REPORT NUMBER 61 

Issued September 2006

 CENTERS FOR DISEASE CONTROL AND PREVENTION 

HEPATITIS

 SURVEILLANCE 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service
Suggested Citation

Centers for Disease Control and Prevention. Hepatitis Surveillance Report No. 61. Atlanta, GA: 

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2006 

The report is also available by Internet at: www.cdc.gov/hepatitis

Preface 

 Hepatitis Surveillance, No. 61 presents statistics and trends in viral hepatitis in the United 

States through 2004. This publication, which summarizes viral hepatitis case reports received from 

state health departments, is intended as a reference document for policy makers, program managers, 

health planners, researchers and others who are concerned with the public health implications of 

these diseases. Any comments and suggestions that would improve the usefulness of future 

publications are appreciated and should be sent to Chief, Surveillance Team, Division of Viral 

Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G37, Atlanta, 

GA 30333. 

Acknowledgments 

 

Publication of this report would not have been possible without the contributions of the State and 

Territorial Health Departments that provide state and local surveillance data to the Centers for 

Disease Control and Prevention. 

 This report was prepared by the following staff members of the Surveillance Team of 

the Epidemiology Branch of the Division of Viral Hepatitis, National Center for Infectious 

Diseases: Annemarie Wasley, Jeremy Miller, and Lyn Finelli
HEPATITIS SURVEILLANCE -- NUMBER 61 3 

Contents 

List of Figures ................................................................................................................................... 

List of Tables..................................................................................................................................... 

Acute Hepatitis A, 2004................................................................................................................16 

Acute Hepatitis B, 2004 ................................................................................................................30 

Acute Hepatitis C, 2004 ................................................................................................................43 
HEPATITIS SURVEILLANCE -- NUMBER 61 4 

List of Figures

Figure 1: Geographic Divisions of the United States.........................................................................10 

Figure 2: Incidence of reported viral hepatitis, United States, 1966-2004 .......................................11 

Figure 3: Incidence of Hepatitis A, 1982-2004................................................................................20 

Figure 4: Incidence of Hepatitis A, by Region, United States, 1990-2004.......................................21 

Figure 5: Incidence of Hepatitis A, by County, 2004 ......................................................................22 

Figure 6: Incidence of Hepatitis A, by Age, 1990-2004 ..................................................................23 

Figure 7: Incidence of Hepatitis A, by Sex, 1990-2004...................................................................24 

Figure 8: Incidence of Hepatitis A, by Age and Sex, 2004..............................................................25 

Figure 9: Incidence of Hepatitis A, by Race and Ethnicity,..............................................................26 

Figure 10:Trends in Selected Epidemiologic Characteristics among Patients with Hepatitis A, by 

Year ..........................................................................................................................................28 

Figure 11: Incidence of Acute Hepatitis B, 1982-2004 ...................................................................33 

Figure 12: Incidence of Acute Hepatitis B, by Region, ....................................................................34 

Figure 13: Incidence of Acute Hepatitis B, by County, 2004 ..........................................................35 

Figure 14: Incidence of Acute Hepatitis B, by Age, 1990-2004......................................................36 

Figure 15: Incidence of Acute Hepatitis B, by Sex, 1990-2004 ......................................................37 

Figure 16: Incidence of Acute Hepatitis B, by Age and Sex, ...........................................................38 

Figure 17: Incidence of Acute Hepatitis B, by Race and Ethnicity, .................................................39 

Figure 18: Trends in Selected Epidemiologic Characteristics among Patients with Acute Hepatitis 

B, by Year ..................................................................................................................................41 

Figure 19: Incidence of Acute Hepatitis C/NANB, 1992-2004 .......................................................45 

Figure 20: Incidence of Acute Hepatitis C/NANB, by Age,.............................................................46 

Figure 21: Incidence of Acute Hepatitis C/NANB, by Sex, .............................................................47 

Figure 22: Incidence of Acute Hepatitis C, by Age and Sex, 2004 .................................................48 

Figure 23: Incidence of Acute Hepatitis C/NANB, by Race and Ethnicity,.....................................49 

Figure 24: Trends in Selected Epidemiologic Characteristics among Patients with Acute Hepatitis 

C/NANB, by Year......................................................................................................................51 
HEPATITIS SURVEILLANCE -- NUMBER 61 5 

List of Tables

Table 1: Proportion of Cases That Included Risk Factor Data, by State, 2004 ..................................9 

Table 2: Reported cases of acute viral hepatitis, by type and year, United States, 1966-2004.........12 

Table 3: Incidence per 100,000 of acute hepatitis A, by state and year, United States ....................13 

Table 4: Incidence per 100,000 of acute hepatitis B, by state and year, United States.....................14 

Table 5: Incidence per 100,000 of acute hepatitis C, by state and year, United States.....................15 

Table 6: Epidemiologic Characteristics of Patients with Hepatitis A,..............................................27 

Table 7: Clinical Characteristics of Patients with Hepatitis A, By Age, ..........................................29 

Table 8: Epidemiologic Characteristics of Patients with Acute Hepatitis B, by Age, 2004............40 

Table 9: Clinical Characteristics of Patients with Acute Hepatitis B, by Age, United States, 2004 42

Table 10: Epidemiologic Characteristics of Patients with Acute Hepatitis C,...................................50 

Table 11: Clinical Characteristics of Patients with Acute Hepatitis C by Age, United States, 2004 52
HEPATITIS SURVEILLANCE -- NUMBER 61 6 

Methods 

Conditions under surveillance

 National surveillance is conducted for acute hepatitis A, acute hepatitis B, and acute 

hepatitis C. Case definitions for these conditions are below. Nationwide reporting of perinatal 

HBV infection was implemented in 2001. In addition, chronic hepatitis B virus (HBV) infection 

and hepatitis C virus (HCV) infection, past or present were added to the list of nationally notifiable 

conditions in January 2003. This publication summarizes information received about cases of acute 

disease. Future issues will summarize the information about reported cases of perinatal and chronic 

infection with hepatitis viruses. 

Sources of data

 Cases of acute hepatitis are reported to CDC by state and territorial health departments on a 

weekly basis via the National Notifiable Diseases Surveillance System (NNDSS). As of January 1, 

2002, all reports are received electronically by CDC via NETSS (National Electronic 

Telecommunications System for Surveillance). 

 Participation by states in the reporting of viral hepatitis cases to CDC is voluntary as it is for 

all nationally notifiable diseases. Currently, all states collect and report basic information (event 

date, source of report, demographic characteristics) about cases of acute viral hepatitis that are 

identified in their states. States are also asked to report additional information (laboratory test 

results, clinical information and exposure history) about investigated cases. Completeness of 

reporting of these additional data varies among and within states. Currently, approximately 40% of 

case reports received by CDC include any of these additional data. See Table 1 for information on 

state-specific reporting profiles. 

Analyses

Incidence rate calculations 

 Crude incidence rates of new cases were calculated on an annual basis per 100,000 

population using Bureau of the Census estimates of the U.S. resident population. 
HEPATITIS SURVEILLANCE -- NUMBER 61 7 

Frequency analysis 

The percentage of cases reporting a specific risk factor is determined using the number of 

cases reporting any information, positive or negative, about that exposure as the denominator. 

Depending on the type of hepatitis, the percentage of cases with any risk factor information ranges 

from 30-40%. Multiple risk factors can be reported by a single case. Consequently, the percentages 

of cases with specific risk factors may sum to >100%. 

Data Limitations

There is considerable variability by state in terms of both the sensitivity of reporting (i.e. frequency 

of underreporting) and the completeness of individual case reports. Information to assess the degree 

of underreporting is not available. Only 40% of cases are reported with extended case investigation 

data (e.g., clinical characteristics, exposure history) and this percentage varies by state from 0 to 

100% (see Table 1). Analyses of trends in the characteristics of cases are based on records for 

which this information is complete; it is not known if or how cases that are reported with complete 

data differ from those for which data are missing or from those that are not reported. 

Case definitions 

Reported cases must meet the clinical criteria and be serologically confirmed. 

Clinical case definition

An acute illness with a) discrete onset of symptoms and b) jaundice or elevated serum 

aminotransferase levels 

Laboratory criteria for diagnosis: 

• Acute hepatitis A: 

o Immunoglobulin M (IgM) antibody to hepatitis A virus (anti-HAV) positive 

• Acute hepatitis B: 

o IgM antibody to hepatitis B core antigen (anti-HBc) positive or hepatitis B 

surface antigen (HBsAg) positive 
HEPATITIS SURVEILLANCE -- NUMBER 61 8 

o IgM anti-HAV negative (if done)

• Acute hepatitis C: 

o Serum alanine aminotransferase levels greater than 7 times the upper limit of 

normal, and 

o IgM anti-HAV negative, and 

o IgM anti-HBc negative or if not done, HBsAg negative, and 

o One of the following:

 Antibody to hepatitis C virus (anti-HCV) screening-test-positive, 

verified by an additional more specific assay (e.g. RIBA for anti-HCV 

or nucleic acid testing for HCV RNA) OR 

 Anti-HCV screening-test-positive with a signal to cut-off ratio 

predictive of a true positive as determined for the particular assay 

(e.g., >3.8 for the enzyme immunoassays). 

