Executive Summary

Since the 2005 edition of the Guidelines for Viral Hepatitis Surveillance and Case Management, the epidemiology of viral hepatitis in the United States has changed substantially. Decreases in hepatitis A incidence that occurred following release of the hepatitis A vaccine in the late 1990s ended in 2016, when large person-to-person outbreaks of hepatitis A began being reported primarily among people who use drugs (PWUD) and people experiencing homelessness. Decreases in acute hepatitis B incidence that occurred after release of the hepatitis B vaccine in the 1980s ceased in 2010. Also in 2010, decreases in acute hepatitis C incidence that were first observed in the 1990s began to reverse. Rates of acute hepatitis C have most notably increased among people 20–49 years of age, American Indian/Alaska Native people, and non-Hispanic White people. The shift in acute hepatitis B and hepatitis C incidence is most evident in jurisdictions disproportionately affected by the opioid crisis.

Chronic hepatitis B prevalence has remained relatively stable at an estimated 0.2% during January 2017–March 2020, representing approximately 660,000 people (1). Prevalence was disproportionately highest among people of Asian/Pacific Islander descent and people born outside of the United States (1). Chronic hepatitis C prevalence among adults was estimated to be 0.9% during January 2017–March 2020, representing approximately 2.2 million people (2). Recent declines in hepatitis C-related mortality have been observed and are encouraging (3); these declines are likely attributable to the availability of highly effective curative therapy with direct-acting antiviral agents coupled with updated testing recommendations.

Viral hepatitis testing recommendations have expanded since 2005, and major advances in information systems and laboratory testing have allowed jurisdictions to conduct more comprehensive viral hepatitis surveillance. In addition, availability of a hepatitis B vaccine and curative hepatitis C therapies have enabled national, state, and local public health agencies to design and implement strategies to eliminate these infections. Monitoring elimination efforts will require development of person-level databases to

• track incidence, prevalence, and mortality through maintenance of surveillance data and matching with secondary data sources;
• detect test conversions that indicate acute infection, resolution, reactivation (for hepatitis B), and re-infections (for hepatitis C); and
• identify people who have been treated or need linkage to health care services.

This document contains the following:

• revised Centers for Disease Control and Prevention (CDC)/Council of State and Territorial Epidemiologists (CSTE) case definitions for hepatitis A, acute hepatitis B, chronic hepatitis B, perinatal hepatitis B, acute hepatitis C, and chronic hepatitis C;
• new CDC/CSTE case definition for perinatal hepatitis C and guidance for hepatitis C during pregnancy and perinatal hepatitis C surveillance and case management;
• data notification mechanisms to CDC including using Health Level Seven (HL7) case notification; and
• updated guidance on reporting, ascertainment, investigation, and classification.