
12,329
4.35
(4.27-4.43)
11,389
3.95
(3.88-4.03)
10,781
3.70
(3.63-3.78)
9,858
3.35
(3.28-3.42)
9,056
3.08
(3.01–3.14)
Black,
non-Hispanic
3,602
8.13
(7.86-8.40)
3,360
7.42
(7.16-7.68)
3,262
7.03
(6.79-7.28)
2,978
6.31
(6.08-6.54)
2,646
5.44
(5.23–5.65)
Hispanic
2,737
6.48
(6.23-6.74)
2,510
5.76
(5.53-6.00)
2,399
5.29
(5.08-5.51)
2,190
4.64
(4.44-4.84)
1,865
3.84
(3.66–4.02)
Asian/Pacific Islander
415
2.32
(2.09-2.55)
384
2.03
(1.82-2.24)
368
1.86
(1.67-2.05)
300
1.43
(1.27-1.60)
308
1.43
(1.27–1.59)
American Indian/
Alaska Native
324
11.45
(10.18-12.73)
285
9.80
(8.63-10.97)
299
10.24
(9.04-11.44)
264
9.05
(7.93-10.17)
259
8.63
(7.55–9.72)
732
3.78
(3.50-4.07)
616
3.10
(2.85-3.35)
602
2.97
(2.72-3.21)
519
2.56
(2.33-2.79)
448
2.15
(1.94–2.36)
2: New York
1,379
3.78
(3.58-3.98)
1,167
3.12
(2.94-3.30)
1,043
2.76
(2.59-2.93)
924
2.48
(2.31-2.64)
780
2.06
(1.91–2.21)
3: Philadelphia
1,675
4.17
(3.96-4.37)
1,478
3.68
(3.48-3.87)
1,441
3.53
(3.35-3.72)
1,253
3.04
(2.87-3.22)
1,185
2.85
(2.68–3.02)
4: Atlanta
3,703
4.53
(4.38-4.68)
3,500
4.18
(4.03-4.32)
3,450
4.03
(3.89-4.16)
3,160
3.60
(3.47-3.72)
2,996
3.36
(3.24–3.49)
5: Chicago
2,182
3.24
(3.11-3.38)
2,064
3.01
(2.88-3.15)
1,846
2.63
(2.51-2.75)
1,762
2.52
(2.40-2.64)
1,611
2.27
(2.15–2.38)
6: Dallas
3,280
7.08
(6.83-7.33)
3,194
6.69
(6.45-6.92)
3,169
6.54
(6.31-6.77)
2,907
5.85
(5.64-6.07)
2,562
5.06
(4.86–5.25)
7: Kansas City
623
3.58
(3.29-3.87)
593
3.31
(3.04-3.59)
589
3.24
(2.97-3.51)
544
3.04
(2.78-3.30)
496
2.67
(2.43–2.92)
8: Denver
634
4.67
(4.30-5.04)
640
4.69
(4.32-5.06)
615
4.38
(4.02-4.73)
636
4.45
(4.09-4.80)
600
4.10
(3.77–4.44)
9: San Francisco
4,053
6.84
(6.63-7.05)
3,668
6.08
(5.88-6.28)
3,330
5.37
(5.19-5.56)
2,928
4.63
(4.46-4.80)
2,564
4.00
(3.84–4.15)
10: Seattle
1,305
7.49
(7.08-7.91)
1,173
6.56
(6.17-6.94)
1,168
6.38
(6.01-6.76)
1,080
5.79
(5.43-6.14)
1,000
5.27
(4.94–5.61)
Total
Age (years)
Sex
Race/ethnicity
HHS Region: Regional Office¶
1: Boston
Source: CDC, National Center for Health Statistics, Multiple Cause of Death
1999–2019 on CDC WONDER Online Database. Data are from the 2015–2019
Multiple Cause of Death files and are based on information from all death
certificates filed in the vital records offices of the 50 states and the District
of Columbia through the Vital Statistics Cooperative Program. Deaths of
nonresidents (e.g., nonresident aliens, nationals living abroad, residents of
Puerto Rico, Guam, the Virgin Islands, and other US territories) and fetal
deaths are excluded. Numbers are slightly lower than previously reported for
2015–2016 because of NCHS standards that restrict displayed data to US
residents. Accessed at http://wonder.cdc.gov/mcd-icd10.html on January 11,
2021. CDC WONDER data set documentation and technical methods can be
accessed at https://wonder.cdc.gov/wonder/help/mcd.html.