Case classification 

 Confirmed: a case that meets the clinical case definition and is laboratory confirmed or, for 

hepatitis A, a case that meets the clinical case definition and occurs in a person who has an 

epidemiologic link with a person who has laboratory-confirmed hepatitis A (i.e., household or 

sexual contact with an infected person during the 15-50 days before the onset of symptoms) 
HEPATITIS SURVEILLANCE -- NUMBER 61 9 

Table 1: Proportion of Cases That Included Risk Factor Data, by State, 2004 

81%-100% 61% - 80% 41-60% 11-40% 0-10% 

Alabama 

Colorado 

District of 

Columbia 

Florida 

Hawaii 

Iowa 

Kansas 

Maine 

Maryland 

Minnesota 

Nevada 

New Mexico 

North Carolina 

North Dakota 

Ohio 

Oklahoma 

Rhode Island 

South Dakota 

Washington 

West Virginia 

Arkansas 

Connecticut 

Indiana 

Kentucky 

Massachusetts 

Pennsylvania 

Tennessee 

Vermont

Wisconsin 

Michigan 

Missouri 

Nebraska 

New York 

Utah 

Wyoming 

Arizona 

Illinois 

Louisiana 

Montana 

South Carolina 

Texas 

Virginia 

Alaska 

California 

Delaware 

Georgia 

Idaho 

Mississippi 

New Hampshire 

New Jersey 

New York City 

Oregon 

Note: blue font indicates states where completeness of reporting has increased by at least one 

category in the last year; red font indicates states where completeness of reporting decreased by at 

least one category. 
HEPATITIS SURVEILLANCE -- NUMBER 61 10 

Figure 1: Geographic Divisions of the United States

West Midwest South Northeast

Alaska 

Arizona 

California 

Colorado 

Hawaii 

Idaho 

Montana 

Nevada 

New Mexico 

Oregon 

Utah 

Washington 

Wyoming 

Illinois 

Indiana 

Iowa 

Kansas 

Michigan 

Minnesota 

Missouri 

Nebraska 

North Dakota 

Ohio 

South Dakota 

Wisconsin 

Alabama 

Arkansas 

Delaware 

District of Columbia 

Florida 

Georgia 

Kentucky 

Louisiana 

Maryland 

Mississippi 

North Carolina 

Oklahoma 

South Carolina 

Tennessee 

Texas 

Virginia 

West Virginia 

Connecticut 

Maine 

Massachusetts 

New Hampshire 

New Jersey 

New York 

Pennsylvania 

Rhode Island 

Vermont 
HEPATITIS SURVEILLANCE -- NUMBER 61 11 

Figure 2: Incidence of viral hepatitis, United States, 1966-2004 

0

5

10

15

20

25

30

35

19661968197019721974197619781980198219841986198819901992199419961998200020022004

Year

Rep

orted cases

per 100,000 p

o

pulation

Hepatitis A

Hepatitis B

Hepatitis C/NANB
HEPATITIS SURVEILLANCE -- NUMBER 61 12 

Table 2: Reported cases of acute viral hepatitis, by type and year, United States, 1966-2004 

Hepatitis A Hepatitis B Hepatitis C/NANB 

Year No. Rate* No. Rate No. Rate

1966 32,859 16.8 1,497 0.8 --- ---

1967 38,909 19.7 2,458 1.3 --- ---

1968 45,893 23.0 4,829 2.5 --- ---

1969 48,416 24.0 5,909 3.0 --- ---

1970 56,797 27.9 8,310 4.1 --- ---

1971 59,606 28.9 9,556 4.7 --- ---

1972 54,074 26.0 9,402 4.5 --- ---

1973 50,749 24.2 8,451 4.0 --- ---

1974 40,358 19.5 10,631 5.2 --- ---

1975 35,855 16.8 13,121 6.3 --- ---

1976 33,288 15.5 14,973 7.1 --- ---

1977 31,153 14.4 16,831 7.8 --- ---

1978 29,500 13.5 15,016 6.9 --- ---

1979 30,407 13.8 15,452 7.0 --- ---

1980 29,087 12.8 19,015 8.4 --- ---

1981 25,802 11.3 21,152 9.2 --- ---

1982 23,403 10.1 22,177 9.6 2,629† 1.1†

1983 21,532 9.2 24,318 10.4

** 

3,470† 1.5†

1984 22,040 9.3 26,115 11.1 3,871† 1.6†

1985§ 23,257 10.0 26,654 11.5 4,192† 1.8†

1986§ 23,430 10.0 26,107 11.2 3,634† 1.6†

1987 25,280 10.4 25,916 10.7 2,999† 1.2†

1988 28,507 11.6 23,177 9.4 2,619† 1.1†

1989 35,821 14.4 23,419 9.4 2,529† 1.0†

1990 31,441 12.6 21,102 8.5 2,553† 1.0†

1991 24,378 9.7 18,003 7.1 3,582† 1.4†

1992 23,112 9.1 16,126 6.3 6,010 2.4

1993 24,238 9.4 13,361 5.2 4,786 1.9 

1994 26,796 10.3 12,517 4.8 4,470 1.8 

1995 31,582 12.0 10,805 4.1 4,576 1.7 

1996 31,032 11.7 10,637 4.0 3,716 1.4 

1997 30,021 11.2 10,416 3.9 3,816 1.4 

1998 23,229 8.6 10,258 3.8 3,518 1.3 

1999 17,047 6.3 7,694 2.8 3,111 1.1 

2000 13,397 4.8 8,036 2.9 3,197 1.1 

2001 10,615 3.7 7,844 2.8 1,640** 0.7**

2002 8,795 3.1 8,064 2.8 1,223 †† 0.5 ††

2003 7,653 2.6 7,526 2.6 891†† 0.3 ††

2004 5,683 1.9 6,212 2.1 758 0.3 

Source: National Notifiable Diseases Surveillance System * Rate per 100,000 population. †Numbers and rates shown for 

hepatitis C/ Non-A, non-B hepatitis are unreliable. § Excludes cases from New York City; data not available for 1985 or 1986. 

**Excludes cases from New Jersey and Missouri. ††Excludes cases from Missouri 
HEPATITIS SURVEILLANCE -- NUMBER 61 13 

Table 3: Incidence per 100,000 of acute hepatitis A, by state and year, United States 

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Alabama 2.4 1.1 1.3 1.4 3.3 2.2 5.1 2.0 1.9 1.4 1.3 1.8 0.9 0.5 0.2

