Drug use, unstable housing top risk factors during recent hepatitis A virus outbreak
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Key takeaways:
- Hepatitis A virus outbreak-related deaths peaked in 2019 and decreased annually through 2022.
- Drug use, homelessness or unstable housing and coinfection with HBV or HCV were among reported risk factors.
Nearly twice as many hepatitis A virus-related deaths were reported in the United States from 2016 to 2022 compared with the previous 6 years, with individuals who use drugs or experience homelessness and unstable housing most at risk.
“Since 2016, hepatitis A outbreaks associated with person-to-person transmission have been reported in 37 states, involving approximately 44,900 cases, 27,450 hospitalizations and 423 deaths as of October 6, 2023,” Megan G. Hofmeister, MD, of the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention, and colleagues wrote in Morbidity and Mortality Weekly Report. “Nearly twice as many deaths involving hepatitis A in the United States occurred during 2016 to 2022 compared with 2009 to 2015.”
Using reports from 27 states, which accounted for 315 outbreak-related deaths, the CDC characterized demographic, risk factor, clinical and cause-of-death data from August 2016 through October 2022. The median age at death was 55 years, with most deaths reported among men (73%) and non-Hispanic white individual (84%). Outbreak-related deaths peaked in 2019 and decreased annually through 2022, with a median interval of 17 days between symptom onset and death.
Researchers reported that 91% of individuals were hospitalized, 77% had jaundice and less than 1% underwent liver transplantation; the median length of hospital stay was 7 days among those (n = 218) with available information. The most common risk factors for HAV infection included drug use (41%) followed by homelessness or unstable housing (16%). Only 4% of those who died had evidence of previous HAV vaccination and 63% had at least one documented indication for vaccination, including drug use, homelessness or coinfection with hepatitis B or hepatitis C viruses.
Further, of 60% of death certificates in which HAV was documented, HAV was the cause of death on 87% and cited as a “significant condition contributing to death” on 16%.
“As of October 2023, 34 states have declared ends to their outbreaks; however, many susceptible adults, particularly among persons who use drugs, persons experiencing homelessness and persons with chronic liver disease, remain at increased risk for HAV infection or severe disease from HAV infection,” Hofmeister and colleagues wrote. “Increased hepatitis A vaccination coverage is critical to maintain the progress that has been made and prevent future hepatitis A deaths.”
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