* Rates for race/ethnicity, sex, HHS region, and the overall total are age-adjusted per 100,000 US standard population during 2000
by using the following age group distribution (in years): <1, 1–4, 5–14, 15–24, 25–34, 35–44, 45–54, 55–64, 65–74, 75–84, and
≥85. Missing data are not included. For age-adjusted death rates, the age-specific death rate is rounded to 1 decimal place before
proceeding to the next step in the calculation of age-adjusted death rates for NCHS Multiple Cause of Death on CDC WONDER. This
rounding step might affect the precision of rates calculated for small numbers of deaths.
† Cause of death is defined as 1 of the multiple causes of death and is based on the International Classification of Diseases, 10th Rev.
(ICD-10) codes B17.1, and B18.2 (hepatitis C).
¶§
US Department of Health and Human Services (HHS) regions were categorized according to the grouping of states and US
territories assigned under each of the 10 HHS regional offices (https://www.hhs.gov/about/agencies/iea/regional-offices/
index.html). For the purposes of this report, regions with US territories (Regions 2 and 9) contain data from states only.
64
2019 VIRAL HEPATITIS
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This table summarizes the characteristics of hepatitis C-associated deaths among residents in the United States. During
2019, a total of 14,242 hepatitis C-associated deaths were reported among US residents in the US Multiple Cause of
Death data from the National Center for Health Statistics, resulting in an age-adjusted mortality rate of 3.33 deaths per
100,000 population. Mortality rates were highest among persons aged 55–74 years, compared with other age categories,
and deaths in this age group accounted for 76% of all hepatitis C-associated deaths reported during 2019. Non-Hispanic
White persons accounted for 64% of all hepatitis C-associated deaths; however, the mortality rates among American
Indian/Alaska Native persons and non-Hispanic Black persons were 2.8 times and 1.8 times, respectively, the mortality rate
among non-Hispanic White persons. The highest hepatitis C-associated mortality rate was reported in Health and Human
Services Region 10 (Alaska, Idaho, Oregon, and Washington), compared with other regions. Region-specific mortality
rates have been consistently decreasing each year since 2015 for all regions except Health and Human Services Region
8 (Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming), which has had the lowest overall decrease in
hepatitis C-associated mortality rate since 2015.
65
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
APPENDIX
Table A.1. Number of reported acute viral hepatitis infection cases and
estimated infections with 95% bootstrap confidence intervals — United
States, 2012–2019
Hepatitis A
Year
Estimated*
Acute Hepatitis B
Estimated*
Acute Hepatitis C
Estimated*
Reported
(95% bootstrap
confidence interval)
Reported
(95% bootstrap
confidence interval)
Reported
(95% bootstrap
confidence interval)
2012
1,562
3,100 (2,200–3,400)
2,895
18,800 (10,700–46,000)
1,778
24,700 (19,600–84,300)
2013
1,781
3,600 (2,500–3,900)
3,050
19,800 (11,300–48,500)
2,138
29,700 (23,500–101,300)
2014
1,239
2,500 (1,700–2,700)
2,791
18,100 (10,300–44,400)
2,194
30,500 (24,100–104,000)
2015
1,390
2,800 (1,900–3,100)
3,370
21,900 (12,500–53,600)
2,436
33,900 (26,800–115,500)
2016
2,007
4,000 (2,800–4,400)
3,218
20,900 (11,900–51,200)
2,967
41,200 (32,600–140,600)
2017
3,366
6,700 (4,700–7,400)
3,409
22,200 (12,600–54,200)
3,216
44,700 (35,400–152,400)
2018
12,474
24,900 (17,500–27,400)
3,322
21,600 (12,300–52,800)
3,621
50,300 (39,800–171,600)
2019
18,846
37,700 (26,400–41,500)
3,192
20,700 (11,800–50,800)
4,136
57,500 (45,500–196,000)
Source:
CDC, National Notifiable Diseases Surveillance System.
Klevens RM, Liu, S, Roberts H, et al. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health 2014;104:482. PMC3953761.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953761/pdf/AJPH.2013.301601.pdf
* To account for underestimation, a probabilistic model to estimate the true incidence (symptomatic and asymptomatic cases) of acute hepatitis A, B, and C virus infections
from reported (symptomatic) cases has been published previously. The model includes the probabilities of symptoms, referral to care and treatment, and rates of
reporting to local and state health departments. The published multipliers have since been corrected by CDC to indicate that each reported case of hepatitis A represents
2.0 estimated infections (95% bootstrap confidence interval [CI]: 1.4–2.2); each reported case of acute hepatitis B represents 6.5 estimated infections (95% CI: 3.7–15.9);
and each reported case of hepatitis C represents 13.9 estimated infections (95% CI: 11.0–47.4).