Alaska 34.4 16.9 22.1 129.8 34.8 8.3 8.9 5.6 2.8 2.4 2.1 2.5 1.9 1.5 0.6

Arizona 53.8 29.7 31.7 37.4 52.1 31.6 39.9 51.2 39.5 14.6 9.0 7.7 5.6 5.0 4.6

Arkansas 25.7 10.9 6.5 3.1 10.3 26.7 20.0 8.8 3.2 3.2 5.4 2.7 2.7 1.4 2.2

California 21.4 16.5 16.0 18.2 21.1 21.4 20.9 19.9 12.8 10.4 8.8 5.4 4.1 3.2 2.5

Colorado 10.7 20.2 25.5 24.6 16.0 13.6 13.4 10.3 8.7 5.4 5.2 2.0 1.6 1.4 1.1

Connecticut 4.2 3.8 2.5 3.6 3.0 2.6 4.3 4.6 3.0 3.9 5.2 7.0 2.7 2.6 2.1

Delaware 14.3 1.9 8.1 1.7 3.1 1.7 2.9 4.2 0.8 0.3 1.9 2.0 1.9 1.1 0.7

District of 6.5 13.0 2.9 1.9 4.8 4.7 7.2 6.8 12.7 11.4 7.0 14.0 14.3 7.7 1.3

Florida 5.2 6.4 4.3 5.1 5.6 4.7 5.1 5.5 4.1 5.7 4.1 5.2 6.3 2.3 1.5

Georgia 5.8 3.7 3.4 2.1 0.6 1.2 5.6 10.2 11.5 6.2 4.6 11.1 6.0 9.1 3.6

Hawaii 9.5 7.9 14.9 5.9 4.9 14.1 10.1 12.4 4.5 2.0 1.1 1.4 2.0 1.0 2.1

Idaho 9.5 9.5 12.8 27.1 33.5 30.3 20.8 12.4 19.1 3.8 3.5 4.3 2.3 1.3 1.4

Illinois 15.1 12.2 6.7 8.7 5.2 5.6 6.4 7.2 6.8 7.0 5.6 3.5 2.1 1.5 1.2

Indiana 4.6 8.9 14.1 11.3 6.3 3.3 6.3 5.6 2.9 1.8 2.2 1.7 0.8 1.2 1.0

Iowa 10.1 1.7 1.9 2.1 2.3 3.8 11.7 17.2 14.0 5.6 2.3 1.2 2.2 1.4 1.7

Kansas 10.9 3.6 5.6 3.1 4.3 6.3 15.1 10.0 4.1 2.5 4.1 6.7 2.6 1.0 0.8

Kentucky 2.5 1.9 3.7 3.7 5.8 1.1 1.4 2.0 0.8 1.7 1.6 3.6 1.1 0.9 0.7

Louisiana 5.3 3.5 5.5 2.5 3.9 4.5 6.0 6.1 4.0 4.9 2.4 1.9 2.0 1.1 1.1

Maine 0.9 1.7 2.3 1.1 2.0 2.4 2.3 5.3 1.6 2.2 1.7 0.9 0.6 1.6 1.3

Maryland 19.8 5.6 5.2 3.2 4.0 4.4 5.1 3.7 8.1 5.9 4.0 5.5 5.5 3.2 1.9

Massachusetts 6.6 4.8 4.9 3.5 1.9 2.7 3.8 4.2 2.1 2.3 2.2 5.9 2.2 3.4 10.3

Michigan 4.1 3.1 1.6 2.2 3.7 3.8 5.2 14.0 21.7 12.7 4.9 3.3 2.2 2.0 1.4

Minnesota 7.4 10.9 19.8 11.0 5.7 4.3 3.8 5.2 3.1 2.7 3.7 0.9 1.1 1.0 1.1

Mississippi 1.8 1.3 1.6 2.3 2.9 8.3 8.3 3.5 2.5 4.6 5.0 1.3 2.2 0.6 0.8

Missouri 12.1 12.7 28.9 27.5 11.7 25.1 26.3 21.3 11.7 13.0 4.6 1.6 1.5 1.0 0.6

Montana 19.9 10.2 10.6 9.2 2.9 19.9 14.8 8.1 10.9 2.0 0.8 1.8 1.4 0.9 0.8

Nebraska 6.6 15.5 16.6 12.1 7.5 4.0 9.5 6.8 1.6 3.2 2.2 2.2 1.1 0.8 0.7

Nevada 26.3 24.2 8.3 12.6 17.4 21.9 28.1 26.1 13.0 8.1 4.5 3.3 2.5 2.3 0.7

New Hampshire 0.8 2.7 2.9 1.6 1.5 1.1 1.9 3.0 1.6 1.5 1.5 1.4 0.9 1.5 2.1

New Jersey 5.6 4.2 4.0 3.7 3.9 3.9 4.9 3.9 4.2 1.9 3.4 3.3 2.2 2.4 2.2

New Mexico 71.1 44.7 21.7 24.8 66.5 48.0 20.8 20.4 8.9 3.2 3.8 2.2 1.7 1.3 1.3

New York 11.5 10.6 6.8 6.5 8.2 8.4 5.8 7.2 5.3 3.8 4.2 4.1 3.3 3.1 2.4

North Carolina 9.7 2.4 1.6 1.4 2.1 1.5 2.8 2.8 1.7 2.2 1.9 3.0 2.5 1.5 1.2

North Dakota 5.2 10.4 22.5 12.6 0.9 3.6 21.8 2.2 0.6 0.5 0.6 0.5 0.6 0.3 0.3

Ohio 2.7 3.3 4.1 3.1 10.8 15.8 7.0 3.0 3.5 5.8 2.3 2.3 2.6 1.5 0.4

Oklahoma 19.3 9.0 6.8 6.6 12.9 43.7 78.6 43.6 20.0 15.9 7.9 3.3 1.5 0.8 0.6

Oregon 29.0 15.3 18.5 17.5 40.2 86.7 27.4 11.6 13.3 7.6 5.0 3.0 1.8 1.7 1.5

Pennsylvania 15.0 3.6 2.1 1.5 1.8 2.1 4.5 4.2 3.5 3.0 3.6 2.5 2.4 8.2 1.2

Rhode Island 5.2 11.4 17.0 7.7 3.0 3.5 2.6 13.3 1.8 3.5 3.0 7.1 3.2 1.6 2.2

South Carolina 1.3 1.2 0.6 0.5 1.1 1.2 1.5 2.9 1.4 1.2 2.4 2.1 1.6 1.3 0.9

South Dakota 70.8 119.3 30.3 2.5 5.4 13.6 5.9 3.7 5.5 1.4 0.4 0.4 0.4 . 0.5

Tennessee 4.4 3.2 2.3 2.0 6.7 37.2 14.6 7.8 4.3 2.7 2.7 3.3 2.1 3.5 1.6

Texas 16.0 15.4 10.4 15.5 15.7 16.1 18.2 23.3 17.9 12.6 9.2 2.6 3.9 2.8 2.8

Utah 35.3 16.2 38.2 44.1 39.1 35.2 53.1 26.6 9.3 3.0 3.2 2.9 2.4 1.7 1.5

Vermont 1.1 4.2 2.5 1.6 2.4 1.4 2.0 2.5 2.9 4.0 1.6 2.6 0.6 1.0 1.3

Virginia 4.9 3.0 2.6 2.4 3.0 3.6 3.3 3.7 3.3 2.7 2.3 2.3 2.2 1.9 1.9

Washington 28.1 12.1 16.8 17.6 21.0 17.3 18.2 18.1 18.2 8.8 5.0 3.1 2.7 1.2 1.1

West Virginia 1.3 1.2 0.6 1.6 1.3 1.3 1.0 0.7 0.5 2.6 3.1 1.6 1.3 2.1 0.3

Wisconsin 9.8 15.8 18.7 10.0 4.8 3.6 3.8 3.6 3.6 1.5 2.0 1.6 3.6 0.8 2.2

Wyoming 16.1 29.5 3.0 3.6 8.6 23.0 8.5 7.3 7.7 1.9 0.8 1.4 0.6 0.4 1.0
HEPATITIS SURVEILLANCE -- NUMBER 61 14 

Table 4: Incidence per 100,000 of acute hepatitis B, by state and year, United States 

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Alabama 4.1 4.2 3.3 2.6 2.1 2.7 1.8 1.9 1.7 2.0 1.6 2.0 2.3 2.1 1.8

