Genomic epidemiology as a tool for understanding drivers of hepatitis A community outbreaks in Massachusetts and New Hampshire

Distinct hepatitis A virus strains drove the Massachusetts 2018 and 2023 community outbreaks, despite similar demographics and reported risk factors among affected individuals.

• Why it matters: Even with an effective vaccine, hepatitis A outbreaks persist, and public health needs clearer links between outbreak events and their transmission drivers.
• What they did: Whole-genome sequences were generated from reported cases in Massachusetts and New Hampshire and analyzed with open-source genotyping tools released with the study.
• The result: Genomic and epidemiologic analyses resolved transmission patterns, linking experiencing homelessness and prior drug use to increased transmission and showing spread within and across state borders, including between people with and without these risk factors.

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