ATLANTA, GA — July 31 2025 — HepVu and NASTAD are pleased to announce the release of the 2023 Viral Hepatitis Surveillance Status Report, offering an in-depth look at the state of viral hepatitis surveillance across U.S. jurisdictions. Now in its third year, this annual report provides essential insights into the evolving landscape of Hepatitis B and C surveillance efforts nationwide.
The report reveals both critical progress and persistent challenges. In 2023, 88% of jurisdictions had at least one full-time employee (FTE) dedicated to viral hepatitis surveillance—a marked increase from previous years. However, jurisdictions reported needing an average of four FTEs to effectively meet surveillance demands, yet most only had one. The report also notes that only 65% of jurisdictions produced any annual surveillance summaries for viral hepatitis. While over 80% were able to report case counts, very few (16% for Hepatitis B and 25% for Hepatitis C) produced prevalence estimates, underscoring a continued gap in capacity.
“The 2023 report illustrates the growing sophistication of surveillance infrastructure where funding has been invested,” said Heather Bradley, PhD, Associate Professor of Epidemiology at Emory University’s Rollins School of Public Health, and Project Director for HepVu. “However, it also makes clear that without continued and expanded support, jurisdictions will not be able to sustain this progress, let alone eliminate viral hepatitis as a public health threat.”
This year’s findings highlight the impact of federal investments made since 2021, when the Centers for Disease Control and Prevention (CDC) expanded support from 14 to 59 jurisdictions. These newly funded programs have shown rapid improvement, with some reaching parity with previously funded jurisdictions in areas such as producing surveillance summaries and aligning viral hepatitis reports with other public health datasets.
Despite these gains, the report warns that declining or unstable funding—amid broader cuts to infectious disease programs—puts this fragile progress at risk. Recommendations emphasize the need for increased staffing, better integration across surveillance systems, and enhanced resources to track health disparities and elimination milestones.
The 2023 Viral Hepatitis Surveillance Status Report is available here.
Key Findings from the Surveillance Status Report:
Funding Gaps Persist Despite Progress
- Although 59 jurisdictions now receive federal support through CDC’s Integrated Viral Hepatitis Surveillance & Prevention (IVHSP) program, total viral hepatitis surveillance funding in 2023 was just $26 million, compared to $400 million for HIV surveillance.
- Nearly three-quarters (74%) of jurisdictions relied on additional funding sources (e.g., HIV/STI programs, emergency funds), up from 48% in 2022—a sign that CDC resources alone remain insufficient.
Staffing Challenges Undermine Capacity
- Jurisdictions reported needing an average of 4 full-time employees (FTEs) to conduct effective surveillance, but on average had only 1 FTE in place.
- Although the percentage of jurisdictions with at least one FTE rose to 88% in 2023, 12% still had no dedicated staffing. Issues cited included funding unpredictability, uncompetitive salaries, and slow hiring timelines.
Gaps in Surveillance Outputs
- Only 65% of jurisdictions produced annual viral hepatitis surveillance summaries in 2023.
- Case estimates were far more common (>80%) than prevalence estimates, with just:
- 16% producing hepatitis B prevalence estimates
- 25% producing hepatitis C prevalence estimates
- These gaps limit understanding of disease burden and intervention planning.
Newly Funded Jurisdictions Show Rapid Growth
- After receiving CDC funding in 2021, newly funded jurisdictions significantly closed gaps with their previously funded counterparts in metrics such as:
- Having a viral hepatitis elimination plan
- Producing surveillance summaries
- Integrating case reports with other health datasets.
Pregnancy Status Surveillance is Uneven
- Pregnancy status was a reportable condition in:
- 63% of jurisdictions for hepatitis B (down from 77% in 2021)
- 51% for hepatitis C (up from 45% in 2021)
- This is critical given that 90% of infants infected with hepatitis B can develop chronic infection without timely intervention.
Data Collection On Disparities Still Lags
- Adequate data to assess and address disparities by:
- Race/ethnicity: 77% of jurisdictions (up from 54% in 2022)
- Urbanicity: 72% (up from 54%)
- Risk group (e.g., people who inject drugs): 65% (up from 61%)
- Birthplace: 32% (up from 28%)
- Sexual orientation and gender identity: 21% (down from 33%)
Elimination Goals Are Widely Embraced—But Not Funded
- 79% of jurisdictions now have viral hepatitis elimination plans (up from 43% in 2021).
- However, only 7% said they had the capacity to make progress toward elimination goals at current CDC funding levels.
Recommendations
Expanded, standardized, and reliable viral hepatitis surveillance is necessary to promote effective public health efforts, identify resource needs, and support response across the U.S. to this epidemic. While public health professionals are doing commendable surveillance work with currently available resources, this report showcases the need for additional funding and resources. Based on the state of viral hepatitis surveillance in the U.S, it is recommended to:
- Continue to build viral hepatitis surveillance capacity using a combination of federal and other funding sources.
- Increase collaboration within the health department and leverage other infectious disease resources to approach surveillance syndemically to better understand viral hepatitis trends across time.
- Adjust where federal resources are allocated as needed and increase funding.
About the Survey
HepVu and NASTAD collaborated to create the first-ever viral hepatitis surveillance status report in 2022. This year’s update builds and expands upon the inaugural report with year-over-year trends, deeper dives into capacity by dedicated staffing and funding, availability of health equity data, and more.
HepVu is an interactive online mapping tool that visualizes the impact of the viral hepatitis epidemics on communities across the United States to promote data-driven public health decision-making. NASTAD is a leading non-partisan non-profit association that represents public health officials who administer HIV and viral hepatitis programs in the U.S. to end HIV/AIDS, viral hepatitis, and intersecting epidemics. We worked with a steering committee comprised of state and local health department representatives, national policy/advocacy organizations, and researchers to develop a set of indicators for survey measurement, determine process, develop a survey, and disseminate results.
In Summer 2024, a survey requesting information on Hepatitis B and C surveillance practices in 2023 was sent to 59 state, local, and territorial jurisdictions across the U.S., and 97% of jurisdictions responded. Data were processed by Emory University and compared to additional indicators like prior viral hepatitis funding, dedicated staffing, and other factors. Moving forward, HepVu and NASTAD will continue to collect data from jurisdictions on these indicators for the first half of each year, analyze the results, and prepare a status report describing findings nationally and by jurisdiction.
For the full report and additional insights, download the report here and share our infographics or read an expert Q&A about viral hepatitis surveillance.
About HepVu
HepVu.org is presented by Emory University’s Rollins School of Public Health in partnership with Gilead Sciences, Inc. and the Center for AIDS Research at Emory University (CFAR). HepVu’s mission is to make data widely available, easily accessible, and locally relevant to inform public health decision-making and action. The platform visualizes data, presents insights, and catalyzes research on the viral hepatitis epidemic in the U.S. Each year, HepVu strives to increase the granularity of its publicly available data and continues its commitment to provide public health officials, policymakers, healthcare professionals, researchers, and community leaders with a more comprehensive view of the viral hepatitis epidemic at the local, state, and national levels.