2023 Viral Hepatitis National Profile

National overview

Staff at health departments routinely submit case reports of viral hepatitis to CDC through the National Notifiable Diseases Surveillance System (NNDSS). The Centers for Disease Control and Prevention (CDC) collects, analyzes, and disseminates viral hepatitis surveillance data.

The annual Surveillance Report, published by CDC, summarizes information from three different data sources: 1) reported cases of hepatitis A, hepatitis B, and hepatitis C from CDC’s NNDSS; 2) deaths listing hepatitis A, hepatitis B, or hepatitis C as a cause of death in CDC’s National Vital Statistics System (NVSS); and 3) outcome data for a birth cohort of infants born to a woman with hepatitis B virus (HBV) infection from the CDC Perinatal Hepatitis B Prevention Program (PHBPP).

These surveillance data are used by public health partners to focus prevention efforts, plan services, allocate resources, develop policy, and detect and respond to clusters of viral hepatitis cases. These actions support the goal of CDC’s 2025 Strategic Plan1 for establishing comprehensive national viral hepatitis surveillance for public health action.

Investment for comprehensive national viral hepatitis surveillance

In May 2021, CDC awarded new funding to 59 US states, territories, and large cities to support viral hepatitis surveillance activities. The five-year funding award is intended to strengthen surveillance for viral hepatitis; increase partner engagement in elimination planning; and improve access to diagnosis, treatment, and prevention among populations most at risk for viral hepatitis. This represents near national coverage, up from 14 sites funded for surveillance activities during May 2017–April 2021. The 2023 Viral Hepatitis Surveillance Report represents the second full year of funding for these 59 jurisdictions.

Impact of COVID-19

The global COVID-19 pandemic began in March 2020 and continued to cause disruptions in access to medical care and routine public health activities in 2021 and 2022. Pandemic-related stay-at-home orders suspended or delayed many routine health care visits, patients avoided seeking medical and preventative services,2 and a decline in testing for hepatitis C was identified.3Furthermore, many health department staff routinely assigned to viral hepatitis case investigation and surveillance activities were reassigned to respond to the COVID-19 pandemic during 2020–2022, which may have affected a health department's capacity to detect, investigate, and report all hepatitis cases in their jurisdiction.4 For these reasons, the numbers and rates of viral hepatitis cases and deaths associated with viral hepatitis during 2020–2022 presented in this report should be interpreted with caution.

Hepatitis A

Morbidity

Overall

During 2023, a total of 1,648 hepatitis A cases were reported to CDC by 49 states and the District of Columbia, corresponding to an estimated 3,300 infections (95% confidence interval [CI]: 2,300–3,600) after adjusting for case underascertainment and underreporting (see Technical Notes).5 The reported case count corresponds to a rate of 0.5 cases per 100,000 population, reflecting a 28% decrease from the reported rate of 0.7 cases per 100,000 population during 2022. This continued decline in reported rates of hepatitis A in 2023 follows a period of several years of increasing rates that peaked in 2019 due to widespread and prolonged hepatitis A outbreaks associated with person-to-person transmission, primarily occurring among persons who use drugs and those experiencing homelessness.6 Maine (4.3 cases per 100,000 population), Kansas (2.8 cases per 100,000 population), and Mississippi (1.4 per 100,000 population) reported the highest rates of hepatitis A during 2023. During 2023, six out of nine states with ongoing outbreaks declared an end to their outbreak; however, at the end of the year, outbreaks remained ongoing in Indiana, Maryland, and Pennsylvania.

A total of 698 patients, or 64% of the 1,084 cases for which hospitalization information was available, were hospitalized due to hepatitis A in 2023.

Demographics and risk factors

The highest rate of reported hepatitis A cases was among persons aged 30–39 years (0.9 cases per 100,000 population) followed by persons aged 40–49 and 20–29 years (each with a rate of 0.7 cases per 100,000 population). Since 2019, the rate of reported cases among persons aged 20 years and older have decreased year-over-year. Rates of reported cases among children and adolescents aged 0–19 years continued to be the lowest of all age groups. During 2023, most cases were reported among males (63%). From 2022–2023, decreases in the rate of reported cases were observed among both males and females, decreasing by 30% and 23%, respectively.

The rate of reported cases was highest among Hispanic persons (0.8 cases per 100,000 population) followed by non-Hispanic Asian/Pacific Islander (A/PI) persons (0.7 cases per 100,000 population); these were the only two racial and ethnic groups that experienced increases in the rate of reported cases from 2022–2023. Compared to non-Hispanic White persons, the rate among Hispanic persons was 2.0 times as high and the rate among non-Hispanic A/PI persons was 1.8 times as high.

