A new report published in the CDC Morbidity and Mortality Weekly Report (MMWR) has linked cases of acute hepatitis A virus (HAV) infections from certain states to person-to-person transmission from drug use or homelessness.  
According to the CDC, HAV incidence in the United States steadily decreased after the hepatitis A vaccine was introduced, but stabilized at an annual average of approximately 1600 cases. Outbreaks typically occur among international travelers returning from countries with endemic HAV or foodborne outbreaks, but can also be spread through injection drug use and conditions associated with homelessness.
The MMWR analysis showed that investigations conducted by local and state health departments pointed to direct person-to-person transmission for sustained HAV infections in certain states. According to the report, a total of 1521 outbreak-associated HAV cases were reported from California, Kentucky, Michigan, and Utah in 2017. Among states reporting increases in HAV infection to the CDC, only these 4 states reported sustained within-state transmission.

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