Impact of Public Health Interventions on Drinking Water–Associated Outbreaks of Hepatitis A — United States, 1971–2017

• Published in: MMWR. Morbidity and mortality weekly report Vol. 68; no. 35; pp. 766 - 770
• Main Authors: Barrett, Catherine E., Pape, Bryn J., Benedict, Katharine M., Foster, Monique A., Roberts, Virginia A., Rotert, Kenneth, Mattioli, Mia C., Yoder, Jonathan S.
• Format: Journal Article Newsletter
• Language: English
• Published: United States Centers for Disease Control & Prevention (CDC) 06.09.2019; U.S. Government Printing Office
• Subjects: Death; Disease Outbreaks - prevention & control; Drinking water; Drinking Water - virology; Etiology (Medicine); Government Regulation; Groundwater; Hepatitis A; Hepatitis A - epidemiology; Hepatitis A - prevention & control; Hepatitis A Vaccines - administration & dosage; Hepatovirus; Humans; Liver; Liver failure; Program Evaluation; Public health; Public Health Practice; RNA; United States - epidemiology; United States Environmental Protection Agency; Water; Water Supply - legislation & jurisprudence; Waterborne infections; United States
• ISSN: 0149-2195; 1545-861X
• DOI: 10.15585/MMWR.MM6835A4

Hepatitis A virus (HAV) is an RNA virus primarily transmitted via the fecal-oral route and, in rare cases, causes liver failure and death in infected persons. Although drinking water-associated hepatitis A outbreaks in the United States are rarely reported (1), HAV was the most commonly reported etiology for outbreaks associated with untreated ground water during 1971-2008 (2), and HAV can remain infectious in water for months (3). This report analyzes drinking water-associated hepatitis A outbreaks reported to the Waterborne Disease and Outbreak Surveillance System (WBDOSS) during 1971-2017. During that period, 32 outbreaks resulting in 857 cases were reported, all before 2010. Untreated ground water was associated with 23 (72%) outbreaks, resulting in 585 (68.3%) reported cases. Reported outbreaks significantly decreased after introduction of Advisory Committee on Immunization Practices (ACIP) hepatitis A vaccination recommendations* and U.S. Environmental Protection Agency's (USEPA) public ground water system regulations. Individual water systems, which are not required to meet national drinking water standards, were the only contaminated drinking water systems to cause the last four reported hepatitis A outbreaks during 1995-2009. No waterborne outbreaks were reported during 2009-2017. Water testing and treatment are important considerations to protect persons who use these unregulated systems from HAV infection.