2020 Viral Hepatitis Surveillance Report

On September 15, the Centers for Disease Control and Prevention (CDC) Division of Viral Hepatitis (DVH) published the viral hepatitis surveillance and progress reports for 2020. The annual viral hepatitis surveillance report, Viral Hepatitis Surveillance Report— United States, 2020, presents data reported by states and jurisdictional health departments for the cases of viral hepatitis infection from January 1, 2020 through December 31, 2020. Due to the significant disruptions to health care systems and service delivery during the COVID-19 pandemic, the results of the 2020 surveillance report should be interpreted with caution. The 2022 Viral Hepatitis National Progress Report provides an update on progress toward achieving established goals for the prevention of viral hepatitis transmission, disease, and associated mortality. This year, the reports were published exclusively in digital format to improve accessibility.  

The 2020 report shows a decrease in the overall reported number of viral hepatitis cases, but the decrease may be related to a reduction in the available hepatitis workforce and fewer people seeking healthcare and being tested during the COVID-19 pandemic. The data published in the surveillance report show the following major findings:  

• The surveillance report shows a 47% decrease in the rate of hepatitis A virus (HAV) cases during 2020 compared to 2019, marking the first decrease in HAV rates after four successive years of increasing rates. The reduction of HAV incidence is likely due to outbreak interventions among adults who use drugs and people who are experiencing homelessness. 

• Reported cases of acute hepatitis B virus (HBV) declined by 30% compared to 2019, but the reduction is likely due to the challenges posed by the COVID-19 pandemic. CDC anticipates that the reduction in cases will not be observed in subsequent years as the healthcare system resumes pre-pandemic capacity.  

• In 2022, there was a 15% increase in the rate of reported cases of acute hepatitis C virus (HCV), largely driven by increases in injection drug use. The increase in HCV cases is notable: despite interruptions to HCV testing due to the COVID-19 pandemic, the rate of acute HCV cases did not decrease due to the updated case definition for acute HCV established in 2020. 

The 2020 surveillance report also included the first-ever Health Equity Takeaways section, which features data analysis and reporting on inequities in viral hepatitis disease burden and mortality. NASTAD applauds DVH for collecting the health equity information and providing interpretation of the inequities in viral hepatitis surveillance data. The report found that:  

• The rate of chronic HBV cases is 12x higher in Asian and Pacific Islander (API) persons than among non-Hispanic White persons, and the rate of HBV-associated deaths is highest in API populations. 

• People who inject drugs continue to bear the burden of acute HCV infection: among the 32% of reported acute HCV cases that included risk information for injection drug use, 66% reported it. 

• The rate of HCV-associated deaths is highest in American Indian/Alaska Native persons and non-Hispanic White persons. 

Additionally, the 2020 progress report shows that many epidemiological targets set by the 2025 DVH Strategic Plan and the Department of Health and Human Services’ (HHS) Viral Hepatitis National Strategic Plan for 2021-2025 were not met. The impact of the COVID-19 pandemic on the overall hepatitis provider network detailed in the 2020 surveillance and progress reports signal an increased urgency to shore up outbreak detection and response capacity at state and local health department hepatitis programs and prioritize interventions that center health equity and focus on vulnerable populations, especially Asian and Pacific Islanders, American Indians and Alaska Natives, non-Hispanic Blacks/African Americans, and people who inject drugs. 

Click here to read a Dear Colleague letter written by Dr. Carolyn Wester, Director of DVH, and Dr. Jonathan Mermin, Director of the CDC National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).