Alaska 10.5 7.2 3.6 2.5 2.2 2.2 2.6 2.5 2.1 2.9 2.1 1.6 1.9 1.2 1.7

Arizona 13.2 4.7 5.1 2.4 2.5 2.8 5.3 4.4 4.0 2.9 4.2 3.1 4.6 5.1 5.0

Arkansas 5.2 6.5 4.5 3.7 2.4 3.3 3.7 4.2 4.5 3.8 4.1 4.0 4.4 3.3 4.3

California 9.8 8.6 9.2 6.0 6.5 5.5 5.4 5.1 4.4 3.7 3.2 2.5 1.8 1.9 1.4

Colorado 5.9 4.2 3.5 2.3 2.7 3.7 3.5 3.8 2.6 2.4 2.5 2.3 1.8 1.8 1.2

Connecticut 7.8 5.9 4.9 2.3 2.9 2.6 2.5 1.7 1.2 1.2 1.4 1.4 2.0 2.8 3.1

Delaware 14.6 7.9 30.3 2.6 2.0 1.3 1.2 1.0 0.5 0.1 1.9 3.6 1.7 1.7 6.4

District of 21.4 26.5 14.6 7.5 9.4 3.8 5.9 5.7 3.6 4.8 6.1 2.3 3.9 2.3 3.4

Florida 7.4 7.2 6.9 6.2 5.4 4.7 4.6 4.4 3.5 3.9 3.8 3.1 3.3 3.7 2.9

Georgia 8.3 8.9 4.7 9.7 7.9 1.4 0.8 3.0 2.7 3.0 4.3 5.2 5.7 7.7 1.2

Hawaii 9.5 4.4 1.6 1.9 2.4 2.7 1.2 0.9 1.5 1.3 1.0 1.8 1.0 2.2 0.9

Idaho 9.1 7.0 7.9 8.1 6.8 8.8 7.4 4.5 4.0 2.3 0.8 0.8 0.5 0.6 1.0

Illinois 5.2 3.6 3.4 2.9 2.7 2.5 2.8 2.4 1.9 1.7 1.4 1.7 1.5 1.0 0.9

Indiana 6.6 4.2 4.0 4.4 3.7 4.2 2.5 1.7 2.0 1.3 1.4 1.2 1.4 1.1 1.3

Iowa 1.9 1.5 1.2 1.3 1.0 1.6 2.6 1.5 1.9 1.5 1.3 0.8 0.7 0.6 0.6

Kansas 5.6 2.4 2.6 2.6 1.2 2.0 1.2 1.2 1.1 0.6 1.0 0.5 0.9 0.7 0.7

Kentucky 12.6 5.2 2.9 2.6 2.0 1.8 2.0 1.1 1.2 1.3 2.0 1.6 1.6 2.3 2.1

Louisiana 8.9 9.1 6.1 6.3 4.7 5.6 4.8 4.8 5.0 3.9 3.5 2.8 3.0 2.6 1.5

Maine 2.4 2.6 2.2 0.9 0.9 1.0 0.6 0.5 0.4 0.2 0.4 0.5 1.1 0.5 0.9

Maryland 11.8 8.0 8.2 5.4 7.1 5.2 3.3 3.4 2.8 2.9 2.5 2.6 2.4 2.4 2.8

Massachusetts 10.7 9.1 6.4 3.6 3.3 1.9 1.8 1.3 1.3 0.7 0.2 0.6 2.6 3.3 3.1

Michigan 6.9 6.5 6.2 4.1 4.5 4.1 4.3 4.7 4.8 5.2 4.3 6.2 3.3 2.2 2.4

Minnesota 2.8 2.3 2.1 2.1 1.8 2.0 2.0 1.3 1.5 1.7 1.2 0.9 1.0 1.1 1.3

Mississippi 4.8 2.9 13.1 14.8 . . 9.0 6.6 3.4 4.7 3.9 3.3 3.2 3.9 3.5

Missouri 12.3 10.6 10.3 11.2 10.2 8.2 6.1 6.7 4.6 4.2 2.7 2.3 2.1 4.3 2.5

Montana 9.4 8.7 4.9 3.3 2.5 2.8 2.4 1.4 0.9 2.4 0.9 0.3 1.1 1.7 1.5

Nebraska 2.1 2.5 2.8 1.2 1.9 2.4 2.4 1.6 1.4 1.3 2.6 2.0 1.8 1.8 2.5

Nevada 24.3 15.0 8.0 5.4 4.1 4.3 6.0 4.8 4.6 3.3 2.7 2.5 3.3 3.9 3.3

New Hampshire 3.7 3.0 4.5 2.4 2.5 2.0 1.8 1.5 1.8 1.4 1.5 1.3 2.0 1.9 3.3

New Jersey 7.0 6.3 6.5 5.2 5.2 4.6 3.5 3.1 2.5 1.7 2.1 3.4 4.0 2.1 2.5

New Mexico 15.5 13.3 13.2 13.3 13.2 19.1 24.4 14.9 17.9 12.4 7.9 7.4 7.9 1.9 1.1

New York 7.6 5.3 5.3 4.5 5.2 5.2 4.7 4.5 3.8 2.7 3.7 4.3 4.6 1.6 1.3

North Carolina 16.4 8.3 6.3 4.5 4.1 4.3 4.6 3.6 3.2 2.9 3.2 2.7 2.8 1.9 2.1

North Dakota 1.3 0.3 0.6 0.2 0.2 0.8 0.3 1.1 0.6 0.3 0.5 0.3 1.3 0.3 0.6

Ohio 3.6 3.7 2.1 1.7 1.5 1.0 1.1 0.8 0.7 0.8 0.9 0.8 1.0 1.4 1.0

Oklahoma 5.8 6.5 5.9 6.0 4.3 5.3 1.7 2.0 5.2 5.5 5.2 3.3 3.2 2.2 2.3

Oregon 14.7 10.6 10.3 7.3 5.1 4.1 4.0 3.7 6.1 3.5 3.6 4.8 3.6 3.4 3.1

Pennsylvania 6.2 4.2 4.1 3.0 3.4 2.4 2.4 2.9 3.0 2.4 2.2 2.7 2.8 2.4 2.4

Rhode Island 5.3 2.8 2.0 1.9 0.8 1.0 1.9 2.2 7.6 4.3 4.4 3.1 3.4 2.0 0.6

South Carolina 17.8 18.7 1.5 1.4 0.9 1.5 2.7 2.6 1.7 1.6 0.6 1.8 3.3 4.8 3.5

South Dakota 1.1 1.3 0.7 . 0.6 0.3 0.7 0.1 0.5 0.1 0.3 0.1 0.4 0.5 0.1

Tennessee 17.7 19.1 21.0 22.7 20.2 12.3 9.7 8.4 5.4 3.8 4.2 4.8 2.5 3.9 3.7

Texas 10.5 11.3 8.7 7.5 7.8 6.5 6.6 6.4 9.9 4.3 5.1 3.3 5.1 4.4 3.1

Utah 6.4 2.5 1.6 3.7 5.0 3.8 6.4 4.5 3.1 1.8 1.6 1.1 2.3 2.2 2.1

Vermont 9.0 3.4 3.0 1.7 2.1 1.2 2.4 1.9 1.7 0.8 1.0 0.8 1.1 0.6 1.0

Virginia 4.5 3.5 3.0 2.4 2.2 1.8 2.4 2.0 1.6 1.5 2.4 3.0 3.1 3.1 4.1

Washington 12.6 9.4 7.7 4.7 4.8 4.2 2.9 2.1 2.4 1.9 2.2 2.9 1.4 1.5 1.0

West Virginia 4.9 3.6 3.0 2.4 2.6 2.9 2.0 0.9 0.8 1.6 1.7 1.9 1.4 2.4 2.9

Wisconsin 9.1 9.7 9.6 6.3 1.9 1.6 1.7 10.9 9.8 0.6 0.8 0.9 0.9 0.9 0.7

Wyoming 5.1 7.2 4.7 7.2 5.1 6.9 9.4 5.2 2.3 2.9 0.6 0.6 3.4 6.2 1.8
HEPATITIS SURVEILLANCE -- NUMBER 61 15 

Table 5: Incidence per 100,000 of acute hepatitis C, by state and year, United States

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 

Alabama 0.6 0.6 0.4 0.1 0.5 0.1 0.2 0.3 0.1 0.0 0.2 0.1 0.2 0.1 0.1

Alaska 1.6 2.3 1.2 2.0 . 0.5 0.5 . . . . . . . .

Arizona 2.0 0.5 0.9 0.3 0.7 1.4 1.7 0.6 0.4 1.0 0.4 0.2 0.1 0.1 0.0

Arkansas 0.8 0.2 0.2 0.2 0.3 0.3 0.3 0.6 1.2 1.2 0.4 0.6 0.4 0.1 0.1

California 2.1 1.3 3.4 1.8 1.8 1.6 1.5 2.7 2.6 0.6 0.3 0.3 0.2 0.1 0.1

Colorado 1.6 2.7 2.9 1.7 2.2 1.8 1.7 1.0 0.8 0.9 0.4 0.2 0.1 0.3 0.3

Connecticut 0.3 0.1 . . . . . . . . . . . . 0.1

Delaware 1.3 0.7 29.6 0.1 0.3 . 0.1 . . . 0.3 1.4 . . 5.4

District of 1.3 40.8 47.6 0.5 0.4 . . . . 0.2 0.5 . . . 0.7

Florida 0.6 0.7 1.4 0.3 0.7 0.9 0.9 1.0 0.7 0.5 0.3 0.4 0.5 0.4 0.2

Georgia 0.2 1.5 2.0 6.5 3.1 0.4 . . 0.1 0.1 0.0 . 0.7 0.1 0.2

Hawaii 1.7 1.6 14.8 0.3 0.4 10.5 18.3 15.3 4.5 . 0.2 . 0.1 0.3 0.2

Idaho 0.8 0.6 . . 6.3 5.0 8.3 7.1 7.1 0.6 0.2 0.2 0.1 0.1 0.1

Illinois 0.7 0.9 1.0 0.9 0.7 0.7 0.8 0.7 0.3 0.4 0.2 0.1 0.2 0.2 0.1

Indiana 0.6 5.7 0.5 0.3 0.2 0.2 0.1 0.2 0.1 0.1 . 0.0 0.0 0.2 0.2

Iowa 0.5 0.4 0.2 0.3 0.5 0.5 1.9 1.0 0.3 . 0.1 . 0.0 0.0 .

Kansas 1.6 0.8 0.6 0.7 0.7 0.7 0.6 0.5 0.2 . 0.3 0.3 . . .

Kentucky 1.1 0.2 0.2 0.4 0.8 0.9 0.7 0.4 0.6 0.7 1.0 0.3 0.1 0.6 0.7

Louisiana 0.1 2.4 3.0 4.2 5.0 5.1 6.7 6.3 3.1 6.9 10.2 3.4 2.2 2.3 0.1

Maine 0.4 0.4 0.5 0.2 . . . . . 0.2 0.2 0.1 . 0.2 .

Maryland 0.9 1.0 0.7 0.8 0.4 0.1 0.1 0.2 0.4 0.4 0.3 0.2 0.3 0.2 0.3

Massachusetts 0.4 0.5 0.9 1.3 2.0 1.7 1.2 0.8 0.8 0.1 0.3 0.4 0.1 . 0.1

Michigan 0.5 1.5 5.1 4.2 2.1 2.5 3.6 4.0 4.8 8.3 2.0 1.4 0.9 1.0 0.8

Minnesota 0.8 0.4 0.6 0.3 0.4 0.1 0.2 0.1 0.4 0.5 0.3 0.7 0.3 0.5 0.4

Mississippi 0.6 0.4 0.0 0.4 . . 5.6 4.1 3.0 7.1 10.7 3.8 3.2 1.5 1.0

Missouri 0.8 0.7 0.5 0.5 0.6 0.4 0.4 0.2 0.3 5.8 10.8 19.8 10.8 4.5 0.1

Montana 0.9 4.1 3.4 0.4 1.5 2.1 2.3 2.7 0.9 0.6 0.6 0.1 0.1 0.4 0.2

Nebraska 0.3 0.1 5.6 0.7 0.9 1.4 0.5 0.2 0.3 0.2 0.3 0.6 0.9 0.2 0.1

Nevada 2.6 2.4 1.1 1.4 1.4 1.7 1.3 1.1 1.1 0.6 0.9 0.6 1.4 1.2 0.7

New Hampshire 0.8 0.8 2.2 0.7 1.0 1.2 0.6 . . . . . . . .

New Jersey 0.6 1.4 1.2 1.2 2.7 2.4 . . . . 6.7 14.3 0.1 . .

New Mexico 1.8 1.6 3.4 6.6 2.7 3.2 4.5 3.5 5.6 2.0 0.9 0.7 0.2 . 0.4

New York 0.7 1.4 1.1 1.4 1.3 1.9 1.5 1.5 0.7 0.4 0.2 0.2 0.3 0.1 0.1

North Carolina 2.2 1.7 1.3 1.2 0.8 0.9 0.6 0.7 0.3 0.4 0.2 0.3 0.3 0.2 0.1

North Dakota 0.3 0.8 0.6 0.5 0.2 1.1 . 0.6 . 0.2 0.2 . . . 0.8

Ohio 0.9 1.5 0.9 0.3 0.2 0.1 0.3 0.2 0.1 0.0 0.1 0.1 0.0 0.1 0.1

Oklahoma 0.9 1.5 1.5 1.5 1.9 1.7 0.2 0.3 0.7 0.5 0.5 0.2 0.6 0.2 0.2

Oregon 2.1 4.5 2.9 1.8 1.5 1.2 0.3 0.1 0.6 0.7 0.8 0.4 0.4 0.4 0.3

Pennsylvania 0.7 0.4 0.3 0.3 0.4 0.5 0.5 0.7 1.0 0.6 0.4 1.2 0.5 0.9 0.5

Rhode Island . 1.2 0.7 1.3 2.0 0.8 0.6 0.8 0.4 0.3 0.7 . 0.1 0.1 .

