DefinitionHepatitis A is a liver disease that results from infection with the hepatitis A virus. A hepatitis A case is defined as a person meeting specific laboratory criteria who has a clinical presentation of the disease.
NumeratorNumber of confirmed hepatitis A infections reported in Utah each year.
DenominatorTotal Utah population per year.
Data Interpretation IssuesThe rate reported is number of cases per 100,000 population per year.
Why Is This Important?Hepatitis A is a contagious liver disease that results from infection with the hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter--even in microscopic amounts--from contact with objects, food, or drinks contaminated by the feces or stool of an infected person. The best way to prevent hepatitis A is by getting vaccinated. The hepatitis A vaccine was introduced in 1995 and health professionals now routinely vaccinate all children, travelers to certain endemic countries, and persons at risk for the disease. Hepatitis A vaccination has dramatically affected rates of the disease in the United States and the number of reported cases in Utah has steadily decreased since its advent. In recent years, hepatitis A outbreaks have occurred from several different sources including foodborne transmission through ingestion of contaminated food and person-to-person transmission through close contact with an infected person, most recently, among people who use drugs, people experiencing homelessness, and men who have sex with men. Recent outbreaks have mainly affected adults. Increased vaccination efforts targeting adults in at-risk populations can help limit the size, duration, and spread of person-to-person outbreaks.
Surveillance data are used to detect outbreaks, determine the effectiveness of hepatitis A vaccination, monitor disease incidence in all age groups, determine the epidemiologic characteristics of infected persons including the source of infection, and assess and reduce missed opportunities for vaccination. While the average number of annual hepatitis A virus (HAV) infections reported to CDC in recent years has declined substantially compared to 2000, fluctuations have occurred in the last 20 years because large outbreaks occurred.
Healthy People Objective IID-23:Reduce hepatitis A
U.S. Target: 0.3 cases per 100,000 population
Other ObjectivesUtah's 42 Community Health Indicators
How Are We Doing?After a long downward trend in the U.S., the first increase between 2012 and 2013 (1,562 and 1,781 reported cases, respectively), was due to a large multi-state outbreak associated with pomegranate arils imported from Turkey. Between 2015 and 2016, the reported cases again increased by 44.4% from 1,390 in 2015 to 2,007 cases in 2016. The 2016 increase was due to two hepatitis A outbreaks, each of which was linked to imported foods. The actual number of cases is considered to be much higher since many people who are infected never have symptoms and are never reported to public health officials. In 2017 and 2018, the Utah Department of Health (UDOH) responded to an outbreak of hepatitis A among people experiencing homelessness and persons who use drugs. UDOH worked closely with affected local health departments and community partners to increase vaccination in communities most at risk, including offering vaccination in jails, emergency departments, syringe service programs, substance use treatment facilities, and homeless shelters.
According to national data provided by the CDC, hepatitis A incidence in the U.S. has declined from 12.0 cases per 100,000 population in 1995 to 0.6 cases per 100,000 population in 2016. Declines were greatest among children and in those states where routine vaccination of children was recommended beginning in 1999. Hepatitis A incidence has increased significantly since 2017, a result of ongoing widespread person-to person outbreaks of hepatitis A in 36 states.
How Do We Compare With the U.S.?The average number of cases reported per 100,000 Utah population per year since 1998 has been lower than the national average. In 2019, the CDC reported an incidence rate of 5.7 cases per 100,000 population (n=18,846). Between May 2017 and November 2018, Utah responded to an outbreak of hepatitis A. The outbreak resulted in an increased incidence rate in 2017 (5.2 per 100,000 population) and 2018 (4.4 per 100,000 population) and was linked to a national outbreak involving several other states. In 2020, Utah's rate decreased to 0.4 cases per 100,000 population.
What Is Being Done?The Bureau of Epidemiology conducts ongoing statewide surveillance of hepatitis A cases. According to the Communicable Disease Rule R386-702-3, health care providers and laboratories are required to report suspected cases of hepatitis A immediately by telephone to the Bureau of Epidemiology or a local health department. The Bureau of Epidemiology assists local health departments with case management and implementation of control measures to prevent additional cases as needed.