66
2019 VIRAL HEPATITIS
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SUPPLEMENTAL REPORT
Perinatal Hepatitis B Prevention Program Data
Technical Notes: Outcome data on infants born to persons with hepatitis
B virus infection are reported by the CDC Perinatal Hepatitis B Prevention
Program (PHBPP)1, which funds 64 jurisdictions to identify pregnant persons
infected with hepatitis B virus and to ensure that medical care is provided
to their infants to improve receipt of post-exposure prophylaxis (hepatitis
B vaccine birth dose and hepatitis B immune globulin), hepatitis B vaccine
series completion, and post-vaccination serologic testing. Participating
jurisdictions are the 50 US states, District of Columbia, 5 cities (Chicago,
Houston, New York City, Philadelphia, and San Antonio), 5 territories
(American Samoa, Guam, N. Mariana Islands, Puerto Rico, U.S. Virgin Islands),
and 3 freely associated island nations (Federated States of Micronesia,
Republic of the Marshall Islands, Republic of Palau). Data in this report are
from the reporting period for the 2018 birth cohort, followed from January
1, 2018 through December 31, 2019 and only include infants managed by
the program. Infants have variable lengths of follow-up time depending on
their date of birth. Not all infants identified as HBsAg positive are reported
to the CDC National Notifiable Diseases Surveillance System (NNDSS).
(https://www.cdc.gov/vaccines/programs/perinatal-hepb/index.html)
1
National Perinatal Hepatitis B Prevention Program: 2009–2017. Koneru A, Fenlon N, Schillie S, et al.
Pediatrics March 2021, 147 (3) e20201823; DOI: https://doi.org/10.1542/peds.2020-1823.
Table S.1. Outcomes of infants born in 2018 to hepatitis B infected persons and managed by the CDC
Perinatal Hepatitis B Prevention Program through the end of 2019, 64 US Jurisdictions
Hepatitis B vaccine administration
Grantee
All infants
managed
HBIG & vaccine
at birth
Complete series by
12 months of age
Complete series after
12 months of age
Post-vaccination serologic testing
Total with
complete series
Received †
HBsAg positive
Immune §
No.
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%¶
No.
%¶
9,950
9617
97%
8,609
87%
129
1%
8,738
88%
6,828
69%
23
0%
6,547
96%
Alabama
61
60
98%
58
95%
0
0%
58
95%
52
85%
1
2%
48
92%
Alaska
31
30
97%
23
74%
0
0%
23
74%
19
61%
1
5%
18
95%
Arizona
120
112
93%
103
86%
7
6%
110
92%
67
56%
0
0%
64
96%
Arkansas
61
60
98%
59
97%
0
0%
59
97%
53
87%
1
2%
50
94%
California
1,739
1,700
98%
1,316
76%
7
0%
1,323
76%
983
57%
3
0%
940
96%
Colorado
131
130
99%
128
98%
1
1%
129
98%
113
86%
0
0%
110
97%
85
84
99%
71
84%
2
2%
73
86%
22
26%
0
0%
21
95%
All Jurisdictions
State
Connecticut
Delaware
46
46
100%
43
93%
2
4%
45
98%
41
89%
0
0%
39
95%
Florida
383
338
88%
308
80%
5
1%
313
82%
141
37%
2
1%
130
92%
Georgia
292
279
96%
260
89%
5
2%
265
91%
230
79%
0
0%
220
96%
Hawaii
152
152
100%
146
96%
3
2%
149
98%
134
88%
0
0%
132
99%
Idaho
20
20
100%
20
100%
0
0%
20
100%
13
65%
0
0%
13
100%
Illinois
168
161
96%
159
95%
1
1%
160
95%
133
79%
0
0%
128
96%
Indiana
130
130
100%
124
95%
0
0%
124
95%
109
84%
0
0%
109
100%
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2019 VIRAL HEPATITIS
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Hepatitis B vaccine administration
Grantee
Iowa
Kansas
All infants
managed
HBIG & vaccine
at birth
No.
No.
100
52
Complete series by
12 months of age
Complete series after
12 months of age
Post-vaccination serologic testing
Total with
complete series
Received †
HBsAg positive
Immune §
%
No.
%
No.
%
No.
%
No.
%
No.
%¶
No.