South Carolina 0.4 1.1 0.0 0.1 0.3 0.6 0.9 1.1 0.5 0.6 0.1 0.3 0.1 0.6 0.1

South Dakota 0.6 0.1 . . . 0.1 . . . . . . 0.1 . .

Tennessee 3.1 9.7 25.2 19.5 17.3 18.8 7.5 4.5 3.2 2.2 2.0 1.2 0.5 0.4 0.6

Texas 0.9 0.8 1.6 2.3 1.7 1.9 1.1 2.0 2.3 1.8 1.3 2.3 1.3 0.2 0.5

Utah 1.6 1.4 2.0 2.2 0.9 0.7 0.9 0.2 1.0 0.3 0.6 0.1 0.2 . 0.3

Vermont 1.4 1.2 3.0 1.0 2.8 2.4 4.4 0.7 1.0 1.2 0.8 1.1 2.4 2.1 1.3

Virginia 0.7 0.6 0.8 0.8 0.4 0.3 0.3 0.4 0.2 0.2 0.0 0.0 0.2 0.2 0.2

Washington 2.9 3.3 3.6 4.2 5.5 4.3 1.2 0.7 0.5 0.4 0.7 0.5 0.4 0.3 0.4

West Virginia 0.2 0.2 0.4 2.4 2.6 2.4 0.5 1.0 0.5 1.2 1.3 1.4 0.2 1.1 1.3

Wisconsin 0.3 2.0 2.0 0.8 . . . 0.5 2.8 0.3 . . 0.1 0.1 .

Wyoming 1.1 1.7 14.2 25.4 37.3 46.6 37.3 17.3 21.2 18.3 0.4 1.6 1.0 . 0.4
HEPATITIS SURVEILLANCE -- NUMBER 61 16 

Acute Hepatitis A, 2004 

 Summary 

With an average of 28,000 cases per year (range: 23,112-35,821) during 1987-1997, hepatitis A 

has historically been one of the most frequently notifiable diseases in the United States. However, 

effective vaccines to prevent hepatitis A virus (HAV) infection have been available in the U.S. since 

1995 for use in individuals at least two years of age. These vaccines have provided the opportunity 

to substantially reduce disease incidence and potentially eliminate transmission. 

Since 1996, hepatitis A vaccine has been recommended for individuals at increased risk of 

hepatitis A including international travelers, men who have sex with men, and injecting and noninjecting drug users1

. In 1999, routine vaccination was also recommended for children living in 11 

states, ten of which are in the western region, with average hepatitis A rates during 1987-1997 that 

were at least 20/100,000 and was suggested for children in an additional six states where rates were 

less than 20/100,000 but above 10/100,000 which was approximately the national average for the 

time period 2

. 

Hepatitis A rates have declined steadily each year since the issuance of these recommendations, 

with the most dramatic decreases occurring in the age groups and regions for which routine 

childhood vaccination is recommended, suggesting that this strategy is reducing the transmission of 

HAV in the United States. The overall rate in 2004 is the lowest recorded. The declines in rates 

that have been observed in recent years have also been accompanied by substantial shifts in the 

epidemiologic profile of this disease in the United States, with an increasing proportion of cases 

occurring among adults, particularly those in high risk populations such as international travelers 

and men who have sex with men. In 2005, the minimum age for which hepatitis A vaccine is 

licensed was reduced by the Food and Drug Administration from 24 months of age to 12 months of 

age, facilitating integration of hepatitis A vaccine into the schedule of routine childhood 

immunizations. In October 2005, the recommendations were expanded to include routine 

vaccination of all children 12-23 months of age nationwide3

. It is anticipated that implementation 

of these expanded recommendations will help sustain or perhaps even further reduce incidence 

rates. 
HEPATITIS SURVEILLANCE -- NUMBER 61 17 

• Historically, hepatitis A rates have varied cyclically with periodic nationwide increases. The 

national rate of hepatitis A has declined steadily since the last peak that occurred in 1995. With 

5683 acute symptomatic cases reported for the year 2004, the national incidence of hepatitis A 

is the lowest recorded (1.9/100,000). When asymptomatic infection and underreporting are 

taken into account, there were an estimated 56,000 new infections in 2004. Figure 3

• In addition to temporal variation, hepatitis A rates have consistently varied geographically with 

higher rates in the West than elsewhere in the country. Following the 1999 issuance of 

recommendations for routine childhood vaccination that focused on states with consistently 

elevated rates of hepatitis A, incidence rates in the West have declined steadily and since 2001 

have been approximately equal to those in other regions of the U.S. Figure 4, Figure 5. 

• Incidence of hepatitis A varies by age. Since the last nationwide increase, rates have declined 

among all age groups but the greatest decreases have been among children. Historically, the 

highest rates have been among children and young adults with the lowest rates observed among 

persons greater than 40 years of age. However, since 1997, rates among children have declined 

more rapidly than among adults and in 2004 rates were similar across all age groups ranging 

from a low of 1.5/100,000 among children <5 years of age to 2.2/100,000 among persons 5-14 

years old. Figure 6 Children <5 years of age have had the lowest rates since 2001 but 

asymptomatic infection is common among very young children and cases in children <5 years 

old represent only a small proportion of infections occurring in this age group. The low and 

relatively stable rates among persons 40+ years of age in large part reflect the higher proportion 

of persons in this age group with immunity due to previous infection; data from the Third 

National Health and Nutrition Examination Survey (NHANES III) conducted during 1988-1994 

4

 indicated that approximately one third of the U.S. population had serologic evidence of 

immunity to HAV, reaching a high of 75% among persons ≥70 years of age. Investigations of 

an increased number of cases reported recently among the oldest age groups (60+ years of age) 

indicate that many of the reports of cases in this age group, although positive for IgM anti-HAV, 

do not represent acute hepatitis A; these false positive results are not believed to be due to poor 

performance of the assay for IgM anti-HAV, which is highly specific and highly sensitive when 

used in persons with symptoms of acute hepatitis, but rather, is a reflection of increased and 
HEPATITIS SURVEILLANCE -- NUMBER 61 18 

largely inappropriate use of testing in individuals without signs or symptoms of clinical 

hepatitis.5

 

• Rates of hepatitis A have historically been higher among males than females and during the late 

1990s through 2001, the difference in the gender-specific rates increased until there were almost 

2 male cases for each female case. However, since 2001, rates have declined more in males 

than females and rates are similar for both genders (2.1/100,000 for males vs. 1.8/100,0000 for 

females) except in the 35-44 year age group where an excess number of cases among males 

persists. Figure 7 , Figure 8

• Historically, hepatitis A rates have differed by race with the highest rates among American 

Indian/Alaska Natives and the lowest rates among Asians, and by ethnicity with higher rates 

among Hispanics than non-Hispanics. However, rates among American Indians, which were 

greater than 60/100,000 prior to 1995, have decreased dramatically following widespread 

vaccination in this group, and since 2001, have been approximately the same or lower than those 

of other races. Rates among Hispanics have also decreased since 1997 but remain higher than 

those for Non-Hispanics. Figure 9 The increase in rates in 2004 among Asians/Pacific Islanders 

reflects an outbreak in several U.S. states that occurred among refugee populations recently 

resettled from a single refugee camp in Thailand.

• Among cases where information about exposures during the incubation period was collected, 

the most frequently identified risk factor for hepatitis A in 2004 was international travel which 

was reported by 16% of cases overall and almost 40% of cases among children <15 years of 

age. Although the majority (59%) of these travel-related cases were, as in previous years, 

associated with travel to Central/South America including Mexico, there was an increase in the 

proportion of cases reporting travel to Asia/South Pacific (28%). This increase reflected a large 

outbreak occurring in several U.S. states among refugees recently resettled from a single camp 

in Thailand. As transmission of HAV within the U.S. has declined, cases in travelers to 

endemic countries have accounted for a steadily increasing proportion of all cases. The 

percentage of cases reporting sexual and household contact with another hepatitis A case, which 

has historically been among the most frequently identified risk factors, was smaller than in 

previous years (11%). The proportion (and the absolute number) of cases reporting male 
HEPATITIS SURVEILLANCE -- NUMBER 61 19 

homosexual behavior, which ranged from 14-23% during the years 1999-2002, declined for the 

second year in a row and in 2004, was reported by <3% of all cases (and approximately 5% of 

male cases). The proportion of cases in persons reporting illegal drug use, which ranged from 6-

10% since 1997, increased to 13% in 2004. Table 4, Figure 10. 

