Public Health Response to Consecutive Hepatitis A Detections in Wastewater, North Carolina, 2024

Wastewater monitoring is a useful tool to complement case-based surveillance. A hepatitis A virus (HAV) investigation in North Carolina demonstrated that wastewater monitoring detections preceded identification of 2 clinical cases by 12 days. State and local health officials used a preestablished decision tree to respond to wastewater detections of HAV and implement public health actions. The investigation determined that HAV detected in wastewater was likely from 2 people who had not yet developed symptoms or sought testing at the time of detection, providing early information for public health response, including vaccination of family members. Targeted outreach to hospitals as well as medically or socially vulnerable groups at high risk of HAV infection could be recommended in response to consistent HAV detections in wastewater.