Among the 1,648 reported cases in 2023, 58% had some risk behavior or exposure information available, of which 29% had an identified risk. During 2023, the most commonly reported risk was international travel to a hepatitis A-endemic region (21% of 748 cases with international travel history information available identified this risk). This marks a change from 2022 when the most commonly reported risk was injection drug use.

Mortality

During 2023, data from death certificates filed in the vital records offices in 50 states and the District of Columbia identified 85 hepatitis A-related deaths (where hepatitis A was listed as a cause of death), corresponding to an age-adjusted death rate of 0.01 deaths per 100,000 population. Hepatitis A-related death rates were highest in persons aged 65 years and older and among males.

Hepatitis B

Acute

Overall

During 2023, a total of 2,214 acute hepatitis B cases were reported to CDC by 47 states and the District of Columbia, corresponding to an estimated 14,400 acute infections (95% CI: 8,200–35,200) after adjusting for case underascertainment and underreporting (see Technical Notes).⁵ The reported case count corresponds to a rate of 0.7 cases per 100,000 population. Following a decade of stable rates from 2011–2019, a decrease was observed from 2019–2020, and rates have remained relatively stable through 2023.

States with the highest rates of reported acute hepatitis B cases were primarily located in the eastern and southern United States, particularly in or near the Appalachian region. The highest rates of acute hepatitis B cases were reported in Florida (3.1 cases per 100,000 population), West Virginia (2.0 cases per 100,000 population), and Kentucky (1.9 cases per 100,000 population). A total of 779 patients, or 64% of 1,215 cases for which hospitalization information was available, were hospitalized due to acute hepatitis B during 2023.

Demographics and risk factors

The highest rate of reported acute hepatitis B cases was among persons aged 40–49 years (1.4 cases per 100,000 population), followed by persons aged 50–59 years (1.2 cases per 100,000 population). Rates of reported cases among children and adolescents aged 0–19 years continued to be the lowest of all age groups. Most acute hepatitis B cases were reported among males (62%). In 2023, the rate of reported cases was 1.7 times as high among males compared to females.

The rate of reported acute hepatitis B cases was highest among non-Hispanic Black persons (1.1 cases per 100,000 population). Non-Hispanic A/PI persons (0.4 cases per 100,000 population) had the lowest rate for 2023. All racial and ethnic groups except non-Hispanic White persons experienced increases in the rate of reported cases from 2022–2023; the rate among non-Hispanic White persons remained relatively stable (decrease of 4%). The rate of reported acute hepatitis B cases among non-Hispanic Black persons was 1.9 times as high compared to non-Hispanic White persons.

Among the 2,214 reported cases in 2023, 52% had some risk behavior or exposure information available, of which 41% had an identified risk. During 2023, the most commonly reported risks (based on proportion of cases with available data reporting the risk) included injection drug use (19% of the 963 cases with information available), having multiple sexual partners (20% of the 528 cases with information available), and male-to-male sexual contact (21% of the 256 male cases with information available).

Perinatal

A total of seven perinatal hepatitis B cases were reported to the CDC through NNDSS from six states during 2023, representing a decrease of six cases compared to 2022. Data from the CDC's Perinatal Hepatitis B Prevention Program (PHBPP) (see Table 4.1 and Figure 4.1) from 64 jurisdictions reported 7,327 infants born to persons with HBV infection during 2022, 92% of whom had received recommended prophylaxis at birth, 86% had completed 3 doses of vaccine by age 12 months, and 65% had received recommended postvaccination serological testing. Among 4,729 infants in the 2022 PHBPP cohort with postvaccination testing, 7 (0.15%) were identified as cases of perinatal hepatitis B.

Chronic

During 2023, a total of 17,650 newly reported cases of chronic hepatitis B were reported to CDC by 44 states and the District of Columbia, corresponding to a rate of 6.1 cases per 100,000 population. Approximately 89% of newly reported cases of chronic hepatitis B were among persons aged 30 years and older, and most were reported among males (57%). The rate of newly reported chronic hepatitis B cases was highest among non-Hispanic A/PI persons (18.9 cases per 100,000 population), which was 9.9 times the rate among non-Hispanic White persons (1.9 cases per 100,000 population).

Mortality

During 2023, data from death certificates filed in the vital records offices in 50 states and the District of Columbia identified 1,769 hepatitis B-related deaths (where hepatitis B was listed as a cause of death), corresponding to an age-adjusted death rate of 0.4 deaths per 100,000 population, which remained stable compared to 2022. Hepatitis B-related death rates were highest among persons aged 65–74 years (1.6 per 100,000 population) and those aged 75 and older (1.5 per 100,000 population). The rate among males was 2.8 times as high compared to females.

