2025 Viral Hepatitis National Progress Report Overview

Background

In 2020, CDC modified the goals and associated targets from previous reports to align them with CDC's Division of Viral Hepatitis 2025 Strategic Plan and the for 2021–2025. Data used for measuring progress toward meeting 2025 goals were based on case reports from 2023.

The global COVID-19 pandemic began in March 2020 and continued to cause disruptions in access to medical care and routine public health activities during 2021 and 2022. Pandemic-related stay-at-home orders suspended or delayed many routine health care visits, patients avoided seeking medical and preventative services, and a decline in testing for hepatitis C was identified. Furthermore, 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 might have affected a health department's capacity to detect, investigate, and report all hepatitis cases in their jurisdiction. The COVID-19 pandemic also had a profound impact on death with the overall age-adjusted death rates increasing during 2020 and 2021 compared to 2019. Provisional mortality data in 2022 suggests that while the impact of COVID-19 on overall mortality decreased, COVID-19 remained a leading cause of death. For these reasons, the numbers and rates of viral hepatitis cases and viral hepatitis-related deaths for 2020–2022 presented in this report should be interpreted with caution.1

Key findings

Following several years of increasing hepatitis A virus (HAV) infections, the number of estimated HAV infections declined for the fourth consecutive year in 2023, surpassing the annual target for the first time. 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 or inject drugs (PWID) and persons experiencing homelessness.2 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. These outbreaks demonstrate the importance of surveillance to identify cases and vaccination to prevent and respond to hepatitis A. Continued efforts to vaccinate people at increased risk for hepatitis A, including PWID and people experiencing homelessness, and people traveling internationally to hepatitis A-endemic regions, are crucial to prevent future outbreaks and meet national elimination goals.

The number of estimated new hepatitis B virus (HBV) infections was relatively stable at around 20,000 infections annually during 2015–2019 but decreased substantially in 2020; since 2020, estimated new infections have remained relatively stable at around 14,000 infections annually and surpassed the annual target for 2023. Changes in health care-seeking behavior and testing during the COVID-19 pandemic could potentially explain the large decrease beginning in 2020; however, the persistence of these lower numbers through 2023 suggests some reduction in HBV transmission that might be unrelated to the COVID-19 pandemic. Despite surpassing the target for reducing new infections, the annual targets for reducing hepatitis B-related deaths overall and among non-Hispanic Asian/Pacific Islander persons were not met in 2023. Continued efforts are needed to implement CDC's expanded hepatitis B vaccination recommendations and hepatitis B screening and testing recommendations among adults, improve appropriate testing and linkage to care, and reduce hepatitis B-related health disparities.

The number of estimated new hepatitis C virus (HCV) infections declined for the first time in 2022 after over a decade of consecutive annual increases. However, the number of estimated new HCV infections remained relatively stable from 2022–2023 and did not meet the annual target. During 2023, the rate of new cases among persons aged 18–40 years, a proxy for PWID, declined for the third year in a row but remained well above the annual target. Death rates among non-Hispanic American Indian/Alaska Native persons remained higher than the overall national rate, with modest progress toward the annual target. Though the annual target was met, death rates among non-Hispanic Black persons remained higher than the national rate. Efforts to connect PWID to harm reduction services, including syringe services programs and substance use disorder treatment, are crucial to prevent ongoing transmission. In addition, continued efforts are needed to improve testing and ensure equitable treatment for all people with hepatitis C.