• The clinical characteristics of hepatitis A cases in 2004 are similar to previous years, with 72% 

of cases having jaundice, 33% requiring hospitalization for their illness and 0.6% resulting in 

death. The proportion of cases that were jaundiced was highest in persons 5-39 years of age 

(81%) and lower among children <5 years (44%) and persons who 60 years of age or more 

(46%). The proportion of cases hospitalized increased with age from 12% among children <5 

years of age to 44% among persons 60 years of age or older. Table 5
HEPATITIS SURVEILLANCE -- NUMBER 61 20 

Figure 3: Incidence of Hepatitis A, United States, 1982-2004 

 

0

2

4

6

8

10

12

14

16

19821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases per 100,000
HEPATITIS SURVEILLANCE -- NUMBER 61 21 

Figure 4: Incidence of Hepatitis A, by Region, United States, 1990-2004 

0

5

10

15

20

25

30

199019911992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases 

per 100,000

Midwest

Northeast

Southeast

West

See page 5 for regional categories 
HEPATITIS SURVEILLANCE -- NUMBER 61 22 

 Figure 5: Incidence of Hepatitis A, by County, United States, 2004 

Source: NNDSS

rate per 100,000 0-4 5-9 10-19

>=20

 DC

 NYC
HEPATITIS SURVEILLANCE -- NUMBER 61 23 

Figure 6: Incidence of Hepatitis A, by Age, United States, 1990-2004 

0

5

10

15

20

25

199019911992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases 

per 100,000

<5 yrs

5 - 14 yrs

15 - 24 yrs

25 - 39 yrs

40+ yrs
HEPATITIS SURVEILLANCE -- NUMBER 61 24 

Figure 7: Incidence of Hepatitis A, by Sex, United States, 1990-2004 

0

2

4

6

8

10

12

14

16

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Re

p

orted cases per 100,000

0

0.5

1

1.5

2

2.5

R

atio (

Male/

F

e

m

ale

Female

Male

ratio

Note: The bars indicate the rate per 100,000 (the left y-axis) by gender; the line is the ratio (right yaxis) of the incidence rate among males to that among females 
HEPATITIS SURVEILLANCE -- NUMBER 61 25 

Figure 8: Incidence of Hepatitis A, by Age and Sex, United States, 2004 

1.5

2.3

2.0

1.9

2.6

2.6

2.0

2.3

1.9

1.8

1.9

1.7

2.1 2.0

1.7

1.4

1.4

1.2

1.4

1.6

2.1

1.4

2.3

2.1

2.0

2.0

<5

 5-9

 10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60+

a

g

e group

s

rate per 100,000 persons

Female Male 

* A total of 5683 cases of hepatitis A were reported. Rates exclude patients with missing data for 

age or sex. 
HEPATITIS SURVEILLANCE -- NUMBER 61 26 

Figure 9: Incidence of Hepatitis A, by Race and Ethnicity, 

United States, 1990-2004 

0

5

10

15

20

25

30

35

40

45

50

199019911992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases per 100,000

American Indian/Alaskan

Native

Asian/Pacific Islander

Black (non Hispanic)

Hispanic

White (non Hispanic)

0

20

40

60

80

100

120'90

'91'92'93'94'95'96'97'98'99'00'01'02'03'04

Year
HEPATITIS SURVEILLANCE -- NUMBER 61 27 

 Table 6: Epidemiologic Characteristics of Patients with Hepatitis A, 

 by Age, United States, 2004 

Age Groups 

<15 15-39 40+ Total Exposures during the 2-6 weeks before 

illness onset

n N % n N % n N % n N % 

Sexual or household contact with hepatitis A 

patient 71 413 17.2 93 777 12.0 47 734 6.4 211 1,924 11.0

International travel† 189 501 37.7 138 909 15.2 68 853 8.0 395 2,263 17.5

Male homosexual activity ‡ . 11 . 10 394 2.5 7 285 2.5 17 690 2.5

Injection drug use 5 392 1.3 180 772 23.3 43 633 6.8 228 1,797 12.7

Child/employee in day-care center 65 488 13.3 65 887 7.3 23 812 2.8 153 2,187 7.0

Suspected food- or waterborne outbreak 102 416 24.5 52 736 7.1 36 716 5.0 190 1,868 10.2

Contact of day-care child/employee 41 449 9.1 58 764 7.6 23 711 3.2 122 1,924 6.3

Other contact with hepatitis A patient¥ 101 413 24.5 73 777 9.4 35 734 4.8 209 1,924 10.9

No risk factor identified 181 534 33.9 497 1,024 48.5 706 942 74.9 1,384 2,500 55.4

No risk factor data submitted . 642 . . 1,056 . . 1,373 . . 3,071 .

TOTAL . 1,176 . . 2,080 . . 2,315 . . 5,571 .

*During the 2 to 6 weeks prior to illness 

† Of cases attributed to travel to a region endemic for hepatitis A, 59% traveled from South/Central America, 

28% from Asia/South Pacific, 4% from Africa and 9% from the Middle East. The high proportion of cases 

associated with travel from Asia/South Pacific reflects an outbreak in several U.S. states that occurred among 

refugee populations recently relocated from a single refugee camp in Thailand. 

‡ Among male cases, 5% were attributed to homosexual behavior 

¥ Examples of other contact include playmate, drug sharing contact, or care provider. 

Note: The percentage of cases reporting a specific risk factor was calculated based on the total 

number of cases reporting any information for that exposure. Multiple risk factors can be reported 

for a single case. 
HEPATITIS SURVEILLANCE -- NUMBER 61 28 

Figure 10: Trends in Selected Epidemiologic Characteristics among Patients with 

Hepatitis A, by Year, United States, 1998-2004 

0

5

10

15

20

25

1998 1999 2000 2001 2002 2003 2004

International travel

0

5

10

15

20

25

1998 1999 2000 2001 2002 2003 2004

Child/employee in day-care center

0

5

10

15

20

25

1998 1999 2000 2001 2002 2003 2004

Percent of cases

Food- or waterborne outbreak

0

5

10

15

20

25

1998 1999 2000 2001 2002 2003 2004

Injection drug use

0

5

10

15

20

25

1998 1999 2000 2001 2002 2003 2004

Percent of cases

Sexual or household contact

0

5

10

15

20

25

1998 1999 2000 2001 2002 2003 2004

Homosexual activity (Male)

Note: The percentage of cases reporting a specific risk factor was calculated based on the total 

number of cases reporting any information for that exposure. Multiple risk factors can be reported 

for a single case. 
HEPATITIS SURVEILLANCE -- NUMBER 61 29 

Table 7 : Clinical Characteristics of Patients with Hepatitis A, By Age, 

United States, 2004 

<5 5-14 15-39 40-59 60+ All 

n N % n N % n N % n N % n N % n N % 

Died from 

Hepatitis 0 151 0.0 1 365 0.3 1 980 0.1 8 546 1.5 4 342 1.2 14 2,384 0.6

Hospitalized 

for Hepatitis 17 142 12.0 80 348 23.0 223 641 34.8 153 435 35.2 161 364 44.2 634 1,930 32.8

Jaundice 60 138 43.5 309 386 80.1 779 957 81.4 393 532 73.9 156 343 45.5 1,697 2,356 72.0

A total of 5,683 cases of hepatitis A including 14 deaths were reported. Percentages are calculated based 

upon the number of cases with non-missing data for age, and for outcome of interest (i.e. jaundice, 

hospitalization or death) 
HEPATITIS SURVEILLANCE -- NUMBER 61 30 

Acute Hepatitis B, 2004 

Summary

Over the past 15 years, a comprehensive strategy has been developed and implemented for 

achieving the elimination of HBV transmission in the United States 6

. The primary elements of this 

strategy are: universal vaccination of infants beginning at birth; prevention of perinatal HBV 

infection through routine screening of all pregnant women for hepatitis B surface antigen (HBsAg) 

and the provision of immunoprophylaxis to infants born to HBsAg-positive women or to women of 

unknown HBsAg status; routine vaccination of previously unvaccinated children and adolescents; 

and vaccination of previously unvaccinated adults at increased risk for infection (including health 

care workers, dialysis patients, household contacts and sex partners of persons with chronic HBV 

infection, recipients of certain blood products, persons with a recent history of multiple sex partners 

or a STD, men who have sex with men, and injecting drug users). 

As highlighted below, the incidence of hepatitis B has declined dramatically since 

implementation of the strategy, particularly among the younger age groups covered by the 

recommendation for routine childhood immunization. However, high rates of disease continue 

among adults, particularly males 25-39 years of age, and the high proportion of cases occurring 

among persons in identified risk groups (i.e. injection drug users, men who have sex with men and 

persons with multiple sex partners) indicate a need to strengthen efforts to reach these populations 

with vaccine. 

 

• With 6,212 acute, symptomatic cases reported nationwide, the overall incidence rate of acute 

hepatitis B in 2004 was 2.1/100,000. This rate is the lowest rate recorded and represents a 

decline of more than 80% since 1985 when incidence peaked at 11.5/100,000. From 1999 to 

2003, rates declined relatively slowly (average 2% per year) but between 2003 and 2004, 

declined by approximately 19%. If asymptomatic infection and underreporting are taken into 

account, the number of cases reported is estimated to represent 60,000 new infections in 2004. 

Figure 11

• For the past decade, hepatitis B rates have been similar for all U.S. regions with rates in the 

West and Southeast only slightly higher than in the Northeast and Midwest (Figure 12, Figure 
HEPATITIS SURVEILLANCE -- NUMBER 61 31 

13). In 2004, rates were similar in the West, Midwest and Northeast but remained higher in the 

Southeast. 

• Hepatitis B rates vary by age with the highest rates among persons 25-44 years of age 

(4.0/100,000 persons) and the lowest among persons less than 15 years of age (0.1/100,000). 