The hepatitis B-related death rate among non-Hispanic A/PI persons (2.2 per 100,000 population) was 8.5 times as high compared to non-Hispanic White persons (0.3 per 100,000 population). The highest hepatitis B-related death rates were reported in Hawaii (1.2 per 100,000 population), Oklahoma (0.8 per 100,000 population), and Minnesota (0.8 per 100,000 population).

Hepatitis C

Acute

Overall

During 2023, a total of 4,966 acute hepatitis C cases were reported to CDC by 47 states and the District of Columbia, corresponding to an estimated 69,000 acute infections (95% CI: 54,600–235,400) after adjusting for case underascertainment and underreporting (see Technical Notes).5 The reported case count corresponds to a rate of 1.5 cases per 100,000 population. Following a decade of increasing rates from 2011–2021, the rate remained relatively stable from 2021–2023. The highest rates of acute hepatitis C (per 100,000 population) were reported in West Virginia (6.4), Florida (6.3), and Kentucky (5.9).

A total of 745 patients, or 39% of the 1,901 cases for which hospitalization information was available, were hospitalized due to acute hepatitis C during 2023.

Demographics and risk factors

The highest rate of reported acute hepatitis C cases was among persons aged 30–39 (3.4 cases per 100,000 population). From 2022–2023, the rate of reported cases of acute hepatitis C remained relatively stable among those aged 29 years and younger and increased slightly among those aged 40 years and older. Most acute hepatitis C cases were reported among males (67%). While the rate of reported cases among females has remained stable since 2018, there was a substantial increase among males from 2018–2020; since then, the rate among males has consistently been ~2.0 times as high compared to females.

The rate of reported acute hepatitis C cases was highest among non-Hispanic American Indian/Alaska Native (AI/AN) persons (3.5 cases per 100,000 population). All racial and ethnic groups, except non-Hispanic White persons, experienced increases in the rate of reported cases from 2022–2023. The rate of reported acute hepatitis C cases among non-Hispanic AI/AN persons was 2.4 times as high compared to non-Hispanic White persons.

Among the 4,966 reported cases in 2023, 43% had some risk behavior or exposure information available; among those with data available, 59% had an identified risk. During 2023, the most commonly reported risk was injection drug use (43% of 1,736 cases with information available).

Perinatal

During 2023, perinatal hepatitis C virus (HCV) infection was a reportable condition in 48 states and the District of Columbia. A total of 235 perinatal hepatitis C cases were reported to CDC through NNDSS from 30 states during 2023, representing an increase of 38 cases compared to 2022.

Chronic

During 2023, a total of 101,525 newly reported cases of chronic hepatitis C were reported to CDC by 45 states and the District of Columbia, corresponding to a rate of 36.2 cases per 100,000 population. The rate of newly reported chronic hepatitis C cases was highest among persons aged 30–39 years (72.1 cases per 100,000 population), followed by persons aged 40–49 years (60.5 cases per 100,000 population). The rate of newly reported chronic hepatitis C cases was highest among non-Hispanic AI/AN persons (99.4 cases per 100,000 population), which was 3.3 times the rate among non-Hispanic White persons (30.0 cases per 100,000 population).

Mortality

During 2023, data from death certificates filed in the vital records offices in 50 states and the District of Columbia identified 11,194 hepatitis C-related deaths (where hepatitis C was listed as a cause of death), corresponding to an age-adjusted death rate of 2.5 deaths per 100,000 population. This rate represented a decrease of 13% from 2022 (2.9 per 100,000 population) and a decrease of 50% from the peak mortality rate during 2013 (5.0 deaths per 100,000 population),7 when highly effective, well-tolerated treatments became available to cure hepatitis C.

Hepatitis C-related death rates were highest among persons aged 65–74 years (13.9 per 100,000 population) followed by persons aged 55–64 years (8.8 per 100,000 population). The death rate among males was 2.5 times as high compared to females. The hepatitis C-related death rate was highest in non-Hispanic AI/AN persons (7.8 per 100,000 population), followed by non-Hispanic Black persons (4.0 per 100,000 population). Compared to non-Hispanic White persons, the rate of hepatitis C-related deaths was 3.2 times as high among non-Hispanic AI/AN persons and 1.7 times as high among non-Hispanic Black persons. From 2022–2023, decreases in the rate of hepatitis C-related deaths were observed among all racial and ethnic groups except among non-Hispanic Asian persons, whose rate was the lowest and remained unchanged. However, the magnitude of these decreases varied and disparities by race and ethnicity persisted. The highest hepatitis C-related death rates (per 100,000 population) were reported in Oklahoma (8.9), the District of Columbia (7.6), Oregon (6.8), and Alaska (6.0).