STATE: North Carolina Hepatitis A outbreak surpasses 1,000 cases

RALEIGH — The North Carolina Department of Health and Human Services Tuesday announced the state has surpassed 1,000 reported cases of hepatitis A associated with a national outbreak that began in April 2017. Sixty-three percent of cases have required hospitalization and 16 people have died.

Since 2017, the Centers for Disease Control and Prevention has received more than 41,000 reports of hepatitis A linked to a national outbreak with higher than expected hospitalization and death rates. North Carolina has been tracking this outbreak since April 2018, and reported cases have increased significantly since August 2020. NCDHHS and local health departments are coordinating outreach events, conducting case investigations and contact tracing, and providing hepatitis A vaccine to those at risk.

Since Jan. 1, 2021, 495 outbreak associated cases of hepatitis A were reported, indicating a marked increase in transmission. Of those cases, 13 percent are also infected with hepatitis B and 48 percent with hepatitis C. Because hepatitis A causes inflammation of the liver, people with other forms of viral hepatitis or anyone with underlying liver disease is at risk of more serious illness if infected.

July 28 is World Hepatitis Day, an opportunity to increase awareness and encourage the health and safety of those at-risk for and living with viral hepatitis, and health officials are reminding North Carolinians a safe and effective vaccine is available to prevent hepatitis A. Hepatitis A vaccine is available for free at all local health departments to people in high-risk groups for this outbreak, including people who use drugs, people experiencing homelessness or unstable housing and men who have sex with men.

“The best way to protect yourself against hepatitis A is through vaccination,” said Dr. Erica Wilson, vaccine preventable disease medical director in NCDHHS’ Division of Public Health. “As always, good hand-washing is key, especially after using the bathroom, changing diapers and before preparing or eating food. Using harm reduction strategies and syringe service programs is also key in reducing the risk for people who use drugs.”

Hepatitis A is a contagious, but vaccine-preventable liver infection that can range from a mild illness lasting a few weeks to severe illness lasting several months. It is usually transmitted through food or water that has been contaminated with small, undetectable amounts of feces from a contagious person. Individuals who use drugs, are experiencing homelessness and men who have sex with men are at highest risk for infection during the current outbreak.

Symptoms of hepatitis A include fever, fatigue, nausea, loss of appetite and stomach pain. Jaundice (yellowing of the skin and/or eyes), dark-colored urine and clay-colored bowel movements may also occur. These symptoms appear 15-50 days (average 28 days) following infection with the virus. Young children can be infected without apparent symptoms.

NCDHHS advises anyone with symptoms of hepatitis A to contact their health care provider or their local health department to be tested and linked to care assistance. Anyone exhibiting these symptoms should refrain from preparing food for others. Patients can transmit the virus to others in the two weeks before and one week after jaundice appears.

People with serious underlying medical conditions, such as hepatitis A, may be at higher risk for severe illness from COVID-19. The COVID-19 vaccines are proven to be safe and effective against the virus and its variants. To find a vaccine provider near you, visit