Rates have declined in all age groups with the greatest percent decline since 1990 occurring 

among children <15 years of age (95%) and young adults 15-24 years of age (87% decline). 

Although less dramatic than the declines in the younger age groups, most of which are covered 

by the recommendations for routine hepatitis B vaccination, there have also been substantial 

decreases in the hepatitis B rates among older persons with a 71% and 51% decrease in rates 

observed for 25-44 year olds and 45+ year old categories respectively. Figure 14

• As in previous years, the rate of acute hepatitis B in males (2.7/100,000) continues to be higher 

than in females (1.6/100,000). The ratio of cases occurring among males to those occurring 

among females increased gradually since 1990. In 2004, the rate in males was approximately 

1.7 times higher than in females. (Figure 15). This difference in hepatitis B rates by sex occurs 

primarily in persons more than 19 years of age and is greatest in persons more than 35 years of 

age where the ratio of male/female cases is approximately 2.0. Figure 15, Figure 16

• Rates of hepatitis B continue to decline among all racial and ethnic groups. Figure 17 Rates of 

hepatitis B remain highest among non-Hispanic blacks (2.9/100,000) and are lowest 

(1.0/100,000) among Hispanics, whose rate dropped below that of non-Hispanic whites for the 

first time in 2003. The downward trend in the rate among Asians/Pacific Islanders continues 

and in 2004, the rate in this group is approximately the same as that among non-Hispanic 

whites. 

• Among cases for which information about exposures during the incubation period was available, 

approximately one third of cases reported at least one sexual risk factor (10% sexual contact 

with a known hepatitis B case, 33% multiple sexual partners, and 12% male homosexual 

activity). Injecting drug use was reported by 16% of cases. Receiving hemodialysis or a blood 

transfusion, both of which historically were major sources of infection, are reported rarely by 

cases (0.5% and 0.6% of cases respectively) as a result of continued improvements in infection 
HEPATITIS SURVEILLANCE -- NUMBER 61 32 

control and the required screening of donated blood for markers of HBV infection. The 

percentage of cases reporting occupational exposure to blood continues to be low 

(approximately 0.5%) following ongoing hepatitis B vaccination of health care workers. Table 

6, Figure 18

• Among cases of hepatitis B cases reported in 2004, 76% had jaundice, 39% were hospitalized 

because of their illness and 0.5% resulted in death. The proportion of cases that was jaundiced 

ranged from a low of 38% among children <15 years of age to 78% among persons 15-39 years 

of age. The proportion of cases hospitalized increased with age from 17% among children <15 

years of age to 42% among persons 60 years of age or older. Table 7
HEPATITIS SURVEILLANCE -- NUMBER 61 33 

Figure 11: Incidence of Acute Hepatitis B, United States, 1982-2004 

0

2

4

6

8

10

12

14

19821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases per 100,000
HEPATITIS SURVEILLANCE -- NUMBER 61 34 

Figure 12: Incidence of Acute Hepatitis B, by Region, 

United States, 1990-2004 

0

2

4

6

8

10

12

199019911992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases 

per 100,000

Midwest

Northeast

Southeast

West

See page 5 for regional categories 
HEPATITIS SURVEILLANCE -- NUMBER 61 35 

 

Figure 13: Incidence of Acute Hepatitis B, by County, United States, 2004 

Source: NNDSS

rate per 100,000 <4 4-<8 8-<12

>=12

 DC

 NYC
HEPATITIS SURVEILLANCE -- NUMBER 61 36 

Figure 14: Incidence of Acute Hepatitis B, by Age, United States, 1990-2004 

0

2

4

6

8

10

12

14

16

199019911992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases 

per 100,000

<15 yrs

15 - 24 yrs

25 - 44 yrs

45+ yrs
HEPATITIS SURVEILLANCE -- NUMBER 61 37 

 

Figure 15: Incidence of Acute Hepatitis B, by Sex, United States, 1990-2004 

0

1

2

3

4

5

6

7

8

9

10

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Rep

orted Cases 

per 100,000

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

R

atio (

Male/

F

e

m

ale

Female

Male

ratio

Note: The bars indicate the rate per 100,000 (the left y-axis) by gender; the line is the ratio (right yaxis) of the incidence rate among males to that among females 
HEPATITIS SURVEILLANCE -- NUMBER 61 38 

Figure 16: Incidence of Acute Hepatitis B, by Age and Sex, 

United States, 2004 

Female Male 

3.1

5.2

4.9

5.4

4.9

4.0

3.2

2.9

1.4

0.1

0.1

0.1

0.4

3.3

2.4

3.3

2.7

2.5

2.3

1.7

1.3

0.8

0.6

0.1

0.0

0.1

<5

 5-9

 10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60+

a

g

e group

s

rate per 100,000 persons

* A total of 6212 cases of hepatitis B were reported. Rates exclude patients with missing data for 

age or sex. 
HEPATITIS SURVEILLANCE -- NUMBER 61 39 

Figure 17: Incidence of Acute Hepatitis B, by Race and Ethnicity, 

United States, 1990-2004 

0

5

10

15

199019911992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases 

per 100,000

American Indian/Alaskan Native

Asian/Pacific Islander

Black (non Hispanic)

White (non Hispanic)

Hispanic
HEPATITIS SURVEILLANCE -- NUMBER 61 40 

Table 8: Epidemiologic Characteristics of Patients with Acute Hepatitis B, by Age, 

United States, 2004 

Age Groups 

<45* 45+ Total Exposures during the 6 weeks -6 

months before illness onset

n N % n N % n N %

Injection drug use 301 1,540 19.5 61 742 8.2 362 2,282 15.9

Sexual contact with hepatitis B patient 122 1,109 11.0 39 553 7.1 161 1,662 9.7

Household contact of hepatitis B patient 25 1,109 2.3 18 553 3.3 43 1,662 2.6

Male homosexual activity‡ 119 843 14.1 27 358 7.5 146 1,201 12.2

Medical employee with blood contact 4 1,554 0.3 7 763 0.9 11 2,317 0.5

Hemodialysis 5 1,287 0.4 5 597 0.8 10 1,884 0.5

More than one sex partner 402 1,098 36.6 130 518 25.1 532 1616 32.9

Heterosexual 348 1,002 34.7 118 497 23.7 466 1,499 31.1

Male homosexual or bisexual 54 96 56.3 12 21 57.1 66 117 56.4

Blood transfusion 2 1,573 0.1 13 752 1.7 15 2,325 0.6

Surgery 97 1,460 6.6 717 11.9 182 2,177 8.4 85

Percutaneous injury (e.g. needlestick) 50 1,340 3.7 25 665 3.8 75 2,005 3.7

No risk factor identified 934 1,803 51.8 513 835 61.4 1,447 2,638 54.9

No risk factor data submitted . 2,279 . . . . 3,466 . 1,187

TOTAL . 4,082 . . 2,022 . . 6,104 .

*104 (2%) of all cases were <19 years of age 

‡ When calculated for male cases only, 20% homosexual behavior. 

Note: The percentage of cases reporting a specific risk factor was calculated based on the total 

number of cases reporting any information for that exposure. Multiple risk factors can be reported 

for a single case. 
HEPATITIS SURVEILLANCE -- NUMBER 61 41 

Figure 18: Trends in Selected Epidemiologic Characteristics among Patients with 

Acute Hepatitis B, 1998-2004, United States 

0

5

10

15

20

25

1998 1999 2000 2001 2002 2003 2004

Percent of cases

Sexual contact 

0

5

10

15

20

25

1998 1999 2000 2001 2002 2003 2004

Percent of cases

Injection drug use

0

5

10

15

20

1998 1999 2000 2001 2002 2003 2004

Homosexual activity

0

5

10

15

20

1998 1999 2000 2001 2002 2003 2004

Blood transfusion

25

30

35

1998 1999 2000 2001 2002 2003 2004

Percent of cases

Multiple sex partners

0

5

10

15

20

1998 1999 2000 2001 2002 2003 2004

Medical Employee

Note: The percentage of cases reporting a specific risk factor was calculated based on the total number of cases 

reporting any information for that exposure. Multiple risk factors can be reported for a single case. 
HEPATITIS SURVEILLANCE -- NUMBER 61 42 

Table 9: Clinical Characteristics of Patients with Acute Hepatitis B, by Age, United 

States, 2004

<5 5-14 15-39 40-59 60+ All 

n N % n N % n N % n N % n N % n N % 

Died From 

Hepatitis 0 4 0.0 0 16 0.0 6 1,391 0.4 5 1,008 0.5 2 204 1.0 13 2,623 0.5

Hospitalized 

for Hepatitis 0 3 0.0 3 15 20.0 551 1,470 37.5 433 1,064 40.7 93 221 42.1 1,080 2,773 38.9

Jaundice 1 3 33.3 5 13 38.5 1,127 1,454 77.5 776 1,021 76.0 137 224 61.2 2,046 2,715 75.4

Note: A total of 6212 cases of hepatitis B, including 13 deaths were reported. Percentages are calculated 

based upon the number of cases with non-missing data for age, and for outcome of interest (i.e. jaundice, 

hospitalization or death). 
HEPATITIS SURVEILLANCE -- NUMBER 61 43 

Acute Hepatitis C/NANB Hepatitis, 2004 

Summary 

With an estimated 3.2 million chronically infected persons nationwide7

, hepatitis C virus (HCV) 

infection is the most common bloodborne infection in the United States. No effective vaccine 

against this infection is available. National recommendations for prevention and control of HCV 

infection8

, issued in 1998, rely on primary prevention activities to reduce the risk for HCV 

transmission. These activities include: screening and testing of blood donors, viral inactivation of 

plasma-derived products, risk-reduction counseling and services, and implementation and 

maintenance of infection control practices. 