%¶
96
96%
96
96%
1
1%
97
97%
78
78%
0
0%
74
95%
52
100%
48
92%
0
0%
48
92%
33
63%
0
0%
33
100%
Kentucky
78
60
77%
38
49%
8
10%
46
59%
46
59%
0
0%
46
100%
Louisiana
149
136
91%
128
86%
5
3%
133
89%
81
54%
0
0%
78
96%
11
9
82%
7
64%
0
0%
7
64%
6
55%
2
33%
4
67%
Maine
Maryland
253
243
96%
168
66%
1
0%
169
67%
163
64%
0
0%
161
99%
Massachusetts
305
304
100%
287
94%
1
0%
288
94%
255
84%
0
0%
251
98%
Michigan
154
153
99%
144
94%
1
1%
145
94%
118
77%
0
0%
117
99%
Minnesota
378
377
100%
361
96%
4
1%
365
97%
311
82%
0
0%
303
97%
Mississippi
53
50
94%
47
89%
6
11%
53
100%
26
49%
2
8%
18
69%
Missouri
93
87
94%
80
86%
0
0%
80
86%
56
60%
0
0%
51
91%
Montana
3
3
100%
3
100%
0
0%
3
100%
3
100%
0
0%
3
100%
Nebraska
60
56
93%
55
92%
0
0%
55
92%
49
82%
0
0%
47
96%
Nevada
73
67
92%
65
89%
0
0%
65
89%
52
71%
0
0%
49
94%
New Hampshire
13
13
100%
11
85%
0
0%
11
85%
11
85%
0
0%
11
100%
New Jersey
297
278
94%
263
89%
7
2%
270
91%
147
49%
0
0%
124
84%
New Mexico
11
11
100%
11
100%
0
0%
11
100%
7
64%
0
0%
7
100%
New York State
246
239
97%
232
94%
1
0%
233
95%
202
82%
0
0%
196
97%
North Carolina
202
199
99%
187
93%
3
1%
190
94%
143
71%
2
1%
134
94%
North Dakota
40
40
100%
35
88%
0
0%
35
88%
24
60%
0
0%
24
100%
282
251
89%
266
94%
2
1%
268
95%
171
61%
1
1%
157
92%
Ohio
66
64
97%
59
89%
1
2%
60
91%
47
71%
1
2%
43
91%
Oregon
Oklahoma
101
100
99%
93
92%
2
2%
95
94%
80
79%
0
0%
75
94%
Pennsylvania
157
157
100%
150
96%
1
1%
151
96%
126
80%
1
1%
125
99%
Rhode Island
40
40
100%
24
60%
12
30%
36
90%
36
90%
0
0%
36
100%
South Carolina
74
65
88%
69
93%
3
4%
72
97%
58
78%
0
0%
58
100%
South Dakota
25
25
100%
25
100%
0
0%
25
100%
18
72%
0
0%
17
94%
Tennessee
143
141
99%
131
92%
3
2%
134
94%
105
73%
1
1%
100
95%
Texas
647
624
96%
550
85%
5
1%
555
86%
438
68%
1
0%
428
98%
Utah
71
69
97%
70
99%
0
0%
70
99%
59
83%
0
0%
58
98%
Vermont
7
7
100%
6
86%
0
0%
6
86%
1
14%
0
0%
1
100%
Virginia
282
268
95%
254
90%
0
0%
254
90%
165
59%
1
1%
159
96%
Washington
303
291
96%
271
89%
2
1%
273
90%
234
77%
0
0%
204
87%
West Virginia
21
20
95%
21
100%
0
0%
21
100%
17
81%
0
0%
17
100%
128
127
99%
113
88%
2
2%
115
90%
86
67%
0
0%
85
99%
Wisconsin
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2019 VIRAL HEPATITIS
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Hepatitis B vaccine administration
Grantee
All infants
managed
HBIG & vaccine
at birth
Complete series by
12 months of age
Post-vaccination serologic testing
Complete series after
12 months of age
Total with
complete series
Received †
HBsAg positive
Immune §
No.
No.
%
No.
%
No.
%
No.
%
No.
%
No.
%¶
No.