Incidence of hepatitis C has been declining since the late 1980s. This decline is largely the result of 

a decrease in cases among injecting drug users (IDU), the reasons for which are unknown. The 

majority of hepatitis C cases continue to occur in adult age groups (persons >25 years of age) with 

injecting drug use the most commonly identified risk factor for infection. Transmission of HCV 

associated with transfusion, an important risk factor for infection in the past, is rare. Ongoing 

surveillance is needed to ensure that any new cases of hepatitis C are identified and investigated to 

determine the source of infection and limit further spread of the virus. 

• In 2004, there were 758 cases of confirmed acute hepatitis C yielding an overall national rate of 

0.3 per 100,000. If asymptomatic infection and underreporting are taken into account, the 

number of cases reported is estimated to represent 26,000 new HCV infections in 2004. Figure 

19

• Rates have been declining in all age groups since the mid-1990s. The greatest decline in 

incidence has been among 25-39 year olds, which has historically been the age group with the 

highest rates of disease. In this age group, incidence has declined by 62% since 2000 (and 92% 

since 1992) to 0.4/100,000 in 2004. Few cases are reported in persons <15 years of age. 

Figure 20 
HEPATITIS SURVEILLANCE -- NUMBER 61 44 

• As in previous years, the rate of hepatitis C in 2004 is higher among males (0.3 per 100,000) 

than among females (0.2 /100,000). However, this differential has declined over the decade. In 

2004, the ratio of male to female cases was the smallest observed since reporting began. This 

difference in hepatitis C rates by sex is most evident in persons 45-49 years of age and to a 

lesser extent, in persons 50-54 years of age. Figure 21, Figure 22 

• Incidence of hepatitis C has declined in all racial groups since 1995. In 2004, the rates were 

increasingly similar across racial/ethnic groups and ranged from 0.1/100,000 among 

Asian/Pacific Islanders to 0.5/100,000 among American Indians/Alaska Natives. Hispanics 

historically had rates that were higher than those of non-Hispanic whites (but lower than those 

of non-Hispanic blacks) but, since 2000, they have had lower rates than all other racial/ethnic 

groups except Asian/Pacific Islanders. Figure 23 

• Among cases for which information about exposures during the incubation period was available, 

the most common risk factor reported for hepatitis C in 2004 was injection drug use (42%). 

Over the past decade, an average of 39% of cases reported injection drug use (range: 31-45%). 

Another 14% reported sexual contact with a known case and 27% of cases reported having had 

multiple sexual partners during the incubation period. Four percent of cases reported 

occupational exposure to blood. Table 8
HEPATITIS SURVEILLANCE -- NUMBER 61 45 

Figure 19: Incidence of Acute Hepatitis C/NANB, United States, 1992-2004 

0

0.5

1

1.5

2

2.5

1992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases 

per 100,000
HEPATITIS SURVEILLANCE -- NUMBER 61 46 

Figure 20: Incidence of Acute Hepatitis C/NANB, by Age, 

 United States, 1992-2004 

0

1

2

3

4

5

6

1992199319941995199619971998199920002001200220032004

Year

Re

p

orted cases 

per 100,000

<15 yrs

15 - 24 yrs

25 - 39 yrs

40+ yrs
HEPATITIS SURVEILLANCE -- NUMBER 61 47 

Figure 21: Incidence of Acute Hepatitis C/NANB, by Sex, 

United States, 1992-2004 

0

0.5

1

1.5

2

2.5

3

3.5

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Rep

orted Cases per 100,000

0

0.5

1

1.5

2

2.5

Ratio (

Mal

e/F

e

m

ale

Female

Male

ratio

Note: The bars indicate the rate per 100,000 (the left y-axis) by gender; the line is the ratio (right yaxis) of the incidence rate among males to that among females 
HEPATITIS SURVEILLANCE -- NUMBER 61 48 

Figure 22: Incidence of Acute Hepatitis C, by Age and Sex, United States, 2004 

Female Male 

0.2

0.5

0.3

0.4

0.4

0.4

0.7

0.5

0.2

0.1

0.0

0.1

0.1

0.2

0.4

0.4

0.3

0.4

0.4

0.4

0.2

<5 0.0

 5-9

 10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60+

a

g

e group

s

rate per 100,000 persons
HEPATITIS SURVEILLANCE -- NUMBER 61 49 

Figure 23 Incidence of Acute Hepatitis C/NANB, by Race and Ethnicity, 

United States, 1992-2004 

0

1

2

3

4

5

1992199319941995199619971998199920002001200220032004

Year

R

e

p

orte

d cases per 100,000

p

o

p

ulatio

American Indian/Alaskan

Native

Asian/Pacific Islander

Black (non Hispanic)

Hispanic

White (non Hispanic)
HEPATITIS SURVEILLANCE -- NUMBER 61 50 

Table 10: Epidemiologic Characteristics of Patients with Acute Hepatitis C, 

by Age, United States, 2004

Age Groups 

<40* 40+ Total Exposures during the 6 weeks -6 

months before illness onset

n N % n N % n N % 

Injection drug use 81 150 54.0 31 118 26.3 112 41.8 268 

Employment in medical/dental field 2 141 1.4 8 114 7.0 10 255 3.9

Hemodialysis . 133 2 110 1.8 2 243 0.8 .

Sexual contact with hepatitis C patient 11 77 14.3 9 66 13.6 20 143 14.0

Household contact of hepatitis C patient 6 77 7.8 2 66 3.0 8 143 5.6

More than one sex partner 31 86 36.0 68 16.2 42 154 27.3 11

Blood transfusion . 148 . 1 120 0.8 1 268 0.4

Surgery 14 125 11.2 30 109 27.5 44 234 18.8

Percutaneous injury (e.g. needlestick) 5 119 4.2 5 4.9 10 221 4.5 102

No risk factor identified 60 177 33.9 65 137 47.4 125 314 39.8

No risk factor data submitted . 199 . . 242 . . 441 .

TOTAL . 376 . . 379 . 755 . . 

 *33 (4%) cases were <19 years of age 

Note: The percentage of cases reporting a specific risk factor was calculated 

based on the total number of cases reporting any information for that exposure. 

Multiple risk factors can be reported for a single case.
HEPATITIS SURVEILLANCE -- NUMBER 61 51 

Figure 24: Trends in Selected Epidemiologic Characteristics among Patients with 

Acute Hepatitis C/NANB, by Year 

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004

Medical employee

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004

Percent of cases

Injection drug use

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004

Sexual contact

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004

Blood transfusion

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004

Percent of cases

Multiple sex partners

0

5

10

15

20

25

30

35

40

45

50

1998 1999 2000 2001 2002 2003 2004

Percent of cases

Hemodialysis

Note: The percentage of cases reporting a specific risk factor was calculated based on the 

total number of cases reporting any information for that exposure. Multiple risk factors can 

be reported for a single case. 
HEPATITIS SURVEILLANCE -- NUMBER 61 52 

Table 11: Clinical Characteristics of Patients with Acute Hepatitis C by Age, United 

States, 2004 

<5 5-14 15-39 40-59 60+ All 

N N % n N % n N % n N % n N % n N % 

Died From 

Hepatitis 0 2 0.0 0 2 0.0 1 199 0.5 1 113 0.9 1 16 6.3 3 332 0.9

Hospitalized 

for Hepatitis 2 2 100.0 1 3 33.3 83 218 38.1 66 151 43.7 5 14 35.7 157 388 40.5

Jaundice 2 3 66.7 2 3 66.7 150 216 69.4 87 143 60.8 9 13 69.2 250 378 66.1

A total of 758 cases of hepatitis C were reported. Percentages are calculated based upon the 

number of cases with non-missing data for age, and for outcome of interest (i.e. jaundice, 

hospitalization or death). 
HEPATITIS SURVEILLANCE -- NUMBER 61 53 

 

1

 CDC. Prevention of hepatitis A through active or passive immunization. MMWR 1996; 

45(RR:15) 

2

 CDC. Prevention of hepatitis A through active or passive immunization. MMWR 1999; 

48(RR:12) 

3 CDC. Prevention of Hepatitis A through Active or Passive Immunization: Recommendations of 

the Advisory Committee on Immunization Practices. MMWR 2006;55(in press): 

4 Bell, BP, Kruszon-Moran D, Shapiro CN et al. Hepatitis A virus infection in the United States: 

Serologic results from the Third National Health and Nutrition Examination Survey. Vaccine 

23(2005):5798-5806.

5 CDC. Positive test results for acute hepatitis A virus infection among persons with no recent 

history of acute hepatitis—United States, 2002-2004. MMWR 2005; 54(18):453-456. 

6

 CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus 

infection in the United States. Part 1: immunization of infants, children, and adolescents. MMWR 

2005; 54(RR:16) 

7

 Armstrong GL, Wasley AM, Simard EP, McQuillan GM, Kuhnert WL and Alter MJ.. The 

prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Int Med 

2006 (in press). 

8

 CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and 

HCV-related chronic disease. MMWR 1998; 47(RR:19)