%¶
Chicago
96
96
100%
95
99%
0
0%
95
99%
80
83%
0
0%
76
95%
District of Columbia
34
34
100%
32
94%
0
0%
32
94%
29
85%
0
0%
29
100%
139
129
93%
107
77%
1
1%
108
78%
96
69%
0
0%
95
99%
City
Houston
New York City
1,083
1,077
99%
973
90%
8
1%
981
91%
918
85%
3
0%
891
97%
Philadelphia
139
135
97%
124
89%
6
4%
130
94%
108
78%
0
0%
106
98%
San Antonio
34
34
100%
31
91%
0
0%
31
91%
26
76%
0
0%
25
96%
7
7
100%
6
86%
0
0%
6
86%
0
0%
0
0%
0
0%
Territory
American Samoa
Guam
12
12
100%
3
25%
5
42%
8
67%
0
0%
0
0%
0
0%
N. Mariana Islands
9
9
100%
8
89%
1
11%
9
100%
7
78%
0
0%
7
100%
Puerto Rico
3
3
100%
1
33%
0
0%
1
33%
0
0%
0
0%
0
0%
Virgin Islands
3
3
100%
1
33%
1
33%
2
67%
0
0%
0
0%
0
0%
Freely Associated Island Nations
Micronesia
35
35
100%
23
66%
3
9%
26
74%
0
0%
0
0%
0
0%
Republic of the
Marshall Islands
U
U
U
U
U
U
U
U
U
U
U
U
U
U
U
Palau
17
17
100%
17
100%
0
0%
17
100%
0
0%
0
0%
0
0%
HBIG=hepatitis B immune globulin; HBsAg=hepatitis B surface antigen; U=unavailable; anti-HBs=antibody to hepatitis B surface antigen;
PVST=post-vaccination serologic testing.
† Post-vaccination serologic testing includes a test for HBsAg, anti-HBs, or both.
§
Anti-HBs >10 mIU/mL.
* These data only include infants followed by the Perinatal Hepatitis B Prevention Program (PHBPP). National and jurisdictional level
HepB vaccination coverage rates are available via annual MMWR publications of National Immunization Survey data (https://www.cdc.
gov/vaccines/imz-managers/nis/index.html) and via VaxView (https://www.cdc.gov/vaccines/vaxview/index.html).
¶
Percentage is among infants that completed the vaccine series and received PVST.
This table summarizes outcome data on infants born in 2018 to persons with hepatitis B virus infection from the CDC Perinatal Hepatitis B Prevention Program. The
2018 birth cohort includes infants born in 2018 and followed through December 31, 2019. Among the 9,950 infants managed by the Perinatal Hepatitis B Prevention
Program, 97% received recommended prophylaxis at birth, 88% completed the vaccine series, and 69% received recommended post-vaccination serologic testing.
Among infants with post-vaccination testing (6,828), there were 23 (0.3%) cases of perinatal hepatitis B transmission; the proportion of infants testing positive for
hepatitis B was lower among those who received prophylaxis within 1 day of birth (21/6,697, 0.3%) compared to those who did not (2/131, 1.5%).
69
2019 VIRAL HEPATITIS
SURVEILLANCE REPORT
Figure S.1. Outcomes of infants born to hepatitis B infected persons and
managed by the CDC Perinatal Hepatitis B Prevention Program, by birth
cohort year — 56 US Jurisdictions*, 2009–2018
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Infants managed
11,551
11,054
11,018
11,687
10,769
11,186
11,000
11,350
10,757
9,864
PEP
10,937
10,580
10,650
11,333
10,402
10,726
10,627
10,980
10,394
9,531
PSVT
6,792
6,637
6,852
7,433
7,053
7,276
7,135
7,499
7,181
6,820
Source: CDC, National Perinatal Hepatitis B Prevention Program.
Infants managed, number of infants case managed by the Perinatal Hepatitis B Prevention Program (PHBPP).
PEP (post-exposure prophylaxis), number of infants who received PEP (hepatitis B immune globulin and 1st dose of hepatitis B vaccine) for hepatitis B infection.
PVST (post-vaccination serological testing), number of infants who received PVST after hepatitis B vaccine series completion.
* Includes 50 states, District of Columbia, and 5 cities. Excludes territories and freely associated island nations.
The number of infants managed in the Perinatal Hepatitis B Prevention Program from 50 states, District of Columbia, and
5 cities was 11,551 in 2009 and 9,864 in 2018. During 2009 to 2018, the percentage of infants managed who received PEP
has remained relatively stable between 95% to 97% each year. The percentage of infants managed who received PSVT has
increased from 59% (6,792 of 11,551 infants managed) in 2009 to 69% (6,820 of 9,864 infants managed) in 2018.
70
| File Type | application/pdf |
| File Title | Viral Hepatitis Surveillance — United States, 2019 |
| Subject | hepatitis A, hepatitis B, hepatitis C, Division of Viral Hepatitis, surveillance, viral hepatitis acute infections, Rates of rep |
| Author | Division of Viral Hepatitis |
| File Modified | 2021-05-25 |
| File Created | 2